Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ALLOGRAFT VIAFLOW MATRIX 1.0CC

Facility

$25,580.00

Service Code	HCPCS C1734
Hospital Charge Code	270700503
Hospital Revenue Code	278
Min. Negotiated Rate	$616.48
Max. Negotiated Rate	$12,790.00
Rate for Payer: Aetna Commercial	$9,720.40
Rate for Payer: Aetna Medicare Advantage	$7,674.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,522.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,522.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,522.90
Rate for Payer: Cigna Commercial	$12,790.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,190.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,627.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,837.00
Rate for Payer: UnitedHealthcare Community & State	$616.48
Rate for Payer: Wellpoint Medicaid Managed Care	$677.87

ALLOGRAFT VIAFLOW MATRIX 1.0CC

Facility

$25,580.00

Service Code	HCPCS C1734
Hospital Charge Code	270700503
Hospital Revenue Code	278
Min. Negotiated Rate	$3,837.00
Max. Negotiated Rate	$6,190.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,190.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,627.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,837.00

ALLOGRAFT VIAGENEX MAX 3X5CM

Facility

$8,500.00

Service Code	HCPCS Q4205
Hospital Charge Code	270699124
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,057.00
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Community & State	$204.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$225.25

ALLOGRAFT VIAGENEX MAX 3X5CM

Facility

$8,500.00

Service Code	HCPCS Q4205
Hospital Charge Code	270699124
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

ALLOGRFT MESH 1:1 5x23CM101510

Facility

$6,152.50

Hospital Charge Code	270642024
Hospital Revenue Code	636
Min. Negotiated Rate	$922.88
Max. Negotiated Rate	$1,488.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,488.90
Rate for Payer: Qualcare PPO/HMO/WC	$922.88

ALLOGRFT MESH 1:1 5x23CM101510

Facility

$6,152.50

Hospital Charge Code	270642024
Hospital Revenue Code	636
Min. Negotiated Rate	$148.28
Max. Negotiated Rate	$3,076.25
Rate for Payer: Aetna Commercial	$2,337.95
Rate for Payer: Aetna Medicare Advantage	$1,845.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,568.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,568.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,568.89
Rate for Payer: Cigna Commercial	$3,076.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,488.90
Rate for Payer: Qualcare PPO/HMO/WC	$922.88
Rate for Payer: UnitedHealthcare Community & State	$148.28
Rate for Payer: Wellpoint Medicaid Managed Care	$163.04

ALLOMATRIX 10CC

Facility

$5,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270677317
Hospital Revenue Code	278
Min. Negotiated Rate	$795.00
Max. Negotiated Rate	$1,282.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,282.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,166.00
Rate for Payer: Qualcare PPO/HMO/WC	$795.00

ALLOMATRIX 10CC

Facility

$5,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270677317
Hospital Revenue Code	278
Min. Negotiated Rate	$127.73
Max. Negotiated Rate	$2,650.00
Rate for Payer: Aetna Commercial	$2,014.00
Rate for Payer: Aetna Medicare Advantage	$1,590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,351.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,351.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,351.50
Rate for Payer: Cigna Commercial	$2,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,282.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,166.00
Rate for Payer: Qualcare PPO/HMO/WC	$795.00
Rate for Payer: UnitedHealthcare Community & State	$127.73
Rate for Payer: Wellpoint Medicaid Managed Care	$140.45

ALLOMATRIX 5CC PUTTY

Facility

$8,715.00

Service Code	HCPCS C9359
Hospital Charge Code	270665925
Hospital Revenue Code	278
Min. Negotiated Rate	$1,307.25
Max. Negotiated Rate	$2,109.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,743.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,109.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,917.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,307.25

ALLOMATRIX 5CC PUTTY

Facility

$8,715.00

Service Code	HCPCS C9359
Hospital Charge Code	270665925
Hospital Revenue Code	278
Min. Negotiated Rate	$210.03
Max. Negotiated Rate	$4,357.50
Rate for Payer: Aetna Commercial	$3,311.70
Rate for Payer: Aetna Medicare Advantage	$2,614.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,222.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,222.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,743.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,222.32
Rate for Payer: Cigna Commercial	$4,357.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,109.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,917.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,307.25
Rate for Payer: UnitedHealthcare Community & State	$210.03
Rate for Payer: Wellpoint Medicaid Managed Care	$230.95

ALLOPATCH HD THICK 4CMx8CM

Facility

$8,840.00

Service Code	HCPCS Q4128
Hospital Charge Code	270683019
Hospital Revenue Code	278
Min. Negotiated Rate	$1,326.00
Max. Negotiated Rate	$2,139.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,768.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,139.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,944.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,326.00

ALLOPATCH HD THICK 4CMx8CM

Facility

$8,840.00

Service Code	HCPCS Q4128
Hospital Charge Code	270683019
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,139.28
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,768.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,139.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,944.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,326.00
Rate for Payer: UnitedHealthcare Community & State	$213.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$234.26

ALLOPURE 8MM EVANS

Facility

$8,745.00

Service Code	HCPCS C1713
Hospital Charge Code	270682192
Hospital Revenue Code	278
Min. Negotiated Rate	$210.75
Max. Negotiated Rate	$4,372.50
Rate for Payer: Aetna Commercial	$3,323.10
Rate for Payer: Aetna Medicare Advantage	$2,623.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,229.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,229.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,749.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,229.97
Rate for Payer: Cigna Commercial	$4,372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,116.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,923.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,311.75
Rate for Payer: UnitedHealthcare Community & State	$210.75
Rate for Payer: Wellpoint Medicaid Managed Care	$231.74

ALLOPURE 8MM EVANS

Facility

$8,745.00

Service Code	HCPCS C1713
Hospital Charge Code	270682192
Hospital Revenue Code	278
Min. Negotiated Rate	$1,311.75
Max. Negotiated Rate	$2,116.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,749.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,116.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,923.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,311.75

ALLOPURETRICORTICAL BLOCK-MEDI

Facility

$18,754.75

Service Code	HCPCS C1889
Hospital Charge Code	270704023
Hospital Revenue Code	278
Min. Negotiated Rate	$451.99
Max. Negotiated Rate	$9,377.38
Rate for Payer: Aetna Commercial	$7,126.81
Rate for Payer: Aetna Medicare Advantage	$5,626.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,782.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,782.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,782.46
Rate for Payer: Cigna Commercial	$9,377.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,538.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,126.05
Rate for Payer: Qualcare PPO/HMO/WC	$2,813.21
Rate for Payer: UnitedHealthcare Community & State	$451.99
Rate for Payer: Wellpoint Medicaid Managed Care	$497.00

ALLOPURETRICORTICAL BLOCK-MEDI

Facility

$18,754.75

Service Code	HCPCS C1889
Hospital Charge Code	270704023
Hospital Revenue Code	278
Min. Negotiated Rate	$2,813.21
Max. Negotiated Rate	$4,538.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,538.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,126.05
Rate for Payer: Qualcare PPO/HMO/WC	$2,813.21

ALLOPURINOL 100 MG TAB

Facility

$4.00

Service Code	NDC 51079020520
Hospital Charge Code	60628511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

ALLOPURINOL 100 MG TAB

Facility

$4.00

Service Code	NDC 51079020520
Hospital Charge Code	60628511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ALLOPURINOL/100MG/TAB

Facility

$3.00

Hospital Charge Code	60632420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

ALLOPURINOL/100MG/TAB

Facility

$3.00

Hospital Charge Code	60632420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

ALLOPURINOL/100MG/TAB

Facility

$4.00

Hospital Charge Code	60632425
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

ALLOPURINOL/100MG/TAB

Facility

$4.00

Hospital Charge Code	60632425
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ALLOPURINOL/100MG/TAB

Facility

$4.00

Hospital Charge Code	60632422
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ALLOPURINOL/100MG/TAB

Facility

$4.00

Hospital Charge Code	60632422
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

ALLOPURINOL 300 MG TAB

Facility

$5.09

Service Code	NDC 51079020620
Hospital Charge Code	60628512
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Qualcare PPO/HMO/WC	$0.76

Know your out-of-pocket cost for care.

All Charges