Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

AMNIOFIX INJECTABLE 100MG

Facility

$9,170.00

Hospital Charge Code	270660769
Hospital Revenue Code	270
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$4,585.00
Rate for Payer: Aetna Commercial	$3,484.60
Rate for Payer: Aetna Medicare Advantage	$2,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.35
Rate for Payer: Cigna Commercial	$4,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,751.00
Rate for Payer: Oxford Commercial	$1,834.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50
Rate for Payer: UnitedHealthcare Commercial	$1,834.00
Rate for Payer: UnitedHealthcare Community & State	$221.00
Rate for Payer: Wellpoint Medicaid Managed Care	$243.00

AMNIOFIX INJECTABLE 100MG

Facility

$9,170.00

Hospital Charge Code	270660769
Hospital Revenue Code	270
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$1,375.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

AMNIOFIX INJECTABLE 20MG

Facility

$1,652.50

Service Code	HCPCS Q4139
Hospital Charge Code	270679818
Hospital Revenue Code	636
Min. Negotiated Rate	$39.83
Max. Negotiated Rate	$826.25
Rate for Payer: Aetna Commercial	$627.95
Rate for Payer: Aetna Medicare Advantage	$495.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$421.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$421.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$421.39
Rate for Payer: Cigna Commercial	$826.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.90
Rate for Payer: Qualcare PPO/HMO/WC	$247.88
Rate for Payer: UnitedHealthcare Community & State	$39.83
Rate for Payer: Wellpoint Medicaid Managed Care	$43.79

AMNIOFIX INJECTABLE 20MG

Facility

$1,652.50

Service Code	HCPCS Q4139
Hospital Charge Code	270679818
Hospital Revenue Code	636
Min. Negotiated Rate	$247.88
Max. Negotiated Rate	$399.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.90
Rate for Payer: Qualcare PPO/HMO/WC	$247.88

AMNIO MATRIX 1 ML

Facility

$5,250.00

Service Code	HCPCS Q4139
Hospital Charge Code	270681918
Hospital Revenue Code	636
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

AMNIO MATRIX 1 ML

Facility

$5,250.00

Service Code	HCPCS Q4139
Hospital Charge Code	270681918
Hospital Revenue Code	636
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

AMNIO MAXX ACELLULAR 2.0ML

Facility

$9,475.00

Service Code	HCPCS C1762
Hospital Charge Code	270691770
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.25
Max. Negotiated Rate	$2,292.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25

AMNIO MAXX ACELLULAR 2.0ML

Facility

$9,475.00

Service Code	HCPCS C1762
Hospital Charge Code	270691770
Hospital Revenue Code	278
Min. Negotiated Rate	$228.35
Max. Negotiated Rate	$4,737.50
Rate for Payer: Aetna Commercial	$3,600.50
Rate for Payer: Aetna Medicare Advantage	$2,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,416.12
Rate for Payer: Cigna Commercial	$4,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25
Rate for Payer: UnitedHealthcare Community & State	$228.35
Rate for Payer: Wellpoint Medicaid Managed Care	$251.09

AMNION MATRIX CORD 3CMX4CM

Facility

$14,000.00

Service Code	HCPCS C1765
Hospital Charge Code	270703707
Hospital Revenue Code	278
Min. Negotiated Rate	$337.40
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$5,320.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,080.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00
Rate for Payer: UnitedHealthcare Community & State	$337.40
Rate for Payer: Wellpoint Medicaid Managed Care	$371.00

AMNION MATRIX CORD 3CMX4CM

Facility

$14,000.00

Service Code	HCPCS C1765
Hospital Charge Code	270703707
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,080.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

AMNION VIASHIELD DL LAY 4X4CM

Facility

$18,335.00

Service Code	HCPCS Q4211
Hospital Charge Code	270695511
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$4,437.07
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	$3,667.00
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	$4,437.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,033.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,750.25
Rate for Payer: UnitedHealthcare Community & State	$441.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$485.88

AMNION VIASHIELD DL LAY 4X4CM

Facility

$18,335.00

Service Code	HCPCS Q4211
Hospital Charge Code	270695511
Hospital Revenue Code	278
Min. Negotiated Rate	$2,750.25
Max. Negotiated Rate	$4,437.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,667.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,437.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,033.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,750.25

AMNION WOUND MATRIX 2cmx2cm

Facility

$3,975.00

Service Code	HCPCS Q4148
Hospital Charge Code	270679824
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$874.50
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

AMNION WOUND MATRIX 2cmx2cm

Facility

$3,975.00

Service Code	HCPCS Q4148
Hospital Charge Code	270679824
Hospital Revenue Code	278
Min. Negotiated Rate	$95.80
Max. Negotiated Rate	$961.95
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	$795.00
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	$961.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$874.50
Rate for Payer: Qualcare PPO/HMO/WC	$596.25
Rate for Payer: UnitedHealthcare Community & State	$95.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$105.34

AMNIO PROCEDURE

Facility

$250.00

Service Code	HCPCS 59000
Hospital Charge Code	1800192
Hospital Revenue Code	361
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$3,949.84
Rate for Payer: Aetna Commercial	$2,976.31
Rate for Payer: Aetna Medicare Advantage	$3,545.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,949.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,949.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,094.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,949.84
Rate for Payer: Cigna Commercial	$2,193.38
Rate for Payer: Cigna Medicare Advantage	$1,094.23
Rate for Payer: Clover Medicare Advantage	$1,039.52
Rate for Payer: EmblemHealth Commercial	$3,282.69
Rate for Payer: Humana Medicare Advantage	$1,127.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,094.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,094.23
Rate for Payer: Wellcare Medicare Advantage	$1,094.23
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

AMNIO PROCEDURE

Facility

$250.00

Service Code	HCPCS 59000
Hospital Charge Code	1800192
Hospital Revenue Code	361
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

AMNIOTIC FLUID TRI

Facility

$9,170.00

Hospital Charge Code	270680608
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$2,219.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,017.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

AMNIOTIC FLUID TRI

Facility

$9,170.00

Hospital Charge Code	270680608
Hospital Revenue Code	278
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$4,585.00
Rate for Payer: Aetna Commercial	$3,484.60
Rate for Payer: Aetna Medicare Advantage	$2,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.35
Rate for Payer: Cigna Commercial	$4,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,017.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50
Rate for Payer: UnitedHealthcare Community & State	$221.00
Rate for Payer: Wellpoint Medicaid Managed Care	$243.00

AMNIOTIC MEMBRANE ALLOGRAFT

Facility

$9,170.00

Hospital Charge Code	270660772
Hospital Revenue Code	810
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$4,585.00
Rate for Payer: Aetna Commercial	$3,484.60
Rate for Payer: Aetna Medicare Advantage	$2,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.35
Rate for Payer: Cigna Commercial	$4,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,751.00
Rate for Payer: Oxford Commercial	$1,834.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50
Rate for Payer: UnitedHealthcare Commercial	$1,834.00
Rate for Payer: UnitedHealthcare Community & State	$221.00
Rate for Payer: Wellpoint Medicaid Managed Care	$243.00

AMNIOTIC MEMBRANE ALLOGRAFT

Facility

$9,170.00

Hospital Charge Code	270660772
Hospital Revenue Code	810
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$1,375.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

AMNIOTIC MEMBRANE ALLOGRAFT 1.

Facility

$9,170.00

Hospital Charge Code	270662351+
Hospital Revenue Code	272
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$1,375.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

AMNIOTIC MEMBRANE ALLOGRAFT 1.

Facility

$9,170.00

Hospital Charge Code	270662351+
Hospital Revenue Code	272
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$4,585.00
Rate for Payer: Aetna Commercial	$3,484.60
Rate for Payer: Aetna Medicare Advantage	$2,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.35
Rate for Payer: Cigna Commercial	$4,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,751.00
Rate for Payer: Oxford Commercial	$1,834.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50
Rate for Payer: UnitedHealthcare Commercial	$1,834.00
Rate for Payer: UnitedHealthcare Community & State	$221.00
Rate for Payer: Wellpoint Medicaid Managed Care	$243.00

AMNIOTICMEMBRANE ALLOGRAFT.5ML

Facility

$4,475.00

Hospital Charge Code	270662537
Hospital Revenue Code	278
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,700.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25
Rate for Payer: UnitedHealthcare Community & State	$107.85
Rate for Payer: Wellpoint Medicaid Managed Care	$118.59

AMNIOTICMEMBRANE ALLOGRAFT.5ML

Facility

$4,475.00

Hospital Charge Code	270662537
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

AMNIOTICMEMBRNEALLOGRAFT 7X7CM

Facility

$22,475.00

Hospital Charge Code	270662656
Hospital Revenue Code	278
Min. Negotiated Rate	$541.65
Max. Negotiated Rate	$11,237.50
Rate for Payer: Aetna Commercial	$8,540.50
Rate for Payer: Aetna Medicare Advantage	$6,742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,731.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,731.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,731.12
Rate for Payer: Cigna Commercial	$11,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,438.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,944.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,371.25
Rate for Payer: UnitedHealthcare Community & State	$541.65
Rate for Payer: Wellpoint Medicaid Managed Care	$595.59

Know your out-of-pocket cost for care.

All Charges