Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT ALLOAID PIP SZ 2.5X16MM

Facility

$7,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270698494
Hospital Revenue Code	278
Min. Negotiated Rate	$189.79
Max. Negotiated Rate	$3,937.50
Rate for Payer: Aetna Commercial	$2,992.50
Rate for Payer: Aetna Medicare Advantage	$2,362.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,008.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,008.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,008.12
Rate for Payer: Cigna Commercial	$3,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,732.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.25
Rate for Payer: UnitedHealthcare Community & State	$189.79
Rate for Payer: Wellpoint Medicaid Managed Care	$208.69

GRAFT ALLOAID PIP SZ 2.5X16MM

Facility

$7,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270698494
Hospital Revenue Code	278
Min. Negotiated Rate	$1,181.25
Max. Negotiated Rate	$1,905.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,732.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.25

GRAFT ALLODERM2cm x 4cm 102012

Facility

$2,320.00

Hospital Charge Code	270641307
Hospital Revenue Code	636
Min. Negotiated Rate	$55.91
Max. Negotiated Rate	$1,160.00
Rate for Payer: Aetna Commercial	$881.60
Rate for Payer: Aetna Medicare Advantage	$696.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$591.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$591.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$591.60
Rate for Payer: Cigna Commercial	$1,160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.44
Rate for Payer: Qualcare PPO/HMO/WC	$348.00
Rate for Payer: UnitedHealthcare Community & State	$55.91
Rate for Payer: Wellpoint Medicaid Managed Care	$61.48

GRAFT ALLODERM2cm x 4cm 102012

Facility

$2,320.00

Hospital Charge Code	270641307
Hospital Revenue Code	636
Min. Negotiated Rate	$348.00
Max. Negotiated Rate	$561.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.44
Rate for Payer: Qualcare PPO/HMO/WC	$348.00

GRAFT ALLODERM 3cmx7cm 102022

Facility

$3,525.00

Hospital Charge Code	270639358
Hospital Revenue Code	636
Min. Negotiated Rate	$84.95
Max. Negotiated Rate	$1,762.50
Rate for Payer: Aetna Commercial	$1,339.50
Rate for Payer: Aetna Medicare Advantage	$1,057.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$898.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$898.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$898.88
Rate for Payer: Cigna Commercial	$1,762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$853.05
Rate for Payer: Qualcare PPO/HMO/WC	$528.75
Rate for Payer: UnitedHealthcare Community & State	$84.95
Rate for Payer: Wellpoint Medicaid Managed Care	$93.41

GRAFT ALLODERM 3cmx7cm 102022

Facility

$3,525.00

Hospital Charge Code	270639358
Hospital Revenue Code	636
Min. Negotiated Rate	$528.75
Max. Negotiated Rate	$853.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$853.05
Rate for Payer: Qualcare PPO/HMO/WC	$528.75

GRAFT ALLODERM 4cmX22cm 101520

Facility

$4,659.60

Hospital Charge Code	270639961
Hospital Revenue Code	636
Min. Negotiated Rate	$698.94
Max. Negotiated Rate	$1,127.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,127.62
Rate for Payer: Qualcare PPO/HMO/WC	$698.94

GRAFT ALLODERM 4cmX22cm 101520

Facility

$4,659.60

Hospital Charge Code	270639961
Hospital Revenue Code	636
Min. Negotiated Rate	$112.30
Max. Negotiated Rate	$2,329.80
Rate for Payer: Aetna Commercial	$1,770.65
Rate for Payer: Aetna Medicare Advantage	$1,397.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,188.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,188.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,188.20
Rate for Payer: Cigna Commercial	$2,329.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,127.62
Rate for Payer: Qualcare PPO/HMO/WC	$698.94
Rate for Payer: UnitedHealthcare Community & State	$112.30
Rate for Payer: Wellpoint Medicaid Managed Care	$123.48

GRAFT ALLODERM 4X12CM

Facility

$1,859.00

Hospital Charge Code	270664937
Hospital Revenue Code	636
Min. Negotiated Rate	$278.85
Max. Negotiated Rate	$449.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$449.88
Rate for Payer: Qualcare PPO/HMO/WC	$278.85

GRAFT ALLODERM 4X12CM

Facility

$1,859.00

Hospital Charge Code	270664937
Hospital Revenue Code	636
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$929.50
Rate for Payer: Aetna Commercial	$706.42
Rate for Payer: Aetna Medicare Advantage	$557.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$474.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$474.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$474.05
Rate for Payer: Cigna Commercial	$929.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$449.88
Rate for Payer: Qualcare PPO/HMO/WC	$278.85
Rate for Payer: UnitedHealthcare Community & State	$44.80
Rate for Payer: Wellpoint Medicaid Managed Care	$49.26

GRAFT ALLODERM 4X12CM/SQCMJW

Facility

$38.73

Hospital Charge Code	270664937W
Hospital Revenue Code	636
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$9.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.37
Rate for Payer: Qualcare PPO/HMO/WC	$5.81

GRAFT ALLODERM 4X12CM/SQCMJW

Facility

$38.73

Hospital Charge Code	270664937W
Hospital Revenue Code	636
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$19.36
Rate for Payer: Aetna Commercial	$14.72
Rate for Payer: Aetna Medicare Advantage	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.88
Rate for Payer: Cigna Commercial	$19.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.37
Rate for Payer: Qualcare PPO/HMO/WC	$5.81
Rate for Payer: UnitedHealthcare Community & State	$0.93
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

GRAFT ALLODERM ACELLULR 101010

Facility

$8,643.25

Hospital Charge Code	270626611
Hospital Revenue Code	636
Min. Negotiated Rate	$208.30
Max. Negotiated Rate	$4,321.62
Rate for Payer: Aetna Commercial	$3,284.43
Rate for Payer: Aetna Medicare Advantage	$2,592.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,204.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,204.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,204.03
Rate for Payer: Cigna Commercial	$4,321.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,091.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,296.49
Rate for Payer: UnitedHealthcare Community & State	$208.30
Rate for Payer: Wellpoint Medicaid Managed Care	$229.05

GRAFT ALLODERM ACELLULR 101010

Facility

$8,643.25

Hospital Charge Code	270626611
Hospital Revenue Code	636
Min. Negotiated Rate	$1,296.49
Max. Negotiated Rate	$2,091.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,091.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,296.49

graft alloderm dermal 3 x 7

Facility

$2,565.00

Hospital Charge Code	270657868
Hospital Revenue Code	636
Min. Negotiated Rate	$384.75
Max. Negotiated Rate	$620.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$620.73
Rate for Payer: Qualcare PPO/HMO/WC	$384.75

graft alloderm dermal 3 x 7

Facility

$2,565.00

Hospital Charge Code	270657868
Hospital Revenue Code	636
Min. Negotiated Rate	$61.82
Max. Negotiated Rate	$1,282.50
Rate for Payer: Aetna Commercial	$974.70
Rate for Payer: Aetna Medicare Advantage	$769.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$654.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$654.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$654.08
Rate for Payer: Cigna Commercial	$1,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$620.73
Rate for Payer: Qualcare PPO/HMO/WC	$384.75
Rate for Payer: UnitedHealthcare Community & State	$61.82
Rate for Payer: Wellpoint Medicaid Managed Care	$67.97

GRAFT ALLODERM LG PERF THICK

Facility

$34,095.00

Hospital Charge Code	270677774
Hospital Revenue Code	636
Min. Negotiated Rate	$5,114.25
Max. Negotiated Rate	$8,250.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,250.99
Rate for Payer: Qualcare PPO/HMO/WC	$5,114.25

GRAFT ALLODERM LG PERF THICK

Facility

$34,095.00

Hospital Charge Code	270677774
Hospital Revenue Code	636
Min. Negotiated Rate	$821.69
Max. Negotiated Rate	$17,047.50
Rate for Payer: Aetna Commercial	$12,956.10
Rate for Payer: Aetna Medicare Advantage	$10,228.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,694.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,694.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,694.23
Rate for Payer: Cigna Commercial	$17,047.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,250.99
Rate for Payer: Qualcare PPO/HMO/WC	$5,114.25
Rate for Payer: UnitedHealthcare Community & State	$821.69
Rate for Payer: Wellpoint Medicaid Managed Care	$903.52

GRAFT ALLODERM MED PERF THICK

Facility

$27,445.00

Hospital Charge Code	270677773
Hospital Revenue Code	636
Min. Negotiated Rate	$4,116.75
Max. Negotiated Rate	$6,641.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,641.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,116.75

GRAFT ALLODERM MED PERF THICK

Facility

$27,445.00

Hospital Charge Code	270677773
Hospital Revenue Code	636
Min. Negotiated Rate	$661.42
Max. Negotiated Rate	$13,722.50
Rate for Payer: Aetna Commercial	$10,429.10
Rate for Payer: Aetna Medicare Advantage	$8,233.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,998.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,998.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,998.48
Rate for Payer: Cigna Commercial	$13,722.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,641.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,116.75
Rate for Payer: UnitedHealthcare Community & State	$661.42
Rate for Payer: Wellpoint Medicaid Managed Care	$727.29

GRAFT ALLODERM MED PERF THIN

Facility

$27,445.00

Hospital Charge Code	270677772
Hospital Revenue Code	636
Min. Negotiated Rate	$4,116.75
Max. Negotiated Rate	$6,641.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,641.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,116.75

GRAFT ALLODERM MED PERF THIN

Facility

$27,445.00

Hospital Charge Code	270677772
Hospital Revenue Code	636
Min. Negotiated Rate	$661.42
Max. Negotiated Rate	$13,722.50
Rate for Payer: Aetna Commercial	$10,429.10
Rate for Payer: Aetna Medicare Advantage	$8,233.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,998.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,998.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,998.48
Rate for Payer: Cigna Commercial	$13,722.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,641.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,116.75
Rate for Payer: UnitedHealthcare Community & State	$661.42
Rate for Payer: Wellpoint Medicaid Managed Care	$727.29

GRAFT ALLODERM THIN 4x12CM

Facility

$9,170.00

Service Code	HCPCS Q4116
Hospital Charge Code	270677712
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

GRAFT ALLODERM THIN 4x12CM

Facility

$9,170.00

Service Code	HCPCS Q4116
Hospital Charge Code	270677712
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,219.14
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	$1,834.00
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	$2,219.14
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: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$243.00

GRAFT ALLO MAT DR 3c 86DR-0300

Facility

$3,596.00

Hospital Charge Code	270635668
Hospital Revenue Code	278
Min. Negotiated Rate	$539.40
Max. Negotiated Rate	$870.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$719.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$870.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$791.12
Rate for Payer: Qualcare PPO/HMO/WC	$539.40

Know your out-of-pocket cost for care.

All Charges