Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT WOUND MATRIX 5 X 5 CM

Facility

$6,345.00

Service Code	HCPCS Q4166
Hospital Charge Code	270696692
Hospital Revenue Code	278
Min. Negotiated Rate	$951.75
Max. Negotiated Rate	$1,535.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,269.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,535.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,395.90
Rate for Payer: Qualcare PPO/HMO/WC	$951.75

GRAFT WOUND MATRIX 5X5CM

Facility

$6,345.00

Service Code	HCPCS Q4166
Hospital Charge Code	270696726
Hospital Revenue Code	278
Min. Negotiated Rate	$951.75
Max. Negotiated Rate	$1,535.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,269.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,535.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,395.90
Rate for Payer: Qualcare PPO/HMO/WC	$951.75

GRAFT WOUND MATRIX 5X5CM

Facility

$6,345.00

Service Code	HCPCS Q4166
Hospital Charge Code	270696726
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,535.49
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	$1,269.00
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	$1,535.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,395.90
Rate for Payer: Qualcare PPO/HMO/WC	$951.75
Rate for Payer: UnitedHealthcare Community & State	$152.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$168.14

GRAFT XENMATRIX AB 4 X 8 CM

Facility

$30,300.00

Service Code	HCPCS C1781
Hospital Charge Code	270684825
Hospital Revenue Code	278
Min. Negotiated Rate	$730.23
Max. Negotiated Rate	$15,150.00
Rate for Payer: Aetna Commercial	$11,514.00
Rate for Payer: Aetna Medicare Advantage	$9,090.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,726.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,726.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,726.50
Rate for Payer: Cigna Commercial	$15,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,332.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,666.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,545.00
Rate for Payer: UnitedHealthcare Community & State	$730.23
Rate for Payer: Wellpoint Medicaid Managed Care	$802.95

GRAFT XENMATRIX AB 4 X 8 CM

Facility

$30,300.00

Service Code	HCPCS C1781
Hospital Charge Code	270684825
Hospital Revenue Code	278
Min. Negotiated Rate	$4,545.00
Max. Negotiated Rate	$7,332.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,332.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,666.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,545.00

GRAFT ZE AAA LEG EX TFLE-16-88

Facility

$14,320.00

Hospital Charge Code	270637297V
Hospital Revenue Code	278
Min. Negotiated Rate	$345.11
Max. Negotiated Rate	$7,160.00
Rate for Payer: Aetna Commercial	$5,441.60
Rate for Payer: Aetna Medicare Advantage	$4,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,651.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,651.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,651.60
Rate for Payer: Cigna Commercial	$7,160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,465.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,150.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,148.00
Rate for Payer: UnitedHealthcare Community & State	$345.11
Rate for Payer: Wellpoint Medicaid Managed Care	$379.48

GRAFT ZE AAA LEG EX TFLE-16-88

Facility

$14,320.00

Hospital Charge Code	270637297V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,148.00
Max. Negotiated Rate	$3,465.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,864.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,465.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,150.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,148.00

GRAFT ZEN AAA LEG EXT TFLE1454

Facility

$13,392.00

Hospital Charge Code	270634077
Hospital Revenue Code	278
Min. Negotiated Rate	$322.75
Max. Negotiated Rate	$6,696.00
Rate for Payer: Aetna Commercial	$5,088.96
Rate for Payer: Aetna Medicare Advantage	$4,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,678.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,414.96
Rate for Payer: Cigna Commercial	$6,696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,946.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80
Rate for Payer: UnitedHealthcare Community & State	$322.75
Rate for Payer: Wellpoint Medicaid Managed Care	$354.89

GRAFT ZEN AAA LEG EXT TFLE1454

Facility

$13,392.00

Hospital Charge Code	270634077
Hospital Revenue Code	278
Min. Negotiated Rate	$2,008.80
Max. Negotiated Rate	$3,240.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,678.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,946.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80

GRAFT ZEN AAA LEG EXT TFLE1854

Facility

$14,980.00

Hospital Charge Code	270634076V
Hospital Revenue Code	278
Min. Negotiated Rate	$361.02
Max. Negotiated Rate	$7,490.00
Rate for Payer: Aetna Commercial	$5,692.40
Rate for Payer: Aetna Medicare Advantage	$4,494.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,819.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,819.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,996.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,819.90
Rate for Payer: Cigna Commercial	$7,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,625.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,295.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,247.00
Rate for Payer: UnitedHealthcare Community & State	$361.02
Rate for Payer: Wellpoint Medicaid Managed Care	$396.97

GRAFT ZEN AAA LEG EXT TFLE1854

Facility

$14,980.00

Hospital Charge Code	270634076V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,247.00
Max. Negotiated Rate	$3,625.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,996.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,625.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,295.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,247.00

GRAFT ZEN AAA LEG EXT TFLE1854

Facility

$13,392.00

Hospital Charge Code	270634076
Hospital Revenue Code	278
Min. Negotiated Rate	$322.75
Max. Negotiated Rate	$6,696.00
Rate for Payer: Aetna Commercial	$5,088.96
Rate for Payer: Aetna Medicare Advantage	$4,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,678.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,414.96
Rate for Payer: Cigna Commercial	$6,696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,946.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80
Rate for Payer: UnitedHealthcare Community & State	$322.75
Rate for Payer: Wellpoint Medicaid Managed Care	$354.89

GRAFT ZEN AAA LEG EXT TFLE1854

Facility

$13,392.00

Hospital Charge Code	270634076
Hospital Revenue Code	278
Min. Negotiated Rate	$2,008.80
Max. Negotiated Rate	$3,240.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,678.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,946.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80

GRAFT ZEN AAA LEG EXT TFLE1871

Facility

$13,392.00

Hospital Charge Code	270634075
Hospital Revenue Code	278
Min. Negotiated Rate	$322.75
Max. Negotiated Rate	$6,696.00
Rate for Payer: Aetna Commercial	$5,088.96
Rate for Payer: Aetna Medicare Advantage	$4,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,678.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,414.96
Rate for Payer: Cigna Commercial	$6,696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,946.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80
Rate for Payer: UnitedHealthcare Community & State	$322.75
Rate for Payer: Wellpoint Medicaid Managed Care	$354.89

GRAFT ZEN AAA LEG EXT TFLE1871

Facility

$13,392.00

Hospital Charge Code	270634075
Hospital Revenue Code	278
Min. Negotiated Rate	$2,008.80
Max. Negotiated Rate	$3,240.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,678.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,946.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80

GRAFT ZEN AAA LEG EXT TFLE2254

Facility

$13,500.00

Hospital Charge Code	270637296V
Hospital Revenue Code	278
Min. Negotiated Rate	$325.35
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Community & State	$325.35
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

GRAFT ZEN AAA LEG EXT TFLE2254

Facility

$13,500.00

Hospital Charge Code	270637296V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

GRAFT ZEN AAA LEG ILI TFLE2088

Facility

$14,320.00

Hospital Charge Code	270638291V
Hospital Revenue Code	278
Min. Negotiated Rate	$345.11
Max. Negotiated Rate	$7,160.00
Rate for Payer: Aetna Commercial	$5,441.60
Rate for Payer: Aetna Medicare Advantage	$4,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,651.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,651.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,651.60
Rate for Payer: Cigna Commercial	$7,160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,465.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,150.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,148.00
Rate for Payer: UnitedHealthcare Community & State	$345.11
Rate for Payer: Wellpoint Medicaid Managed Care	$379.48

GRAFT ZEN AAA LEG ILI TFLE2088

Facility

$13,500.00

Hospital Charge Code	270638291
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

GRAFT ZEN AAA LEG ILI TFLE2088

Facility

$13,500.00

Hospital Charge Code	270638291
Hospital Revenue Code	278
Min. Negotiated Rate	$325.35
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Community & State	$325.35
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

GRAFT ZEN AAA LEG ILI TFLE2088

Facility

$14,320.00

Hospital Charge Code	270638291V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,148.00
Max. Negotiated Rate	$3,465.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,864.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,465.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,150.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,148.00

GRAFT ZEN AAA LEG TFLE-16-88

Facility

$13,500.00

Hospital Charge Code	270637297
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

GRAFT ZEN AAA LEG TFLE-16-88

Facility

$13,500.00

Hospital Charge Code	270637297
Hospital Revenue Code	278
Min. Negotiated Rate	$325.35
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Community & State	$325.35
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

GRAFT ZEN AAA MAIN BOD TFB3074

Facility

$37,000.00

Hospital Charge Code	270637295V
Hospital Revenue Code	278
Min. Negotiated Rate	$5,550.00
Max. Negotiated Rate	$8,954.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,954.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,140.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,550.00

GRAFT ZEN AAA MAIN BOD TFB3074

Facility

$37,000.00

Hospital Charge Code	270637295V
Hospital Revenue Code	278
Min. Negotiated Rate	$891.70
Max. Negotiated Rate	$18,500.00
Rate for Payer: Aetna Commercial	$14,060.00
Rate for Payer: Aetna Medicare Advantage	$11,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,435.00
Rate for Payer: Cigna Commercial	$18,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,954.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,140.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,550.00
Rate for Payer: UnitedHealthcare Community & State	$891.70
Rate for Payer: Wellpoint Medicaid Managed Care	$980.50

Know your out-of-pocket cost for care.

All Charges