Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRASP NDL OPEN LOOP DISP 10165

Facility

$270.00

Hospital Charge Code	270641145
Hospital Revenue Code	272
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

GREAT RELEASE MTP RELEASE INST

Facility

$2,750.00

Hospital Charge Code	270704035
Hospital Revenue Code	272
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

GREAT RELEASE MTP RELEASE INST

Facility

$2,750.00

Hospital Charge Code	270704035
Hospital Revenue Code	272
Min. Negotiated Rate	$66.28
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$1,045.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$825.00
Rate for Payer: Oxford Commercial	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.50
Rate for Payer: UnitedHealthcare Commercial	$550.00
Rate for Payer: UnitedHealthcare Community & State	$66.28
Rate for Payer: Wellpoint Medicaid Managed Care	$72.88

GREAT TOE LPT REG SZ 0

Facility

$9,970.00

Hospital Charge Code	270675918
Hospital Revenue Code	278
Min. Negotiated Rate	$1,495.50
Max. Negotiated Rate	$2,412.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,994.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,412.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,193.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,495.50

GREAT TOE LPT REG SZ 0

Facility

$9,970.00

Hospital Charge Code	270675918
Hospital Revenue Code	278
Min. Negotiated Rate	$240.28
Max. Negotiated Rate	$4,985.00
Rate for Payer: Aetna Commercial	$3,788.60
Rate for Payer: Aetna Medicare Advantage	$2,991.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,542.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,542.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,994.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,542.35
Rate for Payer: Cigna Commercial	$4,985.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,412.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,193.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,495.50
Rate for Payer: UnitedHealthcare Community & State	$240.28
Rate for Payer: Wellpoint Medicaid Managed Care	$264.20

GREEN PANCREATIC STENT

Facility

$290.00

Hospital Charge Code	270325680
Hospital Revenue Code	278
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$70.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$63.80
Rate for Payer: Qualcare PPO/HMO/WC	$43.50

GREEN PANCREATIC STENT

Facility

$290.00

Hospital Charge Code	270325680
Hospital Revenue Code	278
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$145.00
Rate for Payer: Aetna Commercial	$110.20
Rate for Payer: Aetna Medicare Advantage	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.95
Rate for Payer: Cigna Commercial	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$63.80
Rate for Payer: Qualcare PPO/HMO/WC	$43.50
Rate for Payer: UnitedHealthcare Community & State	$6.99
Rate for Payer: Wellpoint Medicaid Managed Care	$7.68

GRF ALLODERM 9.6x19.3CM

Facility

$25,870.00

Hospital Charge Code	270663698
Hospital Revenue Code	636
Min. Negotiated Rate	$623.47
Max. Negotiated Rate	$12,935.00
Rate for Payer: Aetna Commercial	$9,830.60
Rate for Payer: Aetna Medicare Advantage	$7,761.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,596.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,596.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,596.85
Rate for Payer: Cigna Commercial	$12,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,260.54
Rate for Payer: Qualcare PPO/HMO/WC	$3,880.50
Rate for Payer: UnitedHealthcare Community & State	$623.47
Rate for Payer: Wellpoint Medicaid Managed Care	$685.55

GRF ALLODERM 9.6x19.3CM

Facility

$25,870.00

Hospital Charge Code	270663698
Hospital Revenue Code	636
Min. Negotiated Rate	$3,880.50
Max. Negotiated Rate	$6,260.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,260.54
Rate for Payer: Qualcare PPO/HMO/WC	$3,880.50

GRF ALLODERM 9.6x19.3CM/SQCMJW

Facility

$139.84

Hospital Charge Code	270663698W
Hospital Revenue Code	636
Min. Negotiated Rate	$20.98
Max. Negotiated Rate	$33.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.84
Rate for Payer: Qualcare PPO/HMO/WC	$20.98

GRF ALLODERM 9.6x19.3CM/SQCMJW

Facility

$139.84

Hospital Charge Code	270663698W
Hospital Revenue Code	636
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$69.92
Rate for Payer: Aetna Commercial	$53.14
Rate for Payer: Aetna Medicare Advantage	$41.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.66
Rate for Payer: Cigna Commercial	$69.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.84
Rate for Payer: Qualcare PPO/HMO/WC	$20.98
Rate for Payer: UnitedHealthcare Community & State	$3.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.71

GRF ALLODERM THICK 4x12CM

Facility

$9,710.00

Service Code	HCPCS Q4116
Hospital Charge Code	270633029
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.50
Max. Negotiated Rate	$2,349.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,942.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,349.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,136.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,456.50

GRF ALLODERM THICK 4x12CM

Facility

$9,710.00

Service Code	HCPCS Q4116
Hospital Charge Code	270633029
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,349.82
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	$1,942.00
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	$2,349.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,136.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,456.50
Rate for Payer: UnitedHealthcare Community & State	$234.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$257.31

GRF ALLODERM THK 4x12CM/SQCMJW

Facility

$185.52

Hospital Charge Code	270633029W
Hospital Revenue Code	636
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$92.76
Rate for Payer: Aetna Commercial	$70.50
Rate for Payer: Aetna Medicare Advantage	$55.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.31
Rate for Payer: Cigna Commercial	$92.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.83
Rate for Payer: UnitedHealthcare Community & State	$4.47
Rate for Payer: Wellpoint Medicaid Managed Care	$4.92

GRF ALLODERM THK 4x12CM/SQCMJW

Facility

$185.52

Hospital Charge Code	270633029W
Hospital Revenue Code	636
Min. Negotiated Rate	$27.83
Max. Negotiated Rate	$44.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.90
Rate for Payer: Qualcare PPO/HMO/WC	$27.83

GRF ALLODRM CONT 164 SQCM

Facility

$32,575.00

Service Code	HCPCS Q4116
Hospital Charge Code	270665417
Hospital Revenue Code	278
Min. Negotiated Rate	$4,886.25
Max. Negotiated Rate	$7,883.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,515.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,883.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,166.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,886.25

GRF ALLODRM CONT 164 SQCM

Facility

$32,575.00

Service Code	HCPCS Q4116
Hospital Charge Code	270665417
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$7,883.15
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	$6,515.00
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	$7,883.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,166.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,886.25
Rate for Payer: UnitedHealthcare Community & State	$785.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$863.24

GRF ALLODRM CONT164SQCM/SQCMJW

Facility

$195.95

Hospital Charge Code	270665417W
Hospital Revenue Code	636
Min. Negotiated Rate	$29.39
Max. Negotiated Rate	$47.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.42
Rate for Payer: Qualcare PPO/HMO/WC	$29.39

GRF ALLODRM CONT164SQCM/SQCMJW

Facility

$195.95

Hospital Charge Code	270665417W
Hospital Revenue Code	636
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$97.97
Rate for Payer: Aetna Commercial	$74.46
Rate for Payer: Aetna Medicare Advantage	$58.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.97
Rate for Payer: Cigna Commercial	$97.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.42
Rate for Payer: Qualcare PPO/HMO/WC	$29.39
Rate for Payer: UnitedHealthcare Community & State	$4.72
Rate for Payer: Wellpoint Medicaid Managed Care	$5.19

GRF ALODRM 10.7x21.5CM/SQCM JW

Facility

$139.69

Hospital Charge Code	270665577W
Hospital Revenue Code	636
Min. Negotiated Rate	$20.95
Max. Negotiated Rate	$33.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.95

GRF ALODRM 10.7x21.5CM/SQCM JW

Facility

$139.69

Hospital Charge Code	270665577W
Hospital Revenue Code	636
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$69.84
Rate for Payer: Aetna Commercial	$53.08
Rate for Payer: Aetna Medicare Advantage	$41.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.62
Rate for Payer: Cigna Commercial	$69.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.95
Rate for Payer: UnitedHealthcare Community & State	$3.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.70

GRF ALODRM LG 10.7x21.5CM

Facility

$32,135.00

Hospital Charge Code	270665577
Hospital Revenue Code	636
Min. Negotiated Rate	$4,820.25
Max. Negotiated Rate	$7,776.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,776.67
Rate for Payer: Qualcare PPO/HMO/WC	$4,820.25

GRF ALODRM LG 10.7x21.5CM

Facility

$32,135.00

Hospital Charge Code	270665577
Hospital Revenue Code	636
Min. Negotiated Rate	$774.45
Max. Negotiated Rate	$16,067.50
Rate for Payer: Aetna Commercial	$12,211.30
Rate for Payer: Aetna Medicare Advantage	$9,640.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,194.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,194.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,194.42
Rate for Payer: Cigna Commercial	$16,067.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,776.67
Rate for Payer: Qualcare PPO/HMO/WC	$4,820.25
Rate for Payer: UnitedHealthcare Community & State	$774.45
Rate for Payer: Wellpoint Medicaid Managed Care	$851.58

GRF ALODRM XTHK 16x20CM

Facility

$62,740.00

Hospital Charge Code	270646078
Hospital Revenue Code	636
Min. Negotiated Rate	$9,411.00
Max. Negotiated Rate	$15,183.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,183.08
Rate for Payer: Qualcare PPO/HMO/WC	$9,411.00

GRF ALODRM XTHK 16x20CM

Facility

$62,740.00

Hospital Charge Code	270646078
Hospital Revenue Code	636
Min. Negotiated Rate	$1,512.03
Max. Negotiated Rate	$31,370.00
Rate for Payer: Aetna Commercial	$23,841.20
Rate for Payer: Aetna Medicare Advantage	$18,822.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,998.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,998.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,998.70
Rate for Payer: Cigna Commercial	$31,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,183.08
Rate for Payer: Qualcare PPO/HMO/WC	$9,411.00
Rate for Payer: UnitedHealthcare Community & State	$1,512.03
Rate for Payer: Wellpoint Medicaid Managed Care	$1,662.61

Know your out-of-pocket cost for care.

All Charges