Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRF ALODRM XTHK 16x20CM/SQCMJW

Facility

$196.06

Hospital Charge Code	270646078W
Hospital Revenue Code	636
Min. Negotiated Rate	$29.41
Max. Negotiated Rate	$47.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.45
Rate for Payer: Qualcare PPO/HMO/WC	$29.41

GRF ALODRM XTHK 16x20CM/SQCMJW

Facility

$196.06

Hospital Charge Code	270646078W
Hospital Revenue Code	636
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$98.03
Rate for Payer: Aetna Commercial	$74.50
Rate for Payer: Aetna Medicare Advantage	$58.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.00
Rate for Payer: Cigna Commercial	$98.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.45
Rate for Payer: Qualcare PPO/HMO/WC	$29.41
Rate for Payer: UnitedHealthcare Community & State	$4.73
Rate for Payer: Wellpoint Medicaid Managed Care	$5.20

GRFG AUTO FAT LIPO CC/<

Facility

$10,771.05

Service Code	HCPCS 15773
Hospital Charge Code	1600000358
Hospital Revenue Code	360
Min. Negotiated Rate	$1,615.66
Max. Negotiated Rate	$1,615.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,615.66

GRFG AUTO FAT LIPO CC/<

Facility

$10,771.05

Service Code	HCPCS 15773
Hospital Charge Code	1600000358
Hospital Revenue Code	360
Min. Negotiated Rate	$259.58
Max. Negotiated Rate	$8,848.20
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
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	$8,848.20
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,231.32
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,615.66
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$259.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$285.43

GRFG AUTOL FAT LIPO 50 CC/<

Facility

$13,957.04

Service Code	HCPCS 15771
Hospital Charge Code	16000494
Hospital Revenue Code	360
Min. Negotiated Rate	$2,093.56
Max. Negotiated Rate	$2,093.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,093.56

GRFG AUTOL FAT LIPO 50 CC/<

Facility

$13,957.04

Service Code	HCPCS 15771
Hospital Charge Code	16000494
Hospital Revenue Code	360
Min. Negotiated Rate	$336.36
Max. Negotiated Rate	$15,196.98
Rate for Payer: Aetna Commercial	$11,451.31
Rate for Payer: Aetna Medicare Advantage	$13,640.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,196.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,196.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,210.04
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	$15,196.98
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: Cigna Medicare Advantage	$4,210.04
Rate for Payer: Clover Medicare Advantage	$3,999.54
Rate for Payer: EmblemHealth Commercial	$12,630.12
Rate for Payer: Humana Medicare Advantage	$4,336.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,210.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,187.11
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,093.56
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$336.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,210.04
Rate for Payer: Wellcare Medicare Advantage	$4,210.04
Rate for Payer: Wellpoint Medicaid Managed Care	$369.86

GRFG AUTOL FAT LIPO EA ADDL

Facility

$5,402.61

Service Code	HCPCS 15772
Hospital Charge Code	16000309
Hospital Revenue Code	360
Min. Negotiated Rate	$130.20
Max. Negotiated Rate	$2,701.30
Rate for Payer: Aetna Commercial	$2,052.99
Rate for Payer: Aetna Medicare Advantage	$1,620.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,377.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,377.67
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	$1,377.67
Rate for Payer: Cigna Commercial	$2,701.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,620.78
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.39
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$130.20
Rate for Payer: Wellpoint Medicaid Managed Care	$143.17

GRFG AUTOL FAT LIPO EA ADDL

Facility

$5,402.61

Service Code	HCPCS 15772
Hospital Charge Code	16000309
Hospital Revenue Code	360
Min. Negotiated Rate	$810.39
Max. Negotiated Rate	$810.39
Rate for Payer: Qualcare PPO/HMO/WC	$810.39

GRF MATRX IQ DERM 5X4CM/SQCMJW

Facility

$300.00

Hospital Charge Code	270676216W
Hospital Revenue Code	636
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$72.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

GRF MATRX IQ DERM 5X4CM/SQCMJW

Facility

$300.00

Hospital Charge Code	270676216W
Hospital Revenue Code	636
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Community & State	$7.23
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

GRF MATRX IQ DERMIS 5X4CM

Facility

$6,000.00

Hospital Charge Code	270676216
Hospital Revenue Code	636
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

GRF MATRX IQ DERMIS 5X4CM

Facility

$6,000.00

Hospital Charge Code	270676216
Hospital Revenue Code	636
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

GRF NEOX CORD 1K 3x3CM/SQCM JW

Facility

$1,244.31

Hospital Charge Code	270675812W
Hospital Revenue Code	636
Min. Negotiated Rate	$186.65
Max. Negotiated Rate	$301.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.12
Rate for Payer: Qualcare PPO/HMO/WC	$186.65

GRF NEOX CORD 1K 3x3CM/SQCM JW

Facility

$1,244.31

Hospital Charge Code	270675812W
Hospital Revenue Code	636
Min. Negotiated Rate	$29.99
Max. Negotiated Rate	$622.15
Rate for Payer: Aetna Commercial	$472.84
Rate for Payer: Aetna Medicare Advantage	$373.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$317.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$317.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$317.30
Rate for Payer: Cigna Commercial	$622.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.12
Rate for Payer: Qualcare PPO/HMO/WC	$186.65
Rate for Payer: UnitedHealthcare Community & State	$29.99
Rate for Payer: Wellpoint Medicaid Managed Care	$32.97

GRFT FULL FACE/HF </= 20 SQCM

Facility

$9,070.55

Service Code	HCPCS 15240
Hospital Charge Code	323015240
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$8,848.20
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,848.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$613.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,848.20
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,721.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,360.58
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$240.37

GRFT FULL FACE/HF </= 20 SQCM

Facility

$9,070.55

Service Code	HCPCS 15240
Hospital Charge Code	323015240
Hospital Revenue Code	450
Min. Negotiated Rate	$1,360.58
Max. Negotiated Rate	$1,360.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,360.58

GRFT ZNTH AAA LG EX TFLE-22-71

Facility

$13,392.00

Hospital Charge Code	270633870
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

GRFT ZNTH AAA LG EX TFLE-22-71

Facility

$13,500.00

Hospital Charge Code	270633870V
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

GRFT ZNTH AAA LG EX TFLE-22-71

Facility

$13,392.00

Hospital Charge Code	270633870
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

GRFT ZNTH AAA LG EX TFLE-22-71

Facility

$13,500.00

Hospital Charge Code	270633870V
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

GRFT ZNTH AAA LG EX TFLE-24-88

Facility

$13,392.00

Hospital Charge Code	270636635
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

GRFT ZNTH AAA LG EX TFLE-24-88

Facility

$13,392.00

Hospital Charge Code	270636635
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

GRFT ZNTH AAA LG EX TFLE-24-88

Facility

$13,500.00

Hospital Charge Code	270636635V
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

GRFT ZNTH AAA LG EX TFLE-24-88

Facility

$13,500.00

Hospital Charge Code	270636635V
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

GRID, CT GUIDE LINES BIOPSY

Facility

$575.00

Hospital Charge Code	2706000701
Hospital Revenue Code	272
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

Know your out-of-pocket cost for care.

All Charges