Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INS URETERAL STENT-RT

Facility

$919.00

Hospital Charge Code	2691795
Hospital Revenue Code	320
Min. Negotiated Rate	$22.15
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$349.22
Rate for Payer: Aetna Medicare Advantage	$275.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.34
Rate for Payer: Cigna Commercial	$459.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.70
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$137.85
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$22.15
Rate for Payer: Wellpoint Medicaid Managed Care	$24.35

INS URETERAL STENT-RT

Facility

$919.00

Hospital Charge Code	2691795
Hospital Revenue Code	320
Min. Negotiated Rate	$137.85
Max. Negotiated Rate	$137.85
Rate for Payer: Qualcare PPO/HMO/WC	$137.85

INSYTE 16G 1 1/4 IN

Facility

$11.25

Hospital Charge Code	270041006
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

INSYTE 16G 1 1/4 IN

Facility

$11.25

Hospital Charge Code	270041006
Hospital Revenue Code	272
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

INTAKE ASSESSMENT

Facility

$1,296.00

Service Code	HCPCS 90801
Hospital Charge Code	84504015
Hospital Revenue Code	900
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

INTAKE ASSESSMENT

Facility

$1,296.00

Service Code	HCPCS 90801
Hospital Charge Code	84504015
Hospital Revenue Code	900
Min. Negotiated Rate	$31.23
Max. Negotiated Rate	$3,081.00
Rate for Payer: Aetna Commercial	$492.48
Rate for Payer: Aetna Medicare Advantage	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$648.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.80
Rate for Payer: Oxford Commercial	$1,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: UnitedHealthcare Commercial	$3,081.00
Rate for Payer: UnitedHealthcare Community & State	$31.23
Rate for Payer: Wellpoint Medicaid Managed Care	$34.34

INTAL/10MG/1ML

Facility

$3.00

Hospital Charge Code	60633185
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

INTAL/10MG/1ML

Facility

$3.00

Hospital Charge Code	60633185
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

INTAL/8.1GM

Facility

$3.00

Hospital Charge Code	60633186
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

INTAL/8.1GM

Facility

$3.00

Hospital Charge Code	60633186
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

INTEDERM 6cm X 8cm 64350013

Facility

$7,688.00

Hospital Charge Code	270633020
Hospital Revenue Code	272
Min. Negotiated Rate	$185.28
Max. Negotiated Rate	$3,844.00
Rate for Payer: Aetna Commercial	$2,921.44
Rate for Payer: Aetna Medicare Advantage	$2,306.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,960.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,960.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,960.44
Rate for Payer: Cigna Commercial	$3,844.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,306.40
Rate for Payer: Oxford Commercial	$1,537.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,153.20
Rate for Payer: UnitedHealthcare Commercial	$1,537.60
Rate for Payer: UnitedHealthcare Community & State	$185.28
Rate for Payer: Wellpoint Medicaid Managed Care	$203.73

INTEDERM 6cm X 8cm 64350013

Facility

$7,688.00

Hospital Charge Code	270633020
Hospital Revenue Code	272
Min. Negotiated Rate	$1,153.20
Max. Negotiated Rate	$1,153.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,153.20

INTEGRA BILAYER DERMAL MATRIX

Facility

$14,170.00

Service Code	HCPCS Q4108
Hospital Charge Code	270657175
Hospital Revenue Code	636
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,429.14
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	$156.71
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	$3,429.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,125.50
Rate for Payer: UnitedHealthcare Community & State	$341.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$375.50

INTEGRA BILAYER DERMAL MATRIX

Facility

$14,170.00

Service Code	HCPCS Q4108
Hospital Charge Code	270657175
Hospital Revenue Code	636
Min. Negotiated Rate	$2,125.50
Max. Negotiated Rate	$3,429.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,429.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,125.50

INTEGRA BIOFIX FLOW PLACT TIS

Facility

$19,375.00

Service Code	HCPCS C9399
Hospital Charge Code	270684215
Hospital Revenue Code	636
Min. Negotiated Rate	$2,906.25
Max. Negotiated Rate	$4,688.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,688.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,906.25

INTEGRA BIOFIX FLOW PLACT TIS

Facility

$19,375.00

Service Code	HCPCS C9399
Hospital Charge Code	270684215
Hospital Revenue Code	636
Min. Negotiated Rate	$466.94
Max. Negotiated Rate	$9,687.50
Rate for Payer: Aetna Commercial	$7,362.50
Rate for Payer: Aetna Medicare Advantage	$5,812.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,940.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,940.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,940.62
Rate for Payer: Cigna Commercial	$9,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,688.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,906.25
Rate for Payer: UnitedHealthcare Community & State	$466.94
Rate for Payer: Wellpoint Medicaid Managed Care	$513.44

INTEGRA BONE GRAFT 2.5CC

Facility

$4,250.00

Hospital Charge Code	270657176
Hospital Revenue Code	278
Min. Negotiated Rate	$102.42
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,615.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50
Rate for Payer: UnitedHealthcare Community & State	$102.42
Rate for Payer: Wellpoint Medicaid Managed Care	$112.62

INTEGRA BONE GRAFT 2.5CC

Facility

$4,250.00

Hospital Charge Code	270657176
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

INTEGRA BONE GRAFT 5CC W/ C

Facility

$8,000.00

Hospital Charge Code	270657178
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

INTEGRA BONE GRAFT 5CC W/ C

Facility

$8,000.00

Hospital Charge Code	270657178
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

INTEGRA FLOWABLE WOUND MATRIX

Facility

$14,105.00

Service Code	HCPCS Q4114
Hospital Charge Code	270646968
Hospital Revenue Code	278
Min. Negotiated Rate	$339.93
Max. Negotiated Rate	$7,052.50
Rate for Payer: Aetna Commercial	$5,359.90
Rate for Payer: Aetna Medicare Advantage	$4,231.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,596.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,596.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,821.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,596.78
Rate for Payer: Cigna Commercial	$7,052.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,413.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,103.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,115.75
Rate for Payer: UnitedHealthcare Community & State	$339.93
Rate for Payer: Wellpoint Medicaid Managed Care	$373.78

INTEGRA FLOWABLE WOUND MATRIX

Facility

$14,105.00

Service Code	HCPCS Q4114
Hospital Charge Code	270646968
Hospital Revenue Code	278
Min. Negotiated Rate	$2,115.75
Max. Negotiated Rate	$3,413.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,821.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,413.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,103.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,115.75

INTEGRAL PRIMARY/REV 13X180

Facility

$38,760.00

Service Code	HCPCS C1776
Hospital Charge Code	270686318
Hospital Revenue Code	278
Min. Negotiated Rate	$934.12
Max. Negotiated Rate	$19,380.00
Rate for Payer: Aetna Commercial	$14,728.80
Rate for Payer: Aetna Medicare Advantage	$11,628.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,883.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,883.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,752.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,883.80
Rate for Payer: Cigna Commercial	$19,380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,379.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,527.20
Rate for Payer: Qualcare PPO/HMO/WC	$5,814.00
Rate for Payer: UnitedHealthcare Community & State	$934.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1,027.14

INTEGRAL PRIMARY/REV 13X180

Facility

$50,388.00

Service Code	HCPCS C1776
Hospital Charge Code	270688618
Hospital Revenue Code	278
Min. Negotiated Rate	$1,214.35
Max. Negotiated Rate	$25,194.00
Rate for Payer: Aetna Commercial	$19,147.44
Rate for Payer: Aetna Medicare Advantage	$15,116.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,848.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,848.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,077.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,848.94
Rate for Payer: Cigna Commercial	$25,194.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,193.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,085.36
Rate for Payer: Qualcare PPO/HMO/WC	$7,558.20
Rate for Payer: UnitedHealthcare Community & State	$1,214.35
Rate for Payer: Wellpoint Medicaid Managed Care	$1,335.28

INTEGRAL PRIMARY/REV 13X180

Facility

$38,760.00

Service Code	HCPCS C1776
Hospital Charge Code	270686318
Hospital Revenue Code	278
Min. Negotiated Rate	$5,814.00
Max. Negotiated Rate	$9,379.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,752.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,379.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,527.20
Rate for Payer: Qualcare PPO/HMO/WC	$5,814.00

Know your out-of-pocket cost for care.

All Charges