Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INTEGRA WOUND DRSG 4X10CM

Facility

$2,651.00

Hospital Charge Code	270332610
Hospital Revenue Code	636
Min. Negotiated Rate	$397.65
Max. Negotiated Rate	$641.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$641.54
Rate for Payer: Qualcare PPO/HMO/WC	$397.65

INTEGRA WOUND DRSG 4X10CM

Facility

$2,651.00

Hospital Charge Code	270332610
Hospital Revenue Code	636
Min. Negotiated Rate	$63.89
Max. Negotiated Rate	$1,325.50
Rate for Payer: Aetna Commercial	$1,007.38
Rate for Payer: Aetna Medicare Advantage	$795.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$676.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$676.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$676.00
Rate for Payer: Cigna Commercial	$1,325.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$641.54
Rate for Payer: Qualcare PPO/HMO/WC	$397.65
Rate for Payer: UnitedHealthcare Community & State	$63.89
Rate for Payer: Wellpoint Medicaid Managed Care	$70.25

INTEGRA WOUND MATRIX 2INx2IN

Facility

$7,290.00

Service Code	HCPCS Q4108
Hospital Charge Code	270686598
Hospital Revenue Code	278
Min. Negotiated Rate	$1,093.50
Max. Negotiated Rate	$1,764.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,458.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,603.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,093.50

INTEGRA WOUND MATRIX 2INx2IN

Facility

$7,290.00

Service Code	HCPCS Q4108
Hospital Charge Code	270686598
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,764.18
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	$1,458.00
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	$1,764.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,603.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,093.50
Rate for Payer: UnitedHealthcare Community & State	$175.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$193.19

INTEGRA/X POR RED PROX 8MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680609
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

INTEGRA/X POR RED PROX 8MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680609
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

INTEGRILIN 2MG/MLINJ100ML

Facility

$1,519.00

Hospital Charge Code	60635295
Hospital Revenue Code	636
Min. Negotiated Rate	$36.61
Max. Negotiated Rate	$759.50
Rate for Payer: Aetna Commercial	$577.22
Rate for Payer: Aetna Medicare Advantage	$455.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$387.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$387.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$387.35
Rate for Payer: Cigna Commercial	$759.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.60
Rate for Payer: Qualcare PPO/HMO/WC	$227.85
Rate for Payer: UnitedHealthcare Community & State	$36.61
Rate for Payer: Wellpoint Medicaid Managed Care	$40.25

INTEGRILIN 2MG/MLINJ100ML

Facility

$1,519.00

Hospital Charge Code	60635295
Hospital Revenue Code	636
Min. Negotiated Rate	$227.85
Max. Negotiated Rate	$367.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.60
Rate for Payer: Qualcare PPO/HMO/WC	$227.85

INTEGRILIN 75MG/100ML INJ

Facility

$602.00

Hospital Charge Code	60635296
Hospital Revenue Code	636
Min. Negotiated Rate	$14.51
Max. Negotiated Rate	$301.00
Rate for Payer: Aetna Commercial	$228.76
Rate for Payer: Aetna Medicare Advantage	$180.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.51
Rate for Payer: Cigna Commercial	$301.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.68
Rate for Payer: Qualcare PPO/HMO/WC	$90.30
Rate for Payer: UnitedHealthcare Community & State	$14.51
Rate for Payer: Wellpoint Medicaid Managed Care	$15.95

INTEGRILIN 75MG/100ML INJ

Facility

$602.00

Hospital Charge Code	60635296
Hospital Revenue Code	636
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$145.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.68
Rate for Payer: Qualcare PPO/HMO/WC	$90.30

INTEGRL 180MM RDCD PROX 17X180

Facility

$50,388.00

Service Code	HCPCS C1776
Hospital Charge Code	270687777
Hospital Revenue Code	278
Min. Negotiated Rate	$7,558.20
Max. Negotiated Rate	$12,193.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,077.60
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

INTEGRL 180MM RDCD PROX 17X180

Facility

$50,388.00

Service Code	HCPCS C1776
Hospital Charge Code	270687777
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

INTEGRO DBM PLUS 5 244608

Facility

$4,125.00

Hospital Charge Code	270638273
Hospital Revenue Code	272
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$618.75
Rate for Payer: Qualcare PPO/HMO/WC	$618.75

INTEGRO DBM PLUS 5 244608

Facility

$4,125.00

Hospital Charge Code	270638273
Hospital Revenue Code	272
Min. Negotiated Rate	$99.41
Max. Negotiated Rate	$2,062.50
Rate for Payer: Aetna Commercial	$1,567.50
Rate for Payer: Aetna Medicare Advantage	$1,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.88
Rate for Payer: Cigna Commercial	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,237.50
Rate for Payer: Oxford Commercial	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$618.75
Rate for Payer: UnitedHealthcare Commercial	$825.00
Rate for Payer: UnitedHealthcare Community & State	$99.41
Rate for Payer: Wellpoint Medicaid Managed Care	$109.31

INTEGR SHRT GTRW/2 CABLE 23X53

Facility

$8,482.50

Service Code	HCPCS C1713
Hospital Charge Code	270663515
Hospital Revenue Code	278
Min. Negotiated Rate	$204.43
Max. Negotiated Rate	$4,241.25
Rate for Payer: Aetna Commercial	$3,223.35
Rate for Payer: Aetna Medicare Advantage	$2,544.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,163.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,163.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,696.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,163.04
Rate for Payer: Cigna Commercial	$4,241.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,052.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,866.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,272.38
Rate for Payer: UnitedHealthcare Community & State	$204.43
Rate for Payer: Wellpoint Medicaid Managed Care	$224.79

INTEGR SHRT GTRW/2 CABLE 23X53

Facility

$8,482.50

Service Code	HCPCS C1713
Hospital Charge Code	270663515
Hospital Revenue Code	278
Min. Negotiated Rate	$1,272.38
Max. Negotiated Rate	$2,052.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,696.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,052.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,866.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,272.38

INTELLIJOINT HIP KIT

Facility

$5,425.00

Service Code	HCPCS C1776
Hospital Charge Code	270704147
Hospital Revenue Code	278
Min. Negotiated Rate	$813.75
Max. Negotiated Rate	$1,312.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,085.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,312.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,193.50
Rate for Payer: Qualcare PPO/HMO/WC	$813.75

INTELLIJOINT HIP KIT

Facility

$5,425.00

Service Code	HCPCS C1776
Hospital Charge Code	270704147
Hospital Revenue Code	278
Min. Negotiated Rate	$130.74
Max. Negotiated Rate	$2,712.50
Rate for Payer: Aetna Commercial	$2,061.50
Rate for Payer: Aetna Medicare Advantage	$1,627.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,383.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,383.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,085.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,383.38
Rate for Payer: Cigna Commercial	$2,712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,312.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,193.50
Rate for Payer: Qualcare PPO/HMO/WC	$813.75
Rate for Payer: UnitedHealthcare Community & State	$130.74
Rate for Payer: Wellpoint Medicaid Managed Care	$143.76

INTENSIVE OP TREATMENT IOP

Facility

$750.00

Service Code	HCPCS H0015
Hospital Charge Code	4546755
Hospital Revenue Code	914
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

INTENSIVE OP TREATMENT IOP

Facility

$750.00

Service Code	HCPCS H0015
Hospital Charge Code	4546747
Hospital Revenue Code	914
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

INTENSIVE OP TREATMENT IOP

Facility

$750.00

Service Code	HCPCS H0015
Hospital Charge Code	4546747
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTENSIVE OP TREATMENT IOP

Facility

$750.00

Service Code	HCPCS H0015
Hospital Charge Code	4546755
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$4,700.83

Service Code	APR-DRG 8171
Min. Negotiated Rate	$4,608.66
Max. Negotiated Rate	$4,700.83
Rate for Payer: UnitedHealthcare Community & State	$4,608.66
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,700.83
Rate for Payer: Wellpoint Medicaid Managed Care	$4,608.66

INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$20,323.91

Service Code	APR-DRG 8174
Min. Negotiated Rate	$19,925.40
Max. Negotiated Rate	$20,323.91
Rate for Payer: UnitedHealthcare Community & State	$19,925.40
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,323.91
Rate for Payer: Wellpoint Medicaid Managed Care	$19,925.40

INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$10,231.54

Service Code	APR-DRG 8173
Min. Negotiated Rate	$10,030.92
Max. Negotiated Rate	$10,231.54
Rate for Payer: UnitedHealthcare Community & State	$10,030.92
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,231.54
Rate for Payer: Wellpoint Medicaid Managed Care	$10,030.92

Know your out-of-pocket cost for care.

All Charges