Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MATRIX BURN 5X5CM/SQCM JW

Facility

$153.00

Hospital Charge Code	270662122W
Hospital Revenue Code	636
Min. Negotiated Rate	$3.69
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna Commercial	$58.14
Rate for Payer: Aetna Medicare Advantage	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.02
Rate for Payer: Cigna Commercial	$76.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.03
Rate for Payer: Qualcare PPO/HMO/WC	$22.95
Rate for Payer: UnitedHealthcare Community & State	$3.69
Rate for Payer: Wellpoint Medicaid Managed Care	$4.05

MATRIX BURN 5X5CM/SQCM JW

Facility

$153.00

Hospital Charge Code	270662122W
Hospital Revenue Code	636
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$37.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.03
Rate for Payer: Qualcare PPO/HMO/WC	$22.95

MATRIX BURN 7CM X 10CM

Facility

$5,625.00

Service Code	HCPCS Q4166
Hospital Charge Code	270662121
Hospital Revenue Code	636
Min. Negotiated Rate	$135.56
Max. Negotiated Rate	$1,361.25
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	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Community & State	$135.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$149.06

MATRIX BURN 7CM X 10CM

Facility

$5,625.00

Service Code	HCPCS Q4166
Hospital Charge Code	270662121
Hospital Revenue Code	636
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

MATRIX CONNECTOR 30-33MM SZ4

Facility

$5,926.25

Service Code	HCPCS C1713
Hospital Charge Code	270691917
Hospital Revenue Code	278
Min. Negotiated Rate	$888.94
Max. Negotiated Rate	$1,434.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,185.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,434.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,303.78
Rate for Payer: Qualcare PPO/HMO/WC	$888.94

MATRIX CONNECTOR 30-33MM SZ4

Facility

$5,926.25

Service Code	HCPCS C1713
Hospital Charge Code	270691917
Hospital Revenue Code	278
Min. Negotiated Rate	$142.82
Max. Negotiated Rate	$2,963.12
Rate for Payer: Aetna Commercial	$2,251.97
Rate for Payer: Aetna Medicare Advantage	$1,777.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,511.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,511.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,185.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,511.19
Rate for Payer: Cigna Commercial	$2,963.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,434.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,303.78
Rate for Payer: Qualcare PPO/HMO/WC	$888.94
Rate for Payer: UnitedHealthcare Community & State	$142.82
Rate for Payer: Wellpoint Medicaid Managed Care	$157.05

MATRIX CONNECTOR 38-47MM SZ6

Facility

$5,926.25

Service Code	HCPCS C1713
Hospital Charge Code	270691918
Hospital Revenue Code	278
Min. Negotiated Rate	$888.94
Max. Negotiated Rate	$1,434.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,185.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,434.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,303.78
Rate for Payer: Qualcare PPO/HMO/WC	$888.94

MATRIX CONNECTOR 38-47MM SZ6

Facility

$5,926.25

Service Code	HCPCS C1713
Hospital Charge Code	270691918
Hospital Revenue Code	278
Min. Negotiated Rate	$142.82
Max. Negotiated Rate	$2,963.12
Rate for Payer: Aetna Commercial	$2,251.97
Rate for Payer: Aetna Medicare Advantage	$1,777.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,511.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,511.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,185.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,511.19
Rate for Payer: Cigna Commercial	$2,963.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,434.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,303.78
Rate for Payer: Qualcare PPO/HMO/WC	$888.94
Rate for Payer: UnitedHealthcare Community & State	$142.82
Rate for Payer: Wellpoint Medicaid Managed Care	$157.05

MATRIX CONNECTOR # 5

Facility

$7,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270690701
Hospital Revenue Code	278
Min. Negotiated Rate	$175.93
Max. Negotiated Rate	$3,650.00
Rate for Payer: Aetna Commercial	$2,774.00
Rate for Payer: Aetna Medicare Advantage	$2,190.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,861.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,861.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,460.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,861.50
Rate for Payer: Cigna Commercial	$3,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,766.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,606.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,095.00
Rate for Payer: UnitedHealthcare Community & State	$175.93
Rate for Payer: Wellpoint Medicaid Managed Care	$193.45

MATRIX CONNECTOR # 5

Facility

$7,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270690701
Hospital Revenue Code	278
Min. Negotiated Rate	$1,095.00
Max. Negotiated Rate	$1,766.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,766.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,606.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,095.00

MATRIX DEMINERALIZED BONE PUTT

Facility

$600.00

Service Code	HCPCS C1713
Hospital Charge Code	270655826
Hospital Revenue Code	278
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$132.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

MATRIX DEMINERALIZED BONE PUTT

Facility

$600.00

Service Code	HCPCS C1713
Hospital Charge Code	270655826
Hospital Revenue Code	278
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$132.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

MATRIX FENESTRATED WOUND 3x

Facility

$755.00

Hospital Charge Code	270651180
Hospital Revenue Code	278
Min. Negotiated Rate	$113.25
Max. Negotiated Rate	$182.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$151.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$166.10
Rate for Payer: Qualcare PPO/HMO/WC	$113.25

MATRIX FENESTRATED WOUND 3x

Facility

$755.00

Hospital Charge Code	270651180
Hospital Revenue Code	278
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$377.50
Rate for Payer: Aetna Commercial	$286.90
Rate for Payer: Aetna Medicare Advantage	$226.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$151.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.53
Rate for Payer: Cigna Commercial	$377.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$166.10
Rate for Payer: Qualcare PPO/HMO/WC	$113.25
Rate for Payer: UnitedHealthcare Community & State	$18.20
Rate for Payer: Wellpoint Medicaid Managed Care	$20.01

MATRIX FLWBLE WND 3CC/1CC JW

Facility

$6,525.00

Hospital Charge Code	270646968W
Hospital Revenue Code	636
Min. Negotiated Rate	$157.25
Max. Negotiated Rate	$3,262.50
Rate for Payer: Aetna Commercial	$2,479.50
Rate for Payer: Aetna Medicare Advantage	$1,957.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,663.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,663.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,663.88
Rate for Payer: Cigna Commercial	$3,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,579.05
Rate for Payer: Qualcare PPO/HMO/WC	$978.75
Rate for Payer: UnitedHealthcare Community & State	$157.25
Rate for Payer: Wellpoint Medicaid Managed Care	$172.91

MATRIX FLWBLE WND 3CC/1CC JW

Facility

$6,525.00

Hospital Charge Code	270646968W
Hospital Revenue Code	636
Min. Negotiated Rate	$978.75
Max. Negotiated Rate	$1,579.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,579.05
Rate for Payer: Qualcare PPO/HMO/WC	$978.75

MATRIX FLWBLE WND 3cc FWD301

Facility

$16,350.00

Hospital Charge Code	270646968C
Hospital Revenue Code	272
Min. Negotiated Rate	$394.04
Max. Negotiated Rate	$8,175.00
Rate for Payer: Aetna Commercial	$6,213.00
Rate for Payer: Aetna Medicare Advantage	$4,905.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,169.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,169.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,169.25
Rate for Payer: Cigna Commercial	$8,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,905.00
Rate for Payer: Oxford Commercial	$3,270.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,452.50
Rate for Payer: UnitedHealthcare Commercial	$3,270.00
Rate for Payer: UnitedHealthcare Community & State	$394.04
Rate for Payer: Wellpoint Medicaid Managed Care	$433.27

MATRIX FLWBLE WND 3cc FWD301

Facility

$16,350.00

Hospital Charge Code	270646968C
Hospital Revenue Code	272
Min. Negotiated Rate	$2,452.50
Max. Negotiated Rate	$2,452.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,452.50

MATRIX MICRONIZD PARTCLE 100mg

Facility

$1,504.00

Service Code	HCPCS Q4118
Hospital Charge Code	270651181
Hospital Revenue Code	278
Min. Negotiated Rate	$36.25
Max. Negotiated Rate	$752.00
Rate for Payer: Aetna Commercial	$571.52
Rate for Payer: Aetna Medicare Advantage	$451.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$383.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$383.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$383.52
Rate for Payer: Cigna Commercial	$752.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.88
Rate for Payer: Qualcare PPO/HMO/WC	$225.60
Rate for Payer: UnitedHealthcare Community & State	$36.25
Rate for Payer: Wellpoint Medicaid Managed Care	$39.86

MATRIX MICRONIZD PARTCLE 100mg

Facility

$1,504.00

Service Code	HCPCS Q4118
Hospital Charge Code	270651181
Hospital Revenue Code	278
Min. Negotiated Rate	$225.60
Max. Negotiated Rate	$363.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.88
Rate for Payer: Qualcare PPO/HMO/WC	$225.60

MATRIX MICRONIZD PARTCLE 50

Facility

$7,375.00

Service Code	HCPCS Q4118
Hospital Charge Code	270651028
Hospital Revenue Code	636
Min. Negotiated Rate	$1,106.25
Max. Negotiated Rate	$1,784.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25

MATRIX MICRONIZD PARTCLE 50

Facility

$7,375.00

Service Code	HCPCS Q4118
Hospital Charge Code	270651028
Hospital Revenue Code	636
Min. Negotiated Rate	$177.74
Max. Negotiated Rate	$3,687.50
Rate for Payer: Aetna Commercial	$2,802.50
Rate for Payer: Aetna Medicare Advantage	$2,212.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,880.62
Rate for Payer: Cigna Commercial	$3,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25
Rate for Payer: UnitedHealthcare Community & State	$177.74
Rate for Payer: Wellpoint Medicaid Managed Care	$195.44

MATRIX MICRONIZED FINE 200 MG

Facility

$3,200.00

Service Code	HCPCS Q4118
Hospital Charge Code	270651179
Hospital Revenue Code	278
Min. Negotiated Rate	$77.12
Max. Negotiated Rate	$1,600.00
Rate for Payer: Aetna Commercial	$1,216.00
Rate for Payer: Aetna Medicare Advantage	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$640.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$816.00
Rate for Payer: Cigna Commercial	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$774.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$704.00
Rate for Payer: Qualcare PPO/HMO/WC	$480.00
Rate for Payer: UnitedHealthcare Community & State	$77.12
Rate for Payer: Wellpoint Medicaid Managed Care	$84.80

MATRIX MICRONIZED FINE 200 MG

Facility

$3,200.00

Service Code	HCPCS Q4118
Hospital Charge Code	270651179
Hospital Revenue Code	278
Min. Negotiated Rate	$480.00
Max. Negotiated Rate	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$774.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$704.00
Rate for Payer: Qualcare PPO/HMO/WC	$480.00

MATRIX PLASTIC PSMX0615

Facility

$13,500.00

Hospital Charge Code	270644125
Hospital Revenue Code	272
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

Know your out-of-pocket cost for care.

All Charges