Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MATRIX PLASTIC PSMX0615

Facility

$13,500.00

Hospital Charge Code	270644125
Hospital Revenue Code	272
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) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,050.00
Rate for Payer: Oxford Commercial	$2,700.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$2,700.00
Rate for Payer: UnitedHealthcare Community & State	$325.35
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

MATRIX PLASTIC PSMX1015

Facility

$15,750.00

Hospital Charge Code	270644127
Hospital Revenue Code	272
Min. Negotiated Rate	$2,362.50
Max. Negotiated Rate	$2,362.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50

MATRIX PLASTIC PSMX1015

Facility

$15,750.00

Hospital Charge Code	270644127
Hospital Revenue Code	272
Min. Negotiated Rate	$379.57
Max. Negotiated Rate	$7,875.00
Rate for Payer: Aetna Commercial	$5,985.00
Rate for Payer: Aetna Medicare Advantage	$4,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,016.25
Rate for Payer: Cigna Commercial	$7,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,725.00
Rate for Payer: Oxford Commercial	$3,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50
Rate for Payer: UnitedHealthcare Commercial	$3,150.00
Rate for Payer: UnitedHealthcare Community & State	$379.57
Rate for Payer: Wellpoint Medicaid Managed Care	$417.38

MATRIX PROTEIN

Facility

$15,000.00

Hospital Charge Code	270703297
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

MATRIX PROTEIN

Facility

$15,000.00

Hospital Charge Code	270703297
Hospital Revenue Code	278
Min. Negotiated Rate	$361.50
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$361.50
Rate for Payer: Wellpoint Medicaid Managed Care	$397.50

MATRIX STIMULAN RAP CURE 10CC

Facility

$8,975.00

Hospital Charge Code	270668279
Hospital Revenue Code	278
Min. Negotiated Rate	$216.30
Max. Negotiated Rate	$4,487.50
Rate for Payer: Aetna Commercial	$3,410.50
Rate for Payer: Aetna Medicare Advantage	$2,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.62
Rate for Payer: Cigna Commercial	$4,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,974.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25
Rate for Payer: UnitedHealthcare Community & State	$216.30
Rate for Payer: Wellpoint Medicaid Managed Care	$237.84

MATRIX STIMULAN RAP CURE 10CC

Facility

$8,975.00

Hospital Charge Code	270668279
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$2,171.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,974.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

MATRIX STIMULAN RAPIDCURE 20CC

Facility

$14,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694567
Hospital Revenue Code	278
Min. Negotiated Rate	$2,175.00
Max. Negotiated Rate	$3,509.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,190.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00

MATRIX STIMULAN RAPIDCURE 20CC

Facility

$14,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694567
Hospital Revenue Code	278
Min. Negotiated Rate	$349.45
Max. Negotiated Rate	$7,250.00
Rate for Payer: Aetna Commercial	$5,510.00
Rate for Payer: Aetna Medicare Advantage	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,697.50
Rate for Payer: Cigna Commercial	$7,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,190.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00
Rate for Payer: UnitedHealthcare Community & State	$349.45
Rate for Payer: Wellpoint Medicaid Managed Care	$384.25

MATRIX SURGICAL MATRIX PLUS

Facility

$4,935.00

Service Code	HCPCS C1781
Hospital Charge Code	270677085
Hospital Revenue Code	278
Min. Negotiated Rate	$740.25
Max. Negotiated Rate	$1,194.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$987.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,194.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,085.70
Rate for Payer: Qualcare PPO/HMO/WC	$740.25

MATRIX SURGICAL MATRIX PLUS

Facility

$4,935.00

Service Code	HCPCS C1781
Hospital Charge Code	270677085
Hospital Revenue Code	278
Min. Negotiated Rate	$118.93
Max. Negotiated Rate	$2,467.50
Rate for Payer: Aetna Commercial	$1,875.30
Rate for Payer: Aetna Medicare Advantage	$1,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,258.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,258.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$987.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,258.42
Rate for Payer: Cigna Commercial	$2,467.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,194.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,085.70
Rate for Payer: Qualcare PPO/HMO/WC	$740.25
Rate for Payer: UnitedHealthcare Community & State	$118.93
Rate for Payer: Wellpoint Medicaid Managed Care	$130.78

MATRIX V92 CELLULAR BN 2.5CC

Facility

$9,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270699358
Hospital Revenue Code	278
Min. Negotiated Rate	$1,406.25
Max. Negotiated Rate	$2,268.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,062.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25

MATRIX V92 CELLULAR BN 2.5CC

Facility

$9,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270699358
Hospital Revenue Code	278
Min. Negotiated Rate	$225.94
Max. Negotiated Rate	$4,687.50
Rate for Payer: Aetna Commercial	$3,562.50
Rate for Payer: Aetna Medicare Advantage	$2,812.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,390.62
Rate for Payer: Cigna Commercial	$4,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,062.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25
Rate for Payer: UnitedHealthcare Community & State	$225.94
Rate for Payer: Wellpoint Medicaid Managed Care	$248.44

MATRIX WOUND 10X15CM

Facility

$3,712.50

Service Code	HCPCS Q4166
Hospital Charge Code	270662124
Hospital Revenue Code	278
Min. Negotiated Rate	$89.47
Max. Negotiated Rate	$898.42
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	$742.50
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	$898.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$816.75
Rate for Payer: Qualcare PPO/HMO/WC	$556.88
Rate for Payer: UnitedHealthcare Community & State	$89.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$98.38

MATRIX WOUND 10X15CM

Facility

$3,712.50

Service Code	HCPCS Q4166
Hospital Charge Code	270662124
Hospital Revenue Code	278
Min. Negotiated Rate	$556.88
Max. Negotiated Rate	$898.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$742.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$898.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$816.75
Rate for Payer: Qualcare PPO/HMO/WC	$556.88

MATRIX WOUND 10X15CM/SQCMJW

Facility

$24.75

Hospital Charge Code	270662124W
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.38
Rate for Payer: Aetna Commercial	$9.40
Rate for Payer: Aetna Medicare Advantage	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.31
Rate for Payer: Cigna Commercial	$12.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.99
Rate for Payer: Qualcare PPO/HMO/WC	$3.71
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

MATRIX WOUND 10X15CM/SQCMJW

Facility

$24.75

Hospital Charge Code	270662124W
Hospital Revenue Code	636
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$5.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.99
Rate for Payer: Qualcare PPO/HMO/WC	$3.71

MATRIX WOUND 1-LAYER 3x3.5CM

Facility

$352.50

Service Code	HCPCS Q4166
Hospital Charge Code	270651027
Hospital Revenue Code	278
Min. Negotiated Rate	$52.88
Max. Negotiated Rate	$85.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$77.55
Rate for Payer: Qualcare PPO/HMO/WC	$52.88

MATRIX WOUND 1-LAYER 3x3.5CM

Facility

$352.50

Service Code	HCPCS Q4166
Hospital Charge Code	270651027
Hospital Revenue Code	278
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$533.66
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	$70.50
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	$85.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$77.55
Rate for Payer: Qualcare PPO/HMO/WC	$52.88
Rate for Payer: UnitedHealthcare Community & State	$8.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$9.34

MATRIX WOUND 3 LAYER

Facility

$10,465.00

Service Code	HCPCS Q4166
Hospital Charge Code	270680147
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.75
Max. Negotiated Rate	$2,532.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,093.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,532.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,302.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,569.75

MATRIX WOUND 3 LAYER

Facility

$10,465.00

Service Code	HCPCS Q4166
Hospital Charge Code	270680147
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,532.53
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	$2,093.00
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	$2,532.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,302.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,569.75
Rate for Payer: UnitedHealthcare Community & State	$252.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$277.32

MATRIX WOUND 6X3CM

Facility

$15,966.50

Hospital Charge Code	270673886
Hospital Revenue Code	636
Min. Negotiated Rate	$384.79
Max. Negotiated Rate	$7,983.25
Rate for Payer: Aetna Commercial	$6,067.27
Rate for Payer: Aetna Medicare Advantage	$4,789.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,071.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,071.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,071.46
Rate for Payer: Cigna Commercial	$7,983.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,863.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,394.97
Rate for Payer: UnitedHealthcare Community & State	$384.79
Rate for Payer: Wellpoint Medicaid Managed Care	$423.11

MATRIX WOUND 6X3CM

Facility

$15,966.50

Hospital Charge Code	270673886
Hospital Revenue Code	636
Min. Negotiated Rate	$2,394.97
Max. Negotiated Rate	$3,863.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,863.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,394.97

MATRIX WOUND 6X3CM/SQCM JW

Facility

$887.03

Hospital Charge Code	270673886W
Hospital Revenue Code	636
Min. Negotiated Rate	$133.05
Max. Negotiated Rate	$214.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.66
Rate for Payer: Qualcare PPO/HMO/WC	$133.05

MATRIX WOUND 6X3CM/SQCM JW

Facility

$887.03

Hospital Charge Code	270673886W
Hospital Revenue Code	636
Min. Negotiated Rate	$21.38
Max. Negotiated Rate	$443.51
Rate for Payer: Aetna Commercial	$337.07
Rate for Payer: Aetna Medicare Advantage	$266.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$226.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$226.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$226.19
Rate for Payer: Cigna Commercial	$443.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.66
Rate for Payer: Qualcare PPO/HMO/WC	$133.05
Rate for Payer: UnitedHealthcare Community & State	$21.38
Rate for Payer: Wellpoint Medicaid Managed Care	$23.51

Know your out-of-pocket cost for care.

All Charges