Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MATRIX WOUND 7CM X 10CM

Facility

$1,732.50

Service Code	HCPCS C1762
Hospital Charge Code	270662126
Hospital Revenue Code	278
Min. Negotiated Rate	$259.88
Max. Negotiated Rate	$419.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$346.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$419.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$381.15
Rate for Payer: Qualcare PPO/HMO/WC	$259.88

MATRIX WOUND 7CM X 10CM

Facility

$1,732.50

Service Code	HCPCS C1762
Hospital Charge Code	270662126
Hospital Revenue Code	278
Min. Negotiated Rate	$41.75
Max. Negotiated Rate	$866.25
Rate for Payer: Aetna Commercial	$658.35
Rate for Payer: Aetna Medicare Advantage	$519.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$441.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$441.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$346.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$441.79
Rate for Payer: Cigna Commercial	$866.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$419.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$381.15
Rate for Payer: Qualcare PPO/HMO/WC	$259.88
Rate for Payer: UnitedHealthcare Community & State	$41.75
Rate for Payer: Wellpoint Medicaid Managed Care	$45.91

MATRIX WOUND FENESTR 7x10CM

Facility

$6,730.50

Service Code	HCPCS Q4166
Hospital Charge Code	270662125
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,628.78
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	$1,346.10
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	$1,628.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,480.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,009.58
Rate for Payer: UnitedHealthcare Community & State	$162.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$178.36

MATRIX WOUND FENESTR 7x10CM

Facility

$6,730.50

Service Code	HCPCS Q4166
Hospital Charge Code	270662125
Hospital Revenue Code	278
Min. Negotiated Rate	$1,009.58
Max. Negotiated Rate	$1,628.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,346.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,628.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,480.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,009.58

MATTRESS BARTON ATLAS 660

Facility

$615.00

Hospital Charge Code	270641165
Hospital Revenue Code	272
Min. Negotiated Rate	$92.25
Max. Negotiated Rate	$92.25
Rate for Payer: Qualcare PPO/HMO/WC	$92.25

MATTRESS BARTON ATLAS 660

Facility

$615.00

Hospital Charge Code	270641165
Hospital Revenue Code	272
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$307.50
Rate for Payer: Aetna Commercial	$233.70
Rate for Payer: Aetna Medicare Advantage	$184.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.82
Rate for Payer: Cigna Commercial	$307.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$184.50
Rate for Payer: Oxford Commercial	$123.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.25
Rate for Payer: UnitedHealthcare Commercial	$123.00
Rate for Payer: UnitedHealthcare Community & State	$14.82
Rate for Payer: Wellpoint Medicaid Managed Care	$16.30

MATT TC BARIATRIC PLUS W/FOAM

Facility

$440.00

Hospital Charge Code	270654641
Hospital Revenue Code	271
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$220.00
Rate for Payer: Aetna Commercial	$167.20
Rate for Payer: Aetna Medicare Advantage	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.20
Rate for Payer: Cigna Commercial	$220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.00
Rate for Payer: Oxford Commercial	$88.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.00
Rate for Payer: UnitedHealthcare Commercial	$88.00
Rate for Payer: UnitedHealthcare Community & State	$10.60
Rate for Payer: Wellpoint Medicaid Managed Care	$11.66

MATT TC BARIATRIC PLUS W/FOAM

Facility

$440.00

Hospital Charge Code	270654641
Hospital Revenue Code	271
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$66.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.00

MATULANE/50MG/CAP

Facility

$6.00

Hospital Charge Code	60633356
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

MATULANE/50MG/CAP

Facility

$6.00

Hospital Charge Code	60633356
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

MAT ULTRA-THIN FLEXIBLE

Facility

$290.86

Hospital Charge Code	270635762
Hospital Revenue Code	271
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$145.43
Rate for Payer: Aetna Commercial	$110.53
Rate for Payer: Aetna Medicare Advantage	$87.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.17
Rate for Payer: Cigna Commercial	$145.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.26
Rate for Payer: Oxford Commercial	$58.17
Rate for Payer: Qualcare PPO/HMO/WC	$43.63
Rate for Payer: UnitedHealthcare Commercial	$58.17
Rate for Payer: UnitedHealthcare Community & State	$7.01
Rate for Payer: Wellpoint Medicaid Managed Care	$7.71

MAT ULTRA-THIN FLEXIBLE

Facility

$290.86

Hospital Charge Code	270635762
Hospital Revenue Code	271
Min. Negotiated Rate	$43.63
Max. Negotiated Rate	$43.63
Rate for Payer: Qualcare PPO/HMO/WC	$43.63

MAXBRD#5 MO-6-NDL

Facility

$600.00

Hospital Charge Code	270688617
Hospital Revenue Code	272
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) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.00
Rate for Payer: Oxford Commercial	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Commercial	$120.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

MAXBRD#5 MO-6-NDL

Facility

$600.00

Hospital Charge Code	270688617
Hospital Revenue Code	272
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

MAXBREADED MO 6 BK BL SUTURE

Facility

$650.00

Hospital Charge Code	270691310
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

MAXBREADED MO 6 BK BL SUTURE

Facility

$650.00

Hospital Charge Code	270691310
Hospital Revenue Code	272
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Commercial	$130.00
Rate for Payer: UnitedHealthcare Community & State	$15.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.23

MAXCESS KIT 4

Facility

$17,310.00

Hospital Charge Code	270659707
Hospital Revenue Code	272
Min. Negotiated Rate	$2,596.50
Max. Negotiated Rate	$2,596.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,596.50

MAXCESS KIT 4

Facility

$17,310.00

Hospital Charge Code	270659707
Hospital Revenue Code	272
Min. Negotiated Rate	$417.17
Max. Negotiated Rate	$8,655.00
Rate for Payer: Aetna Commercial	$6,577.80
Rate for Payer: Aetna Medicare Advantage	$5,193.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,414.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,414.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,414.05
Rate for Payer: Cigna Commercial	$8,655.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,193.00
Rate for Payer: Oxford Commercial	$3,462.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,596.50
Rate for Payer: UnitedHealthcare Commercial	$3,462.00
Rate for Payer: UnitedHealthcare Community & State	$417.17
Rate for Payer: Wellpoint Medicaid Managed Care	$458.71

MAXCESS MAS PLIF USAGE

Facility

$10,965.00

Hospital Charge Code	270663763
Hospital Revenue Code	270
Min. Negotiated Rate	$264.26
Max. Negotiated Rate	$5,482.50
Rate for Payer: Aetna Commercial	$4,166.70
Rate for Payer: Aetna Medicare Advantage	$3,289.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,796.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,796.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,796.07
Rate for Payer: Cigna Commercial	$5,482.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,289.50
Rate for Payer: Oxford Commercial	$2,193.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,644.75
Rate for Payer: UnitedHealthcare Commercial	$2,193.00
Rate for Payer: UnitedHealthcare Community & State	$264.26
Rate for Payer: Wellpoint Medicaid Managed Care	$290.57

MAXCESS MAS PLIF USAGE

Facility

$10,965.00

Hospital Charge Code	270663763
Hospital Revenue Code	270
Min. Negotiated Rate	$1,644.75
Max. Negotiated Rate	$1,644.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,644.75

MAXCESS MAS TLIF 2 KIT ACCESS

Facility

$18,375.00

Hospital Charge Code	270693335
Hospital Revenue Code	272
Min. Negotiated Rate	$2,756.25
Max. Negotiated Rate	$2,756.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,756.25

MAXCESS MAS TLIF 2 KIT ACCESS

Facility

$18,375.00

Hospital Charge Code	270693335
Hospital Revenue Code	272
Min. Negotiated Rate	$442.84
Max. Negotiated Rate	$9,187.50
Rate for Payer: Aetna Commercial	$6,982.50
Rate for Payer: Aetna Medicare Advantage	$5,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,685.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,685.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,685.62
Rate for Payer: Cigna Commercial	$9,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,512.50
Rate for Payer: Oxford Commercial	$3,675.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,756.25
Rate for Payer: UnitedHealthcare Commercial	$3,675.00
Rate for Payer: UnitedHealthcare Community & State	$442.84
Rate for Payer: Wellpoint Medicaid Managed Care	$486.94

MAXCESSMASTLIF2KITLATRETRACT

Facility

$13,750.00

Hospital Charge Code	270697195
Hospital Revenue Code	272
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$2,062.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

MAXCESSMASTLIF2KITLATRETRACT

Facility

$13,750.00

Hospital Charge Code	270697195
Hospital Revenue Code	272
Min. Negotiated Rate	$331.38
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$5,225.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,125.00
Rate for Payer: Oxford Commercial	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50
Rate for Payer: UnitedHealthcare Commercial	$2,750.00
Rate for Payer: UnitedHealthcare Community & State	$331.38
Rate for Payer: Wellpoint Medicaid Managed Care	$364.38

MAXEPINE 1GM IN D5W

Facility

$61.00

Hospital Charge Code	60635524
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

Know your out-of-pocket cost for care.

All Charges