Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TISSUE CULT NON-NEOPLASTIC AMN

Facility

$1,042.85

Service Code	HCPCS 88235
Hospital Charge Code	38477211
Hospital Revenue Code	311
Min. Negotiated Rate	$27.64
Max. Negotiated Rate	$542.54
Rate for Payer: Aetna Commercial	$408.82
Rate for Payer: Aetna Medicare Advantage	$486.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$542.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$542.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$150.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$542.54
Rate for Payer: Cigna Commercial	$521.42
Rate for Payer: Cigna Medicare Advantage	$150.30
Rate for Payer: Clover Medicare Advantage	$142.78
Rate for Payer: EmblemHealth Commercial	$450.90
Rate for Payer: Humana Medicare Advantage	$154.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$150.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$312.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$156.43
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$120.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$150.30
Rate for Payer: Wellcare Medicare Advantage	$150.30
Rate for Payer: Wellpoint Medicaid Managed Care	$27.64

TISSUE CULT NON-NEOPLASTIC AMN

Facility

$1,042.85

Service Code	HCPCS 88235
Hospital Charge Code	38477211
Hospital Revenue Code	311
Min. Negotiated Rate	$156.43
Max. Negotiated Rate	$156.43
Rate for Payer: Qualcare PPO/HMO/WC	$156.43

TISSUE EXAMNTN BY KOH SLIDE

Facility

$30.00

Service Code	HCPCS 87220
Hospital Charge Code	38477027
Hospital Revenue Code	309
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

TISSUE EXAMNTN BY KOH SLIDE

Facility

$30.00

Service Code	HCPCS 87220
Hospital Charge Code	38477027
Hospital Revenue Code	309
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.41
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: Cigna Medicare Advantage	$4.27
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Medicare Advantage	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

TISSUE EXPAND ALLOX2 360-430CC

Facility

$9,000.00

Service Code	HCPCS C1789
Hospital Charge Code	270695704
Hospital Revenue Code	278
Min. Negotiated Rate	$216.90
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,980.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$216.90
Rate for Payer: Wellpoint Medicaid Managed Care	$238.50

TISSUE EXPAND ALLOX2 360-430CC

Facility

$9,000.00

Service Code	HCPCS C1789
Hospital Charge Code	270695704
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,980.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

TISSUE EXPANDER 400CC

Facility

$5,650.00

Hospital Charge Code	270663196
Hospital Revenue Code	278
Min. Negotiated Rate	$847.50
Max. Negotiated Rate	$1,367.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,243.00
Rate for Payer: Qualcare PPO/HMO/WC	$847.50

TISSUE EXPANDER 400CC

Facility

$5,650.00

Hospital Charge Code	270663196
Hospital Revenue Code	278
Min. Negotiated Rate	$136.16
Max. Negotiated Rate	$2,825.00
Rate for Payer: Aetna Commercial	$2,147.00
Rate for Payer: Aetna Medicare Advantage	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,440.75
Rate for Payer: Cigna Commercial	$2,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,243.00
Rate for Payer: Qualcare PPO/HMO/WC	$847.50
Rate for Payer: UnitedHealthcare Community & State	$136.16
Rate for Payer: Wellpoint Medicaid Managed Care	$149.72

TISSUE EXPANDER 500CC

Facility

$5,650.00

Hospital Charge Code	270663197
Hospital Revenue Code	278
Min. Negotiated Rate	$136.16
Max. Negotiated Rate	$2,825.00
Rate for Payer: Aetna Commercial	$2,147.00
Rate for Payer: Aetna Medicare Advantage	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,440.75
Rate for Payer: Cigna Commercial	$2,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,243.00
Rate for Payer: Qualcare PPO/HMO/WC	$847.50
Rate for Payer: UnitedHealthcare Community & State	$136.16
Rate for Payer: Wellpoint Medicaid Managed Care	$149.72

TISSUE EXPANDER 500CC

Facility

$5,650.00

Hospital Charge Code	270663197
Hospital Revenue Code	278
Min. Negotiated Rate	$847.50
Max. Negotiated Rate	$1,367.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,243.00
Rate for Payer: Qualcare PPO/HMO/WC	$847.50

TISSUE EXPANDER 650cc W/TABS

Facility

$6,750.00

Hospital Charge Code	270674353
Hospital Revenue Code	278
Min. Negotiated Rate	$162.68
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$162.68
Rate for Payer: Wellpoint Medicaid Managed Care	$178.88

TISSUE EXPANDER 650cc W/TABS

Facility

$6,750.00

Hospital Charge Code	270674353
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

TISSUE EXPANDER HI PRO 475CC

Facility

$10,625.00

Hospital Charge Code	270675145
Hospital Revenue Code	278
Min. Negotiated Rate	$256.06
Max. Negotiated Rate	$5,312.50
Rate for Payer: Aetna Commercial	$4,037.50
Rate for Payer: Aetna Medicare Advantage	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,709.38
Rate for Payer: Cigna Commercial	$5,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,337.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75
Rate for Payer: UnitedHealthcare Community & State	$256.06
Rate for Payer: Wellpoint Medicaid Managed Care	$281.56

TISSUE EXPANDER HI PRO 475CC

Facility

$10,625.00

Hospital Charge Code	270675145
Hospital Revenue Code	278
Min. Negotiated Rate	$1,593.75
Max. Negotiated Rate	$2,571.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,337.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75

TISSUE EXPANDER HI PRO 500CC

Facility

$10,625.00

Hospital Charge Code	270675146
Hospital Revenue Code	278
Min. Negotiated Rate	$1,593.75
Max. Negotiated Rate	$2,571.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,337.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75

TISSUE EXPANDER HI PRO 500CC

Facility

$10,625.00

Hospital Charge Code	270675146
Hospital Revenue Code	278
Min. Negotiated Rate	$256.06
Max. Negotiated Rate	$5,312.50
Rate for Payer: Aetna Commercial	$4,037.50
Rate for Payer: Aetna Medicare Advantage	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,709.38
Rate for Payer: Cigna Commercial	$5,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,337.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75
Rate for Payer: UnitedHealthcare Community & State	$256.06
Rate for Payer: Wellpoint Medicaid Managed Care	$281.56

TISSUE EXPANDER HI PRO 600CC

Facility

$10,625.00

Hospital Charge Code	270675147
Hospital Revenue Code	278
Min. Negotiated Rate	$1,593.75
Max. Negotiated Rate	$2,571.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,337.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75

TISSUE EXPANDER HI PRO 600CC

Facility

$10,625.00

Hospital Charge Code	270675147
Hospital Revenue Code	278
Min. Negotiated Rate	$256.06
Max. Negotiated Rate	$5,312.50
Rate for Payer: Aetna Commercial	$4,037.50
Rate for Payer: Aetna Medicare Advantage	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,709.38
Rate for Payer: Cigna Commercial	$5,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,337.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75
Rate for Payer: UnitedHealthcare Community & State	$256.06
Rate for Payer: Wellpoint Medicaid Managed Care	$281.56

TISSUE EXPANDER HI PRO 750CC

Facility

$10,625.00

Service Code	HCPCS C1789
Hospital Charge Code	270675148
Hospital Revenue Code	278
Min. Negotiated Rate	$1,593.75
Max. Negotiated Rate	$2,571.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,337.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75

TISSUE EXPANDER HI PRO 750CC

Facility

$10,625.00

Service Code	HCPCS C1789
Hospital Charge Code	270675148
Hospital Revenue Code	278
Min. Negotiated Rate	$256.06
Max. Negotiated Rate	$5,312.50
Rate for Payer: Aetna Commercial	$4,037.50
Rate for Payer: Aetna Medicare Advantage	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,709.38
Rate for Payer: Cigna Commercial	$5,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,337.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75
Rate for Payer: UnitedHealthcare Community & State	$256.06
Rate for Payer: Wellpoint Medicaid Managed Care	$281.56

TISSUE EXPANDER MATRIX 500CC

Facility

$7,975.00

Hospital Charge Code	270663627
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

TISSUE EXPANDER MATRIX 500CC

Facility

$7,975.00

Hospital Charge Code	270663627
Hospital Revenue Code	278
Min. Negotiated Rate	$192.20
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$192.20
Rate for Payer: Wellpoint Medicaid Managed Care	$211.34

Tissue Expander Matrix 600cc

Facility

$7,975.00

Hospital Charge Code	270663628
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

Tissue Expander Matrix 600cc

Facility

$7,975.00

Hospital Charge Code	270663628
Hospital Revenue Code	278
Min. Negotiated Rate	$192.20
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$192.20
Rate for Payer: Wellpoint Medicaid Managed Care	$211.34

TISSUE EXPANDERS 800cc W/TABS

Facility

$6,750.00

Service Code	HCPCS C1789
Hospital Charge Code	270673926
Hospital Revenue Code	278
Min. Negotiated Rate	$162.68
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$162.68
Rate for Payer: Wellpoint Medicaid Managed Care	$178.88

Know your out-of-pocket cost for care.

All Charges