Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TISSUE PKP FULL THICKNESS

Facility

$17,250.00

Hospital Charge Code	270688742
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.50
Max. Negotiated Rate	$4,174.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50

TISSUE PKP FULL THICKNESS

Facility

$17,250.00

Hospital Charge Code	270688742
Hospital Revenue Code	278
Min. Negotiated Rate	$415.73
Max. Negotiated Rate	$8,625.00
Rate for Payer: Aetna Commercial	$6,555.00
Rate for Payer: Aetna Medicare Advantage	$5,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,398.75
Rate for Payer: Cigna Commercial	$8,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50
Rate for Payer: UnitedHealthcare Community & State	$415.73
Rate for Payer: Wellpoint Medicaid Managed Care	$457.12

TISSUE REMOVAL KIT

Facility

$4,225.00

Hospital Charge Code	270662181
Hospital Revenue Code	272
Min. Negotiated Rate	$101.82
Max. Negotiated Rate	$2,112.50
Rate for Payer: Aetna Commercial	$1,605.50
Rate for Payer: Aetna Medicare Advantage	$1,267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,077.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,077.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,077.38
Rate for Payer: Cigna Commercial	$2,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,267.50
Rate for Payer: Oxford Commercial	$845.00
Rate for Payer: Qualcare PPO/HMO/WC	$633.75
Rate for Payer: UnitedHealthcare Commercial	$845.00
Rate for Payer: UnitedHealthcare Community & State	$101.82
Rate for Payer: Wellpoint Medicaid Managed Care	$111.96

TISSUE REMOVAL KIT

Facility

$4,225.00

Hospital Charge Code	270662181
Hospital Revenue Code	272
Min. Negotiated Rate	$633.75
Max. Negotiated Rate	$633.75
Rate for Payer: Qualcare PPO/HMO/WC	$633.75

TISSUE REMOVAL KIT TX2

Facility

$4,225.00

Hospital Charge Code	270677971
Hospital Revenue Code	272
Min. Negotiated Rate	$633.75
Max. Negotiated Rate	$633.75
Rate for Payer: Qualcare PPO/HMO/WC	$633.75

TISSUE REMOVAL KIT TX2

Facility

$4,225.00

Hospital Charge Code	270677971
Hospital Revenue Code	272
Min. Negotiated Rate	$101.82
Max. Negotiated Rate	$2,112.50
Rate for Payer: Aetna Commercial	$1,605.50
Rate for Payer: Aetna Medicare Advantage	$1,267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,077.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,077.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,077.38
Rate for Payer: Cigna Commercial	$2,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,267.50
Rate for Payer: Oxford Commercial	$845.00
Rate for Payer: Qualcare PPO/HMO/WC	$633.75
Rate for Payer: UnitedHealthcare Commercial	$845.00
Rate for Payer: UnitedHealthcare Community & State	$101.82
Rate for Payer: Wellpoint Medicaid Managed Care	$111.96

TISSUE RIB SEGMENT 100650

Facility

$2,815.25

Hospital Charge Code	270610653
Hospital Revenue Code	272
Min. Negotiated Rate	$67.85
Max. Negotiated Rate	$1,407.62
Rate for Payer: Aetna Commercial	$1,069.80
Rate for Payer: Aetna Medicare Advantage	$844.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$717.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$717.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$717.89
Rate for Payer: Cigna Commercial	$1,407.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$844.58
Rate for Payer: Oxford Commercial	$563.05
Rate for Payer: Qualcare PPO/HMO/WC	$422.29
Rate for Payer: UnitedHealthcare Commercial	$563.05
Rate for Payer: UnitedHealthcare Community & State	$67.85
Rate for Payer: Wellpoint Medicaid Managed Care	$74.60

TISSUE RIB SEGMENT 100650

Facility

$2,815.25

Hospital Charge Code	270610653
Hospital Revenue Code	272
Min. Negotiated Rate	$422.29
Max. Negotiated Rate	$422.29
Rate for Payer: Qualcare PPO/HMO/WC	$422.29

TISSUE RIB SEGMENT SPLT 500655

Facility

$1,310.45

Hospital Charge Code	270613507
Hospital Revenue Code	272
Min. Negotiated Rate	$196.57
Max. Negotiated Rate	$196.57
Rate for Payer: Qualcare PPO/HMO/WC	$196.57

TISSUE RIB SEGMENT SPLT 500655

Facility

$1,310.45

Hospital Charge Code	270613507
Hospital Revenue Code	272
Min. Negotiated Rate	$31.58
Max. Negotiated Rate	$655.23
Rate for Payer: Aetna Commercial	$497.97
Rate for Payer: Aetna Medicare Advantage	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$334.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$334.16
Rate for Payer: Cigna Commercial	$655.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.13
Rate for Payer: Oxford Commercial	$262.09
Rate for Payer: Qualcare PPO/HMO/WC	$196.57
Rate for Payer: UnitedHealthcare Commercial	$262.09
Rate for Payer: UnitedHealthcare Community & State	$31.58
Rate for Payer: Wellpoint Medicaid Managed Care	$34.73

TISSUES FACIAL 5x8-1/4

Facility

$0.91

Hospital Charge Code	270649124
Hospital Revenue Code	270
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.14
Rate for Payer: Qualcare PPO/HMO/WC	$0.14

TISSUES FACIAL 5x8-1/4

Facility

$0.91

Hospital Charge Code	270649124
Hospital Revenue Code	270
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.46
Rate for Payer: Aetna Commercial	$0.35
Rate for Payer: Aetna Medicare Advantage	$0.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.23
Rate for Payer: Cigna Commercial	$0.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.27
Rate for Payer: Oxford Commercial	$0.18
Rate for Payer: Qualcare PPO/HMO/WC	$0.14
Rate for Payer: UnitedHealthcare Commercial	$0.18
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.02

TISSUE SPLITTER

Facility

$4,234.40

Service Code	HCPCS C1889
Hospital Charge Code	270705738
Hospital Revenue Code	278
Min. Negotiated Rate	$635.16
Max. Negotiated Rate	$1,024.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$846.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,024.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$931.57
Rate for Payer: Qualcare PPO/HMO/WC	$635.16

TISSUE SPLITTER

Facility

$4,234.40

Service Code	HCPCS C1889
Hospital Charge Code	270705738
Hospital Revenue Code	278
Min. Negotiated Rate	$102.05
Max. Negotiated Rate	$2,117.20
Rate for Payer: Aetna Commercial	$1,609.07
Rate for Payer: Aetna Medicare Advantage	$1,270.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,079.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,079.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$846.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,079.77
Rate for Payer: Cigna Commercial	$2,117.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,024.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$931.57
Rate for Payer: Qualcare PPO/HMO/WC	$635.16
Rate for Payer: UnitedHealthcare Community & State	$102.05
Rate for Payer: Wellpoint Medicaid Managed Care	$112.21

TISSUE SPLITTER BLADE SPIN

Facility

$5,231.25

Service Code	HCPCS A4649
Hospital Charge Code	270697433
Hospital Revenue Code	272
Min. Negotiated Rate	$784.69
Max. Negotiated Rate	$784.69
Rate for Payer: Qualcare PPO/HMO/WC	$784.69

TISSUE SPLITTER BLADE SPIN

Facility

$5,231.25

Service Code	HCPCS A4649
Hospital Charge Code	270697433
Hospital Revenue Code	272
Min. Negotiated Rate	$126.07
Max. Negotiated Rate	$2,615.62
Rate for Payer: Aetna Commercial	$1,987.88
Rate for Payer: Aetna Medicare Advantage	$1,569.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,333.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,333.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,333.97
Rate for Payer: Cigna Commercial	$2,615.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,569.38
Rate for Payer: Oxford Commercial	$1,046.25
Rate for Payer: Qualcare PPO/HMO/WC	$784.69
Rate for Payer: UnitedHealthcare Commercial	$1,046.25
Rate for Payer: UnitedHealthcare Community & State	$126.07
Rate for Payer: Wellpoint Medicaid Managed Care	$138.63

TISSUE TIBIALIS ANT 26C 921198

Facility

$7,936.00

Hospital Charge Code	270633564
Hospital Revenue Code	272
Min. Negotiated Rate	$191.26
Max. Negotiated Rate	$3,968.00
Rate for Payer: Aetna Commercial	$3,015.68
Rate for Payer: Aetna Medicare Advantage	$2,380.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,023.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,023.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,023.68
Rate for Payer: Cigna Commercial	$3,968.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,380.80
Rate for Payer: Oxford Commercial	$1,587.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,190.40
Rate for Payer: UnitedHealthcare Commercial	$1,587.20
Rate for Payer: UnitedHealthcare Community & State	$191.26
Rate for Payer: Wellpoint Medicaid Managed Care	$210.30

TISSUE TIBIALIS ANT 26C 921198

Facility

$7,936.00

Hospital Charge Code	270633564
Hospital Revenue Code	272
Min. Negotiated Rate	$1,190.40
Max. Negotiated Rate	$1,190.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,190.40

TISSUE TRANSGLUTAM(IGG,A) I

Facility

$390.00

Service Code	HCPCS 8351691
Hospital Charge Code	39990071A
Hospital Revenue Code	301
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

TISSUE TRANSGLUTAM(IGG,A) I

Facility

$390.00

Service Code	HCPCS 8351691
Hospital Charge Code	39990071A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TISSUE TRANSGLUTAM(IGG,A) II

Facility

$390.00

Service Code	HCPCS 8351691
Hospital Charge Code	39990071B
Hospital Revenue Code	301
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

TISSUE TRANSGLUTAM(IGG,A) II

Facility

$390.00

Service Code	HCPCS 8351691
Hospital Charge Code	39990071B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TISSUE TRANSGLUTAMINASE, IGA

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38476796
Hospital Revenue Code	301
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$43.50
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.31

TISSUE TRANSGLUTAMINASE, IGA

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38476796
Hospital Revenue Code	301
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

TISSUE TRANSGLUTAMINASE,IGA

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38479420
Hospital Revenue Code	301
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

Know your out-of-pocket cost for care.

All Charges