Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WOUND MATRIX 10x15CM/SQCM JW

Facility

$70.50

Hospital Charge Code	270673217W
Hospital Revenue Code	636
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.25
Rate for Payer: Aetna Commercial	$26.79
Rate for Payer: Aetna Medicare Advantage	$21.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.98
Rate for Payer: Cigna Commercial	$35.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.06
Rate for Payer: Qualcare PPO/HMO/WC	$10.57
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

WOUND MATRIX CYTAL 16X35CM

Facility

$40,375.00

Service Code	HCPCS Q4166
Hospital Charge Code	270700145
Hospital Revenue Code	278
Min. Negotiated Rate	$6,056.25
Max. Negotiated Rate	$9,770.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,770.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,882.50
Rate for Payer: Qualcare PPO/HMO/WC	$6,056.25

WOUND MATRIX CYTAL 16X35CM

Facility

$40,375.00

Service Code	HCPCS Q4166
Hospital Charge Code	270700145
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$9,770.75
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	$8,075.00
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	$9,770.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,882.50
Rate for Payer: Qualcare PPO/HMO/WC	$6,056.25
Rate for Payer: UnitedHealthcare Community & State	$973.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$1,069.94

WOUND MATRIX CYTAL 6L 10X15CM

Facility

$24,440.00

Service Code	HCPCS Q4166
Hospital Charge Code	270695955
Hospital Revenue Code	278
Min. Negotiated Rate	$3,666.00
Max. Negotiated Rate	$5,914.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,888.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,914.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,376.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,666.00

WOUND MATRIX CYTAL 6L 10X15CM

Facility

$24,440.00

Service Code	HCPCS Q4166
Hospital Charge Code	270695955
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$5,914.48
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	$4,888.00
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	$5,914.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,376.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,666.00
Rate for Payer: UnitedHealthcare Community & State	$589.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$647.66

WOUND MATRIX MATRISTEM 7x10CM

Facility

$5,875.00

Service Code	HCPCS Q4166
Hospital Charge Code	270667326
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,421.75
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	$1,175.00
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	$1,421.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,292.50
Rate for Payer: Qualcare PPO/HMO/WC	$881.25
Rate for Payer: UnitedHealthcare Community & State	$141.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$155.69

WOUND MATRIX MATRISTEM 7x10CM

Facility

$5,875.00

Service Code	HCPCS Q4166
Hospital Charge Code	270667326
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$1,421.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,292.50
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

WOUND PREP ADDL 100 CM

Facility

$1,595.33

Service Code	HCPCS 15003
Hospital Charge Code	16000597
Hospital Revenue Code	360
Min. Negotiated Rate	$38.45
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$606.23
Rate for Payer: Aetna Medicare Advantage	$478.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$406.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$406.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$406.81
Rate for Payer: Cigna Commercial	$797.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$478.60
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$239.30
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$38.45

WOUND PREP ADDL 100 CM

Facility

$1,595.33

Service Code	HCPCS 15003
Hospital Charge Code	16000597
Hospital Revenue Code	360
Min. Negotiated Rate	$239.30
Max. Negotiated Rate	$239.30
Rate for Payer: Qualcare PPO/HMO/WC	$239.30

WOUND PREP F/N/HF/G 100 SQ CM/

Facility

$2,532.16

Service Code	HCPCS 15004
Hospital Charge Code	1600000567
Hospital Revenue Code	360
Min. Negotiated Rate	$61.03
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$759.65
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$379.82
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$61.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$67.10

WOUND PREP F/N/HF/G 100 SQ CM/

Facility

$2,532.16

Service Code	HCPCS 15004
Hospital Charge Code	1600000567
Hospital Revenue Code	360
Min. Negotiated Rate	$379.82
Max. Negotiated Rate	$379.82
Rate for Payer: Qualcare PPO/HMO/WC	$379.82

WOUND PREP HAND/FT/DIG,100CM

Facility

$2,674.75

Service Code	HCPCS 15004
Hospital Charge Code	323015004
Hospital Revenue Code	450
Min. Negotiated Rate	$70.88
Max. Negotiated Rate	$1,743.30
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.30
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$802.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$401.21
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$70.88

WOUND PREP HAND/FT/DIG,100CM

Facility

$2,674.75

Service Code	HCPCS 15004
Hospital Charge Code	323015004
Hospital Revenue Code	450
Min. Negotiated Rate	$401.21
Max. Negotiated Rate	$401.21
Rate for Payer: Qualcare PPO/HMO/WC	$401.21

WOUND PROTECTOR

Facility

$350.00

Hospital Charge Code	270686469
Hospital Revenue Code	272
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Oxford Commercial	$70.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$70.00
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

WOUND PROTECTOR

Facility

$350.00

Hospital Charge Code	270686469
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

WOUND PROTECTOR RETRACTOR SM

Facility

$270.00

Hospital Charge Code	270670166
Hospital Revenue Code	272
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.00
Rate for Payer: Oxford Commercial	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Commercial	$54.00
Rate for Payer: UnitedHealthcare Community & State	$6.51
Rate for Payer: Wellpoint Medicaid Managed Care	$7.16

WOUND PROTECTOR RETRACTOR SM

Facility

$270.00

Hospital Charge Code	270670166
Hospital Revenue Code	272
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

WOUNDVAC CANISTER W/GEL 500ML

Facility

$163.68

Hospital Charge Code	270100015
Hospital Revenue Code	272
Min. Negotiated Rate	$24.55
Max. Negotiated Rate	$24.55
Rate for Payer: Qualcare PPO/HMO/WC	$24.55

WOUNDVAC CANISTER W/GEL 500ML

Facility

$163.68

Hospital Charge Code	270100015
Hospital Revenue Code	272
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$81.84
Rate for Payer: Aetna Commercial	$62.20
Rate for Payer: Aetna Medicare Advantage	$49.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.74
Rate for Payer: Cigna Commercial	$81.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.10
Rate for Payer: Oxford Commercial	$32.74
Rate for Payer: Qualcare PPO/HMO/WC	$24.55
Rate for Payer: UnitedHealthcare Commercial	$32.74
Rate for Payer: UnitedHealthcare Community & State	$3.94
Rate for Payer: Wellpoint Medicaid Managed Care	$4.34

WOUNDVAC CANISTER W/O GEL

Facility

$171.65

Hospital Charge Code	270644698
Hospital Revenue Code	270
Min. Negotiated Rate	$25.75
Max. Negotiated Rate	$25.75
Rate for Payer: Qualcare PPO/HMO/WC	$25.75

WOUNDVAC CANISTER W/O GEL

Facility

$171.65

Hospital Charge Code	270644698
Hospital Revenue Code	270
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$85.83
Rate for Payer: Aetna Commercial	$65.23
Rate for Payer: Aetna Medicare Advantage	$51.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.77
Rate for Payer: Cigna Commercial	$85.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.49
Rate for Payer: Oxford Commercial	$34.33
Rate for Payer: Qualcare PPO/HMO/WC	$25.75
Rate for Payer: UnitedHealthcare Commercial	$34.33
Rate for Payer: UnitedHealthcare Community & State	$4.14
Rate for Payer: Wellpoint Medicaid Managed Care	$4.55

WOUNDVAC DRAPE

Facility

$35.60

Hospital Charge Code	270100025
Hospital Revenue Code	272
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$17.80
Rate for Payer: Aetna Commercial	$13.53
Rate for Payer: Aetna Medicare Advantage	$10.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.08
Rate for Payer: Cigna Commercial	$17.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.68
Rate for Payer: Oxford Commercial	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$5.34
Rate for Payer: UnitedHealthcare Commercial	$7.12
Rate for Payer: UnitedHealthcare Community & State	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.94

WOUNDVAC DRAPE

Facility

$35.60

Hospital Charge Code	270100025
Hospital Revenue Code	272
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$5.34
Rate for Payer: Qualcare PPO/HMO/WC	$5.34

WOUNDVAC DRSG BLACK LG 10PK

Facility

$245.57

Hospital Charge Code	270672868
Hospital Revenue Code	272
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$122.78
Rate for Payer: Aetna Commercial	$93.32
Rate for Payer: Aetna Medicare Advantage	$73.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.62
Rate for Payer: Cigna Commercial	$122.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.67
Rate for Payer: Oxford Commercial	$49.11
Rate for Payer: Qualcare PPO/HMO/WC	$36.84
Rate for Payer: UnitedHealthcare Commercial	$49.11
Rate for Payer: UnitedHealthcare Community & State	$5.92
Rate for Payer: Wellpoint Medicaid Managed Care	$6.51

WOUNDVAC DRSG BLACK LG 10PK

Facility

$245.57

Hospital Charge Code	270672868
Hospital Revenue Code	272
Min. Negotiated Rate	$36.84
Max. Negotiated Rate	$36.84
Rate for Payer: Qualcare PPO/HMO/WC	$36.84

Know your out-of-pocket cost for care.

All Charges