Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ACEBUTOLOL CAP 200MG

Facility

$10.25

Hospital Charge Code	60627543
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.12
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.61
Rate for Payer: Cigna Commercial	$5.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.08
Rate for Payer: Oxford Commercial	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.54
Rate for Payer: UnitedHealthcare Commercial	$2.05
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

ACEBUTOLOL CAP 200MG

Facility

$10.25

Hospital Charge Code	60627543
Hospital Revenue Code	250
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.54

ACELL MACISTEM P S MATRIX

Facility

$748.00

Hospital Charge Code	270339128
Hospital Revenue Code	636
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$181.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.02
Rate for Payer: Qualcare PPO/HMO/WC	$112.20

ACELL MACISTEM P S MATRIX

Facility

$748.00

Hospital Charge Code	270339128
Hospital Revenue Code	636
Min. Negotiated Rate	$18.03
Max. Negotiated Rate	$374.00
Rate for Payer: Aetna Commercial	$284.24
Rate for Payer: Aetna Medicare Advantage	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$190.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$190.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$190.74
Rate for Payer: Cigna Commercial	$374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.02
Rate for Payer: Qualcare PPO/HMO/WC	$112.20
Rate for Payer: UnitedHealthcare Community & State	$18.03
Rate for Payer: Wellpoint Medicaid Managed Care	$19.82

ACELL MICRO MATRIX 100 MG

Facility

$480.00

Hospital Charge Code	270339126
Hospital Revenue Code	636
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$116.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

ACELL MICRO MATRIX 100 MG

Facility

$480.00

Hospital Charge Code	270339126
Hospital Revenue Code	636
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Community & State	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$12.72

ACELL MICROMATRIX 200 MG

Facility

$789.00

Hospital Charge Code	270339127
Hospital Revenue Code	636
Min. Negotiated Rate	$118.35
Max. Negotiated Rate	$190.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.94
Rate for Payer: Qualcare PPO/HMO/WC	$118.35

ACELL MICROMATRIX 200 MG

Facility

$789.00

Hospital Charge Code	270339127
Hospital Revenue Code	636
Min. Negotiated Rate	$19.01
Max. Negotiated Rate	$394.50
Rate for Payer: Aetna Commercial	$299.82
Rate for Payer: Aetna Medicare Advantage	$236.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.19
Rate for Payer: Cigna Commercial	$394.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$190.94
Rate for Payer: Qualcare PPO/HMO/WC	$118.35
Rate for Payer: UnitedHealthcare Community & State	$19.01
Rate for Payer: Wellpoint Medicaid Managed Care	$20.91

ACELL MICRO MATRIX 30 MG

Facility

$480.00

Hospital Charge Code	270339125
Hospital Revenue Code	636
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$116.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

ACELL MICRO MATRIX 30 MG

Facility

$480.00

Hospital Charge Code	270339125
Hospital Revenue Code	636
Min. Negotiated Rate	$11.57
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Community & State	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$12.72

ACELL MICRO MATRIX 60 MG

Facility

$229.80

Hospital Charge Code	270339114
Hospital Revenue Code	278
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$114.90
Rate for Payer: Aetna Commercial	$87.32
Rate for Payer: Aetna Medicare Advantage	$68.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.60
Rate for Payer: Cigna Commercial	$114.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$50.56
Rate for Payer: Qualcare PPO/HMO/WC	$34.47
Rate for Payer: UnitedHealthcare Community & State	$5.54
Rate for Payer: Wellpoint Medicaid Managed Care	$6.09

ACELL MICRO MATRIX 60 MG

Facility

$229.80

Hospital Charge Code	270339114
Hospital Revenue Code	278
Min. Negotiated Rate	$34.47
Max. Negotiated Rate	$55.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$50.56
Rate for Payer: Qualcare PPO/HMO/WC	$34.47

ACELLULAR DERM MATX IMPLT

Facility

$3,254.52

Service Code	HCPCS 15777
Hospital Charge Code	16000382
Hospital Revenue Code	360
Min. Negotiated Rate	$78.43
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,236.72
Rate for Payer: Aetna Medicare Advantage	$976.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$829.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$829.90
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	$829.90
Rate for Payer: Cigna Commercial	$1,627.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$976.36
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$488.18
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$78.43
Rate for Payer: Wellpoint Medicaid Managed Care	$86.24

ACELLULAR DERM MATX IMPLT

Facility

$3,254.52

Service Code	HCPCS 15777
Hospital Charge Code	16000382
Hospital Revenue Code	360
Min. Negotiated Rate	$488.18
Max. Negotiated Rate	$488.18
Rate for Payer: Qualcare PPO/HMO/WC	$488.18

ACELL WUND POWER 100MG

Facility

$450.00

Hospital Charge Code	270339123
Hospital Revenue Code	636
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$108.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ACELL WUND POWER 100MG

Facility

$450.00

Hospital Charge Code	270339123
Hospital Revenue Code	636
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

ACEPELLA DH (GREEN)

Facility

$208.55

Hospital Charge Code	270665125
Hospital Revenue Code	270
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$104.28
Rate for Payer: Aetna Commercial	$79.25
Rate for Payer: Aetna Medicare Advantage	$62.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.18
Rate for Payer: Cigna Commercial	$104.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.56
Rate for Payer: Oxford Commercial	$41.71
Rate for Payer: Qualcare PPO/HMO/WC	$31.28
Rate for Payer: UnitedHealthcare Commercial	$41.71
Rate for Payer: UnitedHealthcare Community & State	$5.03
Rate for Payer: Wellpoint Medicaid Managed Care	$5.53

ACEPELLA DH (GREEN)

Facility

$208.55

Hospital Charge Code	270665125
Hospital Revenue Code	270
Min. Negotiated Rate	$31.28
Max. Negotiated Rate	$31.28
Rate for Payer: Qualcare PPO/HMO/WC	$31.28

ACETAB LINER LONGEVITY 28X46MM

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

ACETAB LINER LONGEVITY 28X46MM

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696625
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

ACETABULAR 48 SZ D

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687180
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

ACETABULAR 48 SZ D

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687180
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

ACETABULAR CUP CLUST HOLE 44MM

Facility

$9,990.00

Hospital Charge Code	270669067
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.50
Max. Negotiated Rate	$2,417.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,998.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,417.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,197.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,498.50

ACETABULAR CUP CLUST HOLE 44MM

Facility

$9,990.00

Hospital Charge Code	270669067
Hospital Revenue Code	278
Min. Negotiated Rate	$240.76
Max. Negotiated Rate	$4,995.00
Rate for Payer: Aetna Commercial	$3,796.20
Rate for Payer: Aetna Medicare Advantage	$2,997.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,547.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,547.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,547.45
Rate for Payer: Cigna Commercial	$4,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,417.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,197.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,498.50
Rate for Payer: UnitedHealthcare Community & State	$240.76
Rate for Payer: Wellpoint Medicaid Managed Care	$264.74

ACETABULAR CUP CLUST HOLE 46MM

Facility

$9,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270669068
Hospital Revenue Code	278
Min. Negotiated Rate	$240.76
Max. Negotiated Rate	$4,995.00
Rate for Payer: Aetna Commercial	$3,796.20
Rate for Payer: Aetna Medicare Advantage	$2,997.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,547.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,547.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,547.45
Rate for Payer: Cigna Commercial	$4,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,417.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,197.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,498.50
Rate for Payer: UnitedHealthcare Community & State	$240.76
Rate for Payer: Wellpoint Medicaid Managed Care	$264.74

Know your out-of-pocket cost for care.

All Charges