Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DBM CRUSH MIX 2.5 CC

Facility

$6,060.00

Service Code	HCPCS C1713
Hospital Charge Code	270683202
Hospital Revenue Code	278
Min. Negotiated Rate	$146.05
Max. Negotiated Rate	$3,030.00
Rate for Payer: Aetna Commercial	$2,302.80
Rate for Payer: Aetna Medicare Advantage	$1,818.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,545.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,545.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,212.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,545.30
Rate for Payer: Cigna Commercial	$3,030.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,466.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,333.20
Rate for Payer: Qualcare PPO/HMO/WC	$909.00
Rate for Payer: UnitedHealthcare Community & State	$146.05
Rate for Payer: Wellpoint Medicaid Managed Care	$160.59

DBM CUBE GRFT SPNGE 10X10X10MM

Facility

$19,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270691839
Hospital Revenue Code	278
Min. Negotiated Rate	$457.90
Max. Negotiated Rate	$9,500.00
Rate for Payer: Aetna Commercial	$7,220.00
Rate for Payer: Aetna Medicare Advantage	$5,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,845.00
Rate for Payer: Cigna Commercial	$9,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,598.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,180.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,850.00
Rate for Payer: UnitedHealthcare Community & State	$457.90
Rate for Payer: Wellpoint Medicaid Managed Care	$503.50

DBM CUBE GRFT SPNGE 10X10X10MM

Facility

$19,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270691839
Hospital Revenue Code	278
Min. Negotiated Rate	$2,850.00
Max. Negotiated Rate	$4,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,598.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,180.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,850.00

DBM EXPONENT 10 CC

Facility

$14,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270691813
Hospital Revenue Code	278
Min. Negotiated Rate	$343.43
Max. Negotiated Rate	$7,125.00
Rate for Payer: Aetna Commercial	$5,415.00
Rate for Payer: Aetna Medicare Advantage	$4,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,633.75
Rate for Payer: Cigna Commercial	$7,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,135.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50
Rate for Payer: UnitedHealthcare Community & State	$343.43
Rate for Payer: Wellpoint Medicaid Managed Care	$377.62

DBM EXPONENT 10 CC

Facility

$14,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270691813
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$3,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,135.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

DBM FIBER

Facility

$11,750.00

Service Code	HCPCS C9359
Hospital Charge Code	270692411
Hospital Revenue Code	278
Min. Negotiated Rate	$283.18
Max. Negotiated Rate	$5,875.00
Rate for Payer: Aetna Commercial	$4,465.00
Rate for Payer: Aetna Medicare Advantage	$3,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,996.25
Rate for Payer: Cigna Commercial	$5,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,585.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50
Rate for Payer: UnitedHealthcare Community & State	$283.18
Rate for Payer: Wellpoint Medicaid Managed Care	$311.38

DBM FIBER

Facility

$11,750.00

Service Code	HCPCS C9359
Hospital Charge Code	270692411
Hospital Revenue Code	278
Min. Negotiated Rate	$1,762.50
Max. Negotiated Rate	$2,843.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,585.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50

DBM FIBER APEX 5CC

Facility

$8,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270693091
Hospital Revenue Code	278
Min. Negotiated Rate	$201.84
Max. Negotiated Rate	$4,187.50
Rate for Payer: Aetna Commercial	$3,182.50
Rate for Payer: Aetna Medicare Advantage	$2,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,135.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,135.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,135.62
Rate for Payer: Cigna Commercial	$4,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,026.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,842.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,256.25
Rate for Payer: UnitedHealthcare Community & State	$201.84
Rate for Payer: Wellpoint Medicaid Managed Care	$221.94

DBM FIBER APEX 5CC

Facility

$8,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270693091
Hospital Revenue Code	278
Min. Negotiated Rate	$1,256.25
Max. Negotiated Rate	$2,026.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,026.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,842.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,256.25

DBM FIBER GRAFT VESUV 15CC

Facility

$11,945.00

Service Code	HCPCS C1713
Hospital Charge Code	270699278
Hospital Revenue Code	278
Min. Negotiated Rate	$1,791.75
Max. Negotiated Rate	$2,890.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,389.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,890.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,627.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,791.75

DBM FIBER GRAFT VESUV 15CC

Facility

$11,945.00

Service Code	HCPCS C1713
Hospital Charge Code	270699278
Hospital Revenue Code	278
Min. Negotiated Rate	$287.87
Max. Negotiated Rate	$5,972.50
Rate for Payer: Aetna Commercial	$4,539.10
Rate for Payer: Aetna Medicare Advantage	$3,583.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,045.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,045.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,389.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,045.97
Rate for Payer: Cigna Commercial	$5,972.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,890.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,627.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,791.75
Rate for Payer: UnitedHealthcare Community & State	$287.87
Rate for Payer: Wellpoint Medicaid Managed Care	$316.54

DBM FIBER PUTTY 10CC

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270682162
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

DBM FIBER PUTTY 10CC

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270682162
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

DBM FIBER PUTTY 5CC

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270682161
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

DBM FIBER PUTTY 5CC

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270682161
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

DBM NEVOS FIBER 2.5CC

Facility

$2,640.00

Service Code	HCPCS C1713
Hospital Charge Code	270696099
Hospital Revenue Code	278
Min. Negotiated Rate	$63.62
Max. Negotiated Rate	$1,320.00
Rate for Payer: Aetna Commercial	$1,003.20
Rate for Payer: Aetna Medicare Advantage	$792.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$673.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$673.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$528.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$673.20
Rate for Payer: Cigna Commercial	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$638.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$396.00
Rate for Payer: UnitedHealthcare Community & State	$63.62
Rate for Payer: Wellpoint Medicaid Managed Care	$69.96

DBM NEVOS FIBER 2.5CC

Facility

$2,640.00

Service Code	HCPCS C1713
Hospital Charge Code	270696099
Hospital Revenue Code	278
Min. Negotiated Rate	$396.00
Max. Negotiated Rate	$638.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$528.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$638.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$396.00

DBM PLUS STAGRAFT 2CC

Facility

$3,280.00

Service Code	HCPCS C1713
Hospital Charge Code	270680553
Hospital Revenue Code	278
Min. Negotiated Rate	$492.00
Max. Negotiated Rate	$793.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$656.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$721.60
Rate for Payer: Qualcare PPO/HMO/WC	$492.00

DBM PLUS STAGRAFT 2CC

Facility

$3,280.00

Service Code	HCPCS C1713
Hospital Charge Code	270680553
Hospital Revenue Code	278
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$1,640.00
Rate for Payer: Aetna Commercial	$1,246.40
Rate for Payer: Aetna Medicare Advantage	$984.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$836.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$836.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$656.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$836.40
Rate for Payer: Cigna Commercial	$1,640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$721.60
Rate for Payer: Qualcare PPO/HMO/WC	$492.00
Rate for Payer: UnitedHealthcare Community & State	$79.05
Rate for Payer: Wellpoint Medicaid Managed Care	$86.92

DBM PUTTY 1CC

Facility

$1,430.00

Service Code	HCPCS C1765
Hospital Charge Code	270704103
Hospital Revenue Code	278
Min. Negotiated Rate	$34.46
Max. Negotiated Rate	$715.00
Rate for Payer: Aetna Commercial	$543.40
Rate for Payer: Aetna Medicare Advantage	$429.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$364.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$364.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$364.65
Rate for Payer: Cigna Commercial	$715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$314.60
Rate for Payer: Qualcare PPO/HMO/WC	$214.50
Rate for Payer: UnitedHealthcare Community & State	$34.46
Rate for Payer: Wellpoint Medicaid Managed Care	$37.90

DBM PUTTY 1CC

Facility

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	270700323
Hospital Revenue Code	278
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

DBM PUTTY 1CC

Facility

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	270700323
Hospital Revenue Code	278
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

DBM PUTTY 1CC

Facility

$1,430.00

Service Code	HCPCS C1765
Hospital Charge Code	270704103
Hospital Revenue Code	278
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$346.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$314.60
Rate for Payer: Qualcare PPO/HMO/WC	$214.50

DBM PUTTY 2CC

Facility

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	270700322
Hospital Revenue Code	278
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

DBM PUTTY 2CC

Facility

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	270700322
Hospital Revenue Code	278
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

Know your out-of-pocket cost for care.

All Charges