Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ALLOGRAFT BONE 10 BOOST 48DBM2

Facility

$7,000.00

Hospital Charge Code	270634500
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

ALLOGRAFT BONE 5c BOOST 48DBM1

Facility

$3,457.20

Hospital Charge Code	270634499
Hospital Revenue Code	272
Min. Negotiated Rate	$83.32
Max. Negotiated Rate	$1,728.60
Rate for Payer: Aetna Commercial	$1,313.74
Rate for Payer: Aetna Medicare Advantage	$1,037.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$881.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$881.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$881.59
Rate for Payer: Cigna Commercial	$1,728.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,037.16
Rate for Payer: Oxford Commercial	$691.44
Rate for Payer: Qualcare PPO/HMO/WC	$518.58
Rate for Payer: UnitedHealthcare Commercial	$691.44
Rate for Payer: UnitedHealthcare Community & State	$83.32
Rate for Payer: Wellpoint Medicaid Managed Care	$91.62

ALLOGRAFT BONE 5c BOOST 48DBM1

Facility

$3,457.20

Hospital Charge Code	270634499
Hospital Revenue Code	272
Min. Negotiated Rate	$518.58
Max. Negotiated Rate	$518.58
Rate for Payer: Qualcare PPO/HMO/WC	$518.58

ALLOGRAFT BONE MARTIX LG

Facility

$28,425.00

Service Code	HCPCS C1762
Hospital Charge Code	270667320
Hospital Revenue Code	278
Min. Negotiated Rate	$685.04
Max. Negotiated Rate	$14,212.50
Rate for Payer: Aetna Commercial	$10,801.50
Rate for Payer: Aetna Medicare Advantage	$8,527.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,248.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,248.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,685.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,248.38
Rate for Payer: Cigna Commercial	$14,212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,878.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,253.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,263.75
Rate for Payer: UnitedHealthcare Community & State	$685.04
Rate for Payer: Wellpoint Medicaid Managed Care	$753.26

ALLOGRAFT BONE MARTIX LG

Facility

$28,425.00

Service Code	HCPCS C1762
Hospital Charge Code	270667320
Hospital Revenue Code	278
Min. Negotiated Rate	$4,263.75
Max. Negotiated Rate	$6,878.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,685.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,878.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,253.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,263.75

ALLOGRAFT BONUS TRIAD 5CC

Facility

$14,750.00

Service Code	HCPCS C1762
Hospital Charge Code	270689827
Hospital Revenue Code	278
Min. Negotiated Rate	$2,212.50
Max. Negotiated Rate	$3,569.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,569.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,245.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,212.50

ALLOGRAFT BONUS TRIAD 5CC

Facility

$14,750.00

Service Code	HCPCS C1762
Hospital Charge Code	270689827
Hospital Revenue Code	278
Min. Negotiated Rate	$355.48
Max. Negotiated Rate	$7,375.00
Rate for Payer: Aetna Commercial	$5,605.00
Rate for Payer: Aetna Medicare Advantage	$4,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,761.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,761.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,761.25
Rate for Payer: Cigna Commercial	$7,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,569.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,245.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,212.50
Rate for Payer: UnitedHealthcare Community & State	$355.48
Rate for Payer: Wellpoint Medicaid Managed Care	$390.88

ALLOGRAFT CANC CRUSHED 30CC

Facility

$3,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270700444
Hospital Revenue Code	278
Min. Negotiated Rate	$577.50
Max. Negotiated Rate	$931.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$931.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$577.50

ALLOGRAFT CANC CRUSHED 30CC

Facility

$3,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270700444
Hospital Revenue Code	278
Min. Negotiated Rate	$92.78
Max. Negotiated Rate	$1,925.00
Rate for Payer: Aetna Commercial	$1,463.00
Rate for Payer: Aetna Medicare Advantage	$1,155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$981.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$981.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$981.75
Rate for Payer: Cigna Commercial	$1,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$931.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$577.50
Rate for Payer: UnitedHealthcare Community & State	$92.78
Rate for Payer: Wellpoint Medicaid Managed Care	$102.03

ALLOGRAFT DBM+CCC 10CC

Facility

$12,006.25

Service Code	HCPCS C1762
Hospital Charge Code	270670544
Hospital Revenue Code	278
Min. Negotiated Rate	$289.35
Max. Negotiated Rate	$6,003.12
Rate for Payer: Aetna Commercial	$4,562.38
Rate for Payer: Aetna Medicare Advantage	$3,601.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,061.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,061.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,401.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,061.59
Rate for Payer: Cigna Commercial	$6,003.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,905.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,641.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.94
Rate for Payer: UnitedHealthcare Community & State	$289.35
Rate for Payer: Wellpoint Medicaid Managed Care	$318.17

ALLOGRAFT DBM+CCC 10CC

Facility

$12,006.25

Service Code	HCPCS C1762
Hospital Charge Code	270670544
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.94
Max. Negotiated Rate	$2,905.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,401.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,905.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,641.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.94

ALLOGRAFT DERMAL 2X7 64350010

Facility

$3,028.00

Hospital Charge Code	270618728
Hospital Revenue Code	636
Min. Negotiated Rate	$72.97
Max. Negotiated Rate	$1,514.00
Rate for Payer: Aetna Commercial	$1,150.64
Rate for Payer: Aetna Medicare Advantage	$908.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$772.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$772.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$772.14
Rate for Payer: Cigna Commercial	$1,514.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.78
Rate for Payer: Qualcare PPO/HMO/WC	$454.20
Rate for Payer: UnitedHealthcare Community & State	$72.97
Rate for Payer: Wellpoint Medicaid Managed Care	$80.24

ALLOGRAFT DERMAL 2X7 64350010

Facility

$3,028.00

Hospital Charge Code	270618728
Hospital Revenue Code	636
Min. Negotiated Rate	$454.20
Max. Negotiated Rate	$732.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.78
Rate for Payer: Qualcare PPO/HMO/WC	$454.20

ALLOGRAFT DERMAL 4X7 270407

Facility

$3,447.25

Hospital Charge Code	270634788
Hospital Revenue Code	636
Min. Negotiated Rate	$517.09
Max. Negotiated Rate	$834.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.23
Rate for Payer: Qualcare PPO/HMO/WC	$517.09

ALLOGRAFT DERMAL 4X7 270407

Facility

$3,447.25

Hospital Charge Code	270634788
Hospital Revenue Code	636
Min. Negotiated Rate	$83.08
Max. Negotiated Rate	$1,723.62
Rate for Payer: Aetna Commercial	$1,309.95
Rate for Payer: Aetna Medicare Advantage	$1,034.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.05
Rate for Payer: Cigna Commercial	$1,723.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.23
Rate for Payer: Qualcare PPO/HMO/WC	$517.09
Rate for Payer: UnitedHealthcare Community & State	$83.08
Rate for Payer: Wellpoint Medicaid Managed Care	$91.35

ALLOGRAFT EVANS WEDGE 10X22X20

Facility

$12,705.00

Service Code	HCPCS C1713
Hospital Charge Code	270678562
Hospital Revenue Code	278
Min. Negotiated Rate	$306.19
Max. Negotiated Rate	$6,352.50
Rate for Payer: Aetna Commercial	$4,827.90
Rate for Payer: Aetna Medicare Advantage	$3,811.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,239.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,239.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,239.78
Rate for Payer: Cigna Commercial	$6,352.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,074.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,795.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,905.75
Rate for Payer: UnitedHealthcare Community & State	$306.19
Rate for Payer: Wellpoint Medicaid Managed Care	$336.68

ALLOGRAFT EVANS WEDGE 10X22X20

Facility

$12,705.00

Service Code	HCPCS C1713
Hospital Charge Code	270678562
Hospital Revenue Code	278
Min. Negotiated Rate	$1,905.75
Max. Negotiated Rate	$3,074.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,541.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,074.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,795.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,905.75

ALLOGRAFT EVANS WEDGE 12X22X20

Facility

$8,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270681217
Hospital Revenue Code	278
Min. Negotiated Rate	$1,254.00
Max. Negotiated Rate	$2,023.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,672.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,023.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,839.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,254.00

ALLOGRAFT EVANS WEDGE 12X22X20

Facility

$8,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270681217
Hospital Revenue Code	278
Min. Negotiated Rate	$201.48
Max. Negotiated Rate	$4,180.00
Rate for Payer: Aetna Commercial	$3,176.80
Rate for Payer: Aetna Medicare Advantage	$2,508.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,131.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,131.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,131.80
Rate for Payer: Cigna Commercial	$4,180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,023.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,839.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,254.00
Rate for Payer: UnitedHealthcare Community & State	$201.48
Rate for Payer: Wellpoint Medicaid Managed Care	$221.54

ALLOGRAFT EVANS WEDGE 8X22X20m

Facility

$7,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270674060
Hospital Revenue Code	278
Min. Negotiated Rate	$185.57
Max. Negotiated Rate	$3,850.00
Rate for Payer: Aetna Commercial	$2,926.00
Rate for Payer: Aetna Medicare Advantage	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,963.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,963.50
Rate for Payer: Cigna Commercial	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00
Rate for Payer: UnitedHealthcare Community & State	$185.57
Rate for Payer: Wellpoint Medicaid Managed Care	$204.05

ALLOGRAFT EVANS WEDGE 8X22X20m

Facility

$7,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270674060
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

ALLOGRAFTFEMCNDYLEHEMILFMEDFSH

Facility

$56,209.50

Service Code	HCPCS C1762
Hospital Charge Code	270695271
Hospital Revenue Code	278
Min. Negotiated Rate	$1,354.65
Max. Negotiated Rate	$28,104.75
Rate for Payer: Aetna Commercial	$21,359.61
Rate for Payer: Aetna Medicare Advantage	$16,862.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,333.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,333.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,241.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,333.42
Rate for Payer: Cigna Commercial	$28,104.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,602.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,366.09
Rate for Payer: Qualcare PPO/HMO/WC	$8,431.42
Rate for Payer: UnitedHealthcare Community & State	$1,354.65
Rate for Payer: Wellpoint Medicaid Managed Care	$1,489.55

ALLOGRAFTFEMCNDYLEHEMILFMEDFSH

Facility

$56,209.50

Service Code	HCPCS C1762
Hospital Charge Code	270695271
Hospital Revenue Code	278
Min. Negotiated Rate	$8,431.42
Max. Negotiated Rate	$13,602.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,241.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,602.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,366.09
Rate for Payer: Qualcare PPO/HMO/WC	$8,431.42

ALLOGRAFT FLOW 10CC FD

Facility

$4,025.00

Hospital Charge Code	270671269
Hospital Revenue Code	278
Min. Negotiated Rate	$97.00
Max. Negotiated Rate	$2,012.50
Rate for Payer: Aetna Commercial	$1,529.50
Rate for Payer: Aetna Medicare Advantage	$1,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,026.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,026.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,026.38
Rate for Payer: Cigna Commercial	$2,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$974.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$885.50
Rate for Payer: Qualcare PPO/HMO/WC	$603.75
Rate for Payer: UnitedHealthcare Community & State	$97.00
Rate for Payer: Wellpoint Medicaid Managed Care	$106.66

ALLOGRAFT FLOW 10CC FD

Facility

$4,025.00

Hospital Charge Code	270671269
Hospital Revenue Code	278
Min. Negotiated Rate	$603.75
Max. Negotiated Rate	$974.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$805.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$974.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$885.50
Rate for Payer: Qualcare PPO/HMO/WC	$603.75

Know your out-of-pocket cost for care.

All Charges