Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT AFX AORTIC EXT 34x100x20

Facility

$24,900.00

Service Code	HCPCS C1768
Hospital Charge Code	270646484
Hospital Revenue Code	278
Min. Negotiated Rate	$600.09
Max. Negotiated Rate	$12,450.00
Rate for Payer: Aetna Commercial	$9,462.00
Rate for Payer: Aetna Medicare Advantage	$7,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,349.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,349.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,349.50
Rate for Payer: Cigna Commercial	$12,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,025.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,478.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,735.00
Rate for Payer: UnitedHealthcare Community & State	$600.09
Rate for Payer: Wellpoint Medicaid Managed Care	$659.85

GRAFT AFX AORTIC EXT 34x100x20

Facility

$24,900.00

Service Code	HCPCS C1768
Hospital Charge Code	270646484
Hospital Revenue Code	278
Min. Negotiated Rate	$3,735.00
Max. Negotiated Rate	$6,025.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,025.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,478.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,735.00

GRAFT AFX AORTIC EXT 34x34x20

Facility

$24,900.00

Hospital Charge Code	270673846
Hospital Revenue Code	278
Min. Negotiated Rate	$3,735.00
Max. Negotiated Rate	$6,025.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,025.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,478.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,735.00

GRAFT AFX AORTIC EXT 34x34x20

Facility

$24,900.00

Hospital Charge Code	270673846
Hospital Revenue Code	278
Min. Negotiated Rate	$600.09
Max. Negotiated Rate	$12,450.00
Rate for Payer: Aetna Commercial	$9,462.00
Rate for Payer: Aetna Medicare Advantage	$7,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,349.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,349.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,349.50
Rate for Payer: Cigna Commercial	$12,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,025.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,478.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,735.00
Rate for Payer: UnitedHealthcare Community & State	$600.09
Rate for Payer: Wellpoint Medicaid Managed Care	$659.85

GRAFT AFX AORTIC EXT 34x80x20

Facility

$24,775.00

Hospital Charge Code	270646240
Hospital Revenue Code	278
Min. Negotiated Rate	$597.08
Max. Negotiated Rate	$12,387.50
Rate for Payer: Aetna Commercial	$9,414.50
Rate for Payer: Aetna Medicare Advantage	$7,432.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,317.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,317.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,955.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,317.62
Rate for Payer: Cigna Commercial	$12,387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,995.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,450.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,716.25
Rate for Payer: UnitedHealthcare Community & State	$597.08
Rate for Payer: Wellpoint Medicaid Managed Care	$656.54

GRAFT AFX AORTIC EXT 34x80x20

Facility

$24,775.00

Hospital Charge Code	270646240
Hospital Revenue Code	278
Min. Negotiated Rate	$3,716.25
Max. Negotiated Rate	$5,995.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,995.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,450.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,716.25

GRAFT AFX ILIAC EXT 20X13X88

Facility

$16,900.00

Hospital Charge Code	270660507
Hospital Revenue Code	278
Min. Negotiated Rate	$407.29
Max. Negotiated Rate	$8,450.00
Rate for Payer: Aetna Commercial	$6,422.00
Rate for Payer: Aetna Medicare Advantage	$5,070.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,309.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,309.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,380.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,309.50
Rate for Payer: Cigna Commercial	$8,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,089.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,718.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,535.00
Rate for Payer: UnitedHealthcare Community & State	$407.29
Rate for Payer: Wellpoint Medicaid Managed Care	$447.85

GRAFT AFX ILIAC EXT 20X13X88

Facility

$16,900.00

Hospital Charge Code	270660507
Hospital Revenue Code	278
Min. Negotiated Rate	$2,535.00
Max. Negotiated Rate	$4,089.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,089.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,718.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,535.00

GRAFT AFX ILIAC EXT 20X25X55

Facility

$16,900.00

Hospital Charge Code	270667749
Hospital Revenue Code	278
Min. Negotiated Rate	$2,535.00
Max. Negotiated Rate	$4,089.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,089.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,718.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,535.00

GRAFT AFX ILIAC EXT 20X25X55

Facility

$16,900.00

Hospital Charge Code	270667749
Hospital Revenue Code	278
Min. Negotiated Rate	$407.29
Max. Negotiated Rate	$8,450.00
Rate for Payer: Aetna Commercial	$6,422.00
Rate for Payer: Aetna Medicare Advantage	$5,070.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,309.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,309.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,380.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,309.50
Rate for Payer: Cigna Commercial	$8,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,089.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,718.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,535.00
Rate for Payer: UnitedHealthcare Community & State	$407.29
Rate for Payer: Wellpoint Medicaid Managed Care	$447.85

GRAFT AFX MAIN BODY 20x30mm

Facility

$57,900.00

Hospital Charge Code	270675062O
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 20x30mm

Facility

$57,900.00

Hospital Charge Code	270675062O
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.39
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$22,002.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00
Rate for Payer: UnitedHealthcare Community & State	$1,395.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1,534.35

GRAFT AFX MAIN BODY 20x30mm

Facility

$57,900.00

Hospital Charge Code	270675062
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.39
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$22,002.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00
Rate for Payer: UnitedHealthcare Community & State	$1,395.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1,534.35

GRAFT AFX MAIN BODY 20x30mm

Facility

$57,900.00

Hospital Charge Code	270675062
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 22x70

Facility

$65,795.00

Hospital Charge Code	270677514
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.66
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$1,585.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1,743.57

GRAFT AFX MAIN BODY 22x70

Facility

$65,795.00

Hospital Charge Code	270677514
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT AFX MAIN BODY 25x100MM

Facility

$57,900.00

Hospital Charge Code	270675925
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 25x100MM

Facility

$57,900.00

Hospital Charge Code	270675925
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.39
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$22,002.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00
Rate for Payer: UnitedHealthcare Community & State	$1,395.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1,534.35

GRAFT AFX MAIN BODY 25x60 116

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270681010
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.66
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$1,585.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1,743.57

GRAFT AFX MAIN BODY 25x60 116

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270681010
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT AFX MAIN BODY 25x70

Facility

$65,795.00

Hospital Charge Code	270677744
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT AFX MAIN BODY 25x70

Facility

$65,795.00

Hospital Charge Code	270677744
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.66
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$1,585.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1,743.57

GRAFT AFX MAIN BODY 25X70MM

Facility

$57,900.00

Hospital Charge Code	270660506
Hospital Revenue Code	278
Min. Negotiated Rate	$8,685.00
Max. Negotiated Rate	$14,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00

GRAFT AFX MAIN BODY 25X70MM

Facility

$57,900.00

Hospital Charge Code	270660506
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.39
Max. Negotiated Rate	$28,950.00
Rate for Payer: Aetna Commercial	$22,002.00
Rate for Payer: Aetna Medicare Advantage	$17,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,764.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,764.50
Rate for Payer: Cigna Commercial	$28,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,011.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,738.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,685.00
Rate for Payer: UnitedHealthcare Community & State	$1,395.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1,534.35

GRAFT AFX MAIN BODY 25x90

Facility

$65,795.00

Hospital Charge Code	270677832
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

Know your out-of-pocket cost for care.

All Charges