Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT ANTERIOR TIBIALIS TENDON

Facility

$10,534.50

Service Code	HCPCS C1762
Hospital Charge Code	270675692
Hospital Revenue Code	278
Min. Negotiated Rate	$253.88
Max. Negotiated Rate	$5,267.25
Rate for Payer: Aetna Commercial	$4,003.11
Rate for Payer: Aetna Medicare Advantage	$3,160.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,686.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,686.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,106.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,686.30
Rate for Payer: Cigna Commercial	$5,267.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,549.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,317.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,580.17
Rate for Payer: UnitedHealthcare Community & State	$253.88
Rate for Payer: Wellpoint Medicaid Managed Care	$279.16

GRAFT ANTERIOR TIBIALIS TENDON

Facility

$10,000.00

Hospital Charge Code	270666077
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

GRAFT ANTERIOR TIBIALIS TENDON

Facility

$10,000.00

Hospital Charge Code	270666077
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

GRAFT AORTIC A28-28/C75

Facility

$17,475.00

Hospital Charge Code	270647243C
Hospital Revenue Code	278
Min. Negotiated Rate	$421.15
Max. Negotiated Rate	$8,737.50
Rate for Payer: Aetna Commercial	$6,640.50
Rate for Payer: Aetna Medicare Advantage	$5,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,456.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,456.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,456.12
Rate for Payer: Cigna Commercial	$8,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,228.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,844.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,621.25
Rate for Payer: UnitedHealthcare Community & State	$421.15
Rate for Payer: Wellpoint Medicaid Managed Care	$463.09

GRAFT AORTIC A28-28/C75

Facility

$17,475.00

Hospital Charge Code	270647243C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,621.25
Max. Negotiated Rate	$4,228.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,228.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,844.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,621.25

GRAFT AORTIC EXT 34x34x80

Facility

$26,495.00

Hospital Charge Code	270677193
Hospital Revenue Code	278
Min. Negotiated Rate	$638.53
Max. Negotiated Rate	$13,247.50
Rate for Payer: Aetna Commercial	$10,068.10
Rate for Payer: Aetna Medicare Advantage	$7,948.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,756.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,756.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,756.23
Rate for Payer: Cigna Commercial	$13,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,411.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,828.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,974.25
Rate for Payer: UnitedHealthcare Community & State	$638.53
Rate for Payer: Wellpoint Medicaid Managed Care	$702.12

GRAFT AORTIC EXT 34x34x80

Facility

$26,495.00

Hospital Charge Code	270677193
Hospital Revenue Code	278
Min. Negotiated Rate	$3,974.25
Max. Negotiated Rate	$6,411.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,411.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,828.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,974.25

GRAFT AORTIC EXTENSION

Facility

$20,475.00

Hospital Charge Code	270646000
Hospital Revenue Code	278
Min. Negotiated Rate	$3,071.25
Max. Negotiated Rate	$4,954.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,954.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,504.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,071.25

GRAFT AORTIC EXTENSION

Facility

$20,475.00

Hospital Charge Code	270646000
Hospital Revenue Code	278
Min. Negotiated Rate	$493.45
Max. Negotiated Rate	$10,237.50
Rate for Payer: Aetna Commercial	$7,780.50
Rate for Payer: Aetna Medicare Advantage	$6,142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,221.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,221.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,221.12
Rate for Payer: Cigna Commercial	$10,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,954.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,504.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,071.25
Rate for Payer: UnitedHealthcare Community & State	$493.45
Rate for Payer: Wellpoint Medicaid Managed Care	$542.59

GRAFT AORTIC EXTENSION CV100V

Facility

$24,775.00

Service Code	HCPCS C1768
Hospital Charge Code	270666862
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 AORTIC EXTENSION CV100V

Facility

$24,775.00

Service Code	HCPCS C1768
Hospital Charge Code	270666862
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 AORTIC EXT PROXIMAL

Facility

$19,450.00

Hospital Charge Code	270665549
Hospital Revenue Code	278
Min. Negotiated Rate	$2,917.50
Max. Negotiated Rate	$4,706.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,706.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,279.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,917.50

GRAFT AORTIC EXT PROXIMAL

Facility

$19,450.00

Hospital Charge Code	270665549
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$9,725.00
Rate for Payer: Aetna Commercial	$7,391.00
Rate for Payer: Aetna Medicare Advantage	$5,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,959.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,959.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,959.75
Rate for Payer: Cigna Commercial	$9,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,706.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,279.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,917.50
Rate for Payer: UnitedHealthcare Community & State	$468.75
Rate for Payer: Wellpoint Medicaid Managed Care	$515.42

GRAFT APX-FBR 10CC

Facility

$11,937.80

Service Code	HCPCS C9359
Hospital Charge Code	270692410
Hospital Revenue Code	278
Min. Negotiated Rate	$287.70
Max. Negotiated Rate	$5,968.90
Rate for Payer: Aetna Commercial	$4,536.36
Rate for Payer: Aetna Medicare Advantage	$3,581.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,044.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,044.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,387.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,044.14
Rate for Payer: Cigna Commercial	$5,968.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,888.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,626.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,790.67
Rate for Payer: UnitedHealthcare Community & State	$287.70
Rate for Payer: Wellpoint Medicaid Managed Care	$316.35

GRAFT APX-FBR 10CC

Facility

$11,937.80

Service Code	HCPCS C9359
Hospital Charge Code	270692410
Hospital Revenue Code	278
Min. Negotiated Rate	$1,790.67
Max. Negotiated Rate	$2,888.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,387.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,888.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,626.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,790.67

GRAFT ARTEGRAFT 5 MM 34 CM

Facility

$7,095.00

Service Code	HCPCS C1768
Hospital Charge Code	270690091
Hospital Revenue Code	278
Min. Negotiated Rate	$1,064.25
Max. Negotiated Rate	$1,716.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,419.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,560.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,064.25

GRAFT ARTEGRAFT 5 MM 34 CM

Facility

$7,095.00

Service Code	HCPCS C1768
Hospital Charge Code	270690091
Hospital Revenue Code	278
Min. Negotiated Rate	$170.99
Max. Negotiated Rate	$3,547.50
Rate for Payer: Aetna Commercial	$2,696.10
Rate for Payer: Aetna Medicare Advantage	$2,128.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,809.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,809.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,419.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,809.22
Rate for Payer: Cigna Commercial	$3,547.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,560.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,064.25
Rate for Payer: UnitedHealthcare Community & State	$170.99
Rate for Payer: Wellpoint Medicaid Managed Care	$188.02

GRAFT AVANCE NERVE 4-5x70MM

Facility

$24,125.00

Hospital Charge Code	270660289
Hospital Revenue Code	278
Min. Negotiated Rate	$3,618.75
Max. Negotiated Rate	$5,838.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,838.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,307.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,618.75

GRAFT AVANCE NERVE 4-5x70MM

Facility

$24,125.00

Hospital Charge Code	270660289
Hospital Revenue Code	278
Min. Negotiated Rate	$581.41
Max. Negotiated Rate	$12,062.50
Rate for Payer: Aetna Commercial	$9,167.50
Rate for Payer: Aetna Medicare Advantage	$7,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,151.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,151.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,151.88
Rate for Payer: Cigna Commercial	$12,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,838.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,307.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,618.75
Rate for Payer: UnitedHealthcare Community & State	$581.41
Rate for Payer: Wellpoint Medicaid Managed Care	$639.31

GRAFT AX BI FEM 8mm 90cm/40cm

Facility

$13,430.00

Service Code	HCPCS C1768
Hospital Charge Code	270664526
Hospital Revenue Code	278
Min. Negotiated Rate	$323.66
Max. Negotiated Rate	$6,715.00
Rate for Payer: Aetna Commercial	$5,103.40
Rate for Payer: Aetna Medicare Advantage	$4,029.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,424.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,424.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,686.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,424.65
Rate for Payer: Cigna Commercial	$6,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,250.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,954.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,014.50
Rate for Payer: UnitedHealthcare Community & State	$323.66
Rate for Payer: Wellpoint Medicaid Managed Care	$355.89

GRAFT AX BI FEM 8mm 90cm/40cm

Facility

$13,430.00

Service Code	HCPCS C1768
Hospital Charge Code	270664526
Hospital Revenue Code	278
Min. Negotiated Rate	$2,014.50
Max. Negotiated Rate	$3,250.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,686.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,250.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,954.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,014.50

GRAFT BG MAT S 300 2.5 CM

Facility

$6,140.00

Service Code	HCPCS Q4100
Hospital Charge Code	270700855
Hospital Revenue Code	278
Min. Negotiated Rate	$921.00
Max. Negotiated Rate	$1,485.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,350.80
Rate for Payer: Qualcare PPO/HMO/WC	$921.00

GRAFT BG MAT S 300 2.5 CM

Facility

$6,140.00

Service Code	HCPCS Q4100
Hospital Charge Code	270700855
Hospital Revenue Code	278
Min. Negotiated Rate	$147.97
Max. Negotiated Rate	$3,070.00
Rate for Payer: Aetna Commercial	$2,333.20
Rate for Payer: Aetna Medicare Advantage	$1,842.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,565.70
Rate for Payer: Cigna Commercial	$3,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,350.80
Rate for Payer: Qualcare PPO/HMO/WC	$921.00
Rate for Payer: UnitedHealthcare Community & State	$147.97
Rate for Payer: Wellpoint Medicaid Managed Care	$162.71

GRAFT BIFURC TH WALL 16/8 40cm

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270638412
Hospital Revenue Code	278
Min. Negotiated Rate	$684.75
Max. Negotiated Rate	$1,104.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,004.30
Rate for Payer: Qualcare PPO/HMO/WC	$684.75

GRAFT BIFURC TH WALL 16/8 40cm

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270638412
Hospital Revenue Code	278
Min. Negotiated Rate	$110.02
Max. Negotiated Rate	$2,282.50
Rate for Payer: Aetna Commercial	$1,734.70
Rate for Payer: Aetna Medicare Advantage	$1,369.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,164.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,164.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,164.08
Rate for Payer: Cigna Commercial	$2,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,004.30
Rate for Payer: Qualcare PPO/HMO/WC	$684.75
Rate for Payer: UnitedHealthcare Community & State	$110.02
Rate for Payer: Wellpoint Medicaid Managed Care	$120.97

Know your out-of-pocket cost for care.

All Charges