Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT BONE MATRIX COLLAGRAFT

Facility

$3,501.85

Hospital Charge Code	270610062
Hospital Revenue Code	278
Min. Negotiated Rate	$525.28
Max. Negotiated Rate	$847.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.41
Rate for Payer: Qualcare PPO/HMO/WC	$525.28

GRAFT BONE MATRIX LG KT

Facility

$1,645.65

Hospital Charge Code	270605572
Hospital Revenue Code	278
Min. Negotiated Rate	$246.85
Max. Negotiated Rate	$398.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$329.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$398.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$362.04
Rate for Payer: Qualcare PPO/HMO/WC	$246.85

GRAFT BONE MATRIX LG KT

Facility

$1,645.65

Hospital Charge Code	270605572
Hospital Revenue Code	278
Min. Negotiated Rate	$39.66
Max. Negotiated Rate	$822.83
Rate for Payer: Aetna Commercial	$625.35
Rate for Payer: Aetna Medicare Advantage	$493.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$419.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$419.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$329.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$419.64
Rate for Payer: Cigna Commercial	$822.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$398.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$362.04
Rate for Payer: Qualcare PPO/HMO/WC	$246.85
Rate for Payer: UnitedHealthcare Community & State	$39.66
Rate for Payer: Wellpoint Medicaid Managed Care	$43.61

GRAFT BONE OSTEOMATRIX OMCS10

Facility

$4,987.50

Hospital Charge Code	270646938
Hospital Revenue Code	278
Min. Negotiated Rate	$748.12
Max. Negotiated Rate	$1,206.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,097.25
Rate for Payer: Qualcare PPO/HMO/WC	$748.12

GRAFT BONE OSTEOMATRIX OMCS10

Facility

$4,987.50

Hospital Charge Code	270646938
Hospital Revenue Code	278
Min. Negotiated Rate	$120.20
Max. Negotiated Rate	$2,493.75
Rate for Payer: Aetna Commercial	$1,895.25
Rate for Payer: Aetna Medicare Advantage	$1,496.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.81
Rate for Payer: Cigna Commercial	$2,493.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,097.25
Rate for Payer: Qualcare PPO/HMO/WC	$748.12
Rate for Payer: UnitedHealthcare Community & State	$120.20
Rate for Payer: Wellpoint Medicaid Managed Care	$132.17

GRAFT BONE PASTE FD 5cc DBX

Facility

$715.00

Service Code	HCPCS C1713
Hospital Charge Code	270679739
Hospital Revenue Code	278
Min. Negotiated Rate	$17.23
Max. Negotiated Rate	$357.50
Rate for Payer: Aetna Commercial	$271.70
Rate for Payer: Aetna Medicare Advantage	$214.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$182.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$182.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$182.32
Rate for Payer: Cigna Commercial	$357.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$107.25
Rate for Payer: UnitedHealthcare Community & State	$17.23
Rate for Payer: Wellpoint Medicaid Managed Care	$18.95

GRAFT BONE PASTE FD 5cc DBX

Facility

$715.00

Service Code	HCPCS C1713
Hospital Charge Code	270679739
Hospital Revenue Code	278
Min. Negotiated Rate	$107.25
Max. Negotiated Rate	$173.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$157.30
Rate for Payer: Qualcare PPO/HMO/WC	$107.25

GRAFT BONE SPACER 16MM

Facility

$21,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270691814
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$5,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,730.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

GRAFT BONE SPACER 16MM

Facility

$21,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270691814
Hospital Revenue Code	278
Min. Negotiated Rate	$518.15
Max. Negotiated Rate	$10,750.00
Rate for Payer: Aetna Commercial	$8,170.00
Rate for Payer: Aetna Medicare Advantage	$6,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,482.50
Rate for Payer: Cigna Commercial	$10,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,730.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00
Rate for Payer: UnitedHealthcare Community & State	$518.15
Rate for Payer: Wellpoint Medicaid Managed Care	$569.75

GRAFT BONE SUBS ALTAPORE 1.6ML

Facility

$2,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270693009
Hospital Revenue Code	278
Min. Negotiated Rate	$55.43
Max. Negotiated Rate	$1,150.00
Rate for Payer: Aetna Commercial	$874.00
Rate for Payer: Aetna Medicare Advantage	$690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$586.50
Rate for Payer: Cigna Commercial	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$506.00
Rate for Payer: Qualcare PPO/HMO/WC	$345.00
Rate for Payer: UnitedHealthcare Community & State	$55.43
Rate for Payer: Wellpoint Medicaid Managed Care	$60.95

GRAFT BONE SUBS ALTAPORE 1.6ML

Facility

$2,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270693009
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$556.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$506.00
Rate for Payer: Qualcare PPO/HMO/WC	$345.00

GRAFT BONE SUBST GENEX 5CC

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696087
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

GRAFT BONE SUBST GENEX 5CC

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696087
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

GRAFT BONE/TENDON/BONE

Facility

$7,240.00

Hospital Charge Code	270607944
Hospital Revenue Code	278
Min. Negotiated Rate	$174.48
Max. Negotiated Rate	$3,620.00
Rate for Payer: Aetna Commercial	$2,751.20
Rate for Payer: Aetna Medicare Advantage	$2,172.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,846.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,846.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,448.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,846.20
Rate for Payer: Cigna Commercial	$3,620.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,752.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,592.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,086.00
Rate for Payer: UnitedHealthcare Community & State	$174.48
Rate for Payer: Wellpoint Medicaid Managed Care	$191.86

GRAFT BONE/TENDON/BONE

Facility

$7,240.00

Hospital Charge Code	270607944
Hospital Revenue Code	278
Min. Negotiated Rate	$1,086.00
Max. Negotiated Rate	$1,752.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,448.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,752.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,592.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,086.00

GRAFT CARTIFORM 10MM

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270677098
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

GRAFT CARTIFORM 10MM

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270677098
Hospital Revenue Code	278
Min. Negotiated Rate	$421.75
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$421.75
Rate for Payer: Wellpoint Medicaid Managed Care	$463.75

GRAFT CONDUIT 3MMX3CM NERVE

Facility

$6,482.50

Service Code	HCPCS C1889
Hospital Charge Code	270684389
Hospital Revenue Code	278
Min. Negotiated Rate	$972.38
Max. Negotiated Rate	$1,568.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,296.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,568.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,426.15
Rate for Payer: Qualcare PPO/HMO/WC	$972.38

GRAFT CONDUIT 3MMX3CM NERVE

Facility

$6,482.50

Service Code	HCPCS C1889
Hospital Charge Code	270684389
Hospital Revenue Code	278
Min. Negotiated Rate	$156.23
Max. Negotiated Rate	$3,241.25
Rate for Payer: Aetna Commercial	$2,463.35
Rate for Payer: Aetna Medicare Advantage	$1,944.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,653.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,653.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,296.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,653.04
Rate for Payer: Cigna Commercial	$3,241.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,568.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,426.15
Rate for Payer: Qualcare PPO/HMO/WC	$972.38
Rate for Payer: UnitedHealthcare Community & State	$156.23
Rate for Payer: Wellpoint Medicaid Managed Care	$171.79

GRAFT CONDYL RT LATERAL

Facility

$56,000.00

Hospital Charge Code	270676320
Hospital Revenue Code	278
Min. Negotiated Rate	$1,349.60
Max. Negotiated Rate	$28,000.00
Rate for Payer: Aetna Commercial	$21,280.00
Rate for Payer: Aetna Medicare Advantage	$16,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,280.00
Rate for Payer: Cigna Commercial	$28,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,552.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,400.00
Rate for Payer: UnitedHealthcare Community & State	$1,349.60
Rate for Payer: Wellpoint Medicaid Managed Care	$1,484.00

GRAFT CONDYL RT LATERAL

Facility

$56,000.00

Hospital Charge Code	270676320
Hospital Revenue Code	278
Min. Negotiated Rate	$8,400.00
Max. Negotiated Rate	$13,552.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,552.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,400.00

GRAFT CONTLATERL LIMB TFLE127

Facility

$14,320.00

Hospital Charge Code	270633904V
Hospital Revenue Code	278
Min. Negotiated Rate	$2,148.00
Max. Negotiated Rate	$3,465.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,864.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,465.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,150.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,148.00

GRAFT CONTLATERL LIMB TFLE127

Facility

$14,320.00

Hospital Charge Code	270633904V
Hospital Revenue Code	278
Min. Negotiated Rate	$345.11
Max. Negotiated Rate	$7,160.00
Rate for Payer: Aetna Commercial	$5,441.60
Rate for Payer: Aetna Medicare Advantage	$4,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,651.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,651.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,651.60
Rate for Payer: Cigna Commercial	$7,160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,465.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,150.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,148.00
Rate for Payer: UnitedHealthcare Community & State	$345.11
Rate for Payer: Wellpoint Medicaid Managed Care	$379.48

GRAFT CONTLATERL LIMB TFLE1271

Facility

$13,392.00

Hospital Charge Code	270633904
Hospital Revenue Code	278
Min. Negotiated Rate	$322.75
Max. Negotiated Rate	$6,696.00
Rate for Payer: Aetna Commercial	$5,088.96
Rate for Payer: Aetna Medicare Advantage	$4,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,678.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,414.96
Rate for Payer: Cigna Commercial	$6,696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,946.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80
Rate for Payer: UnitedHealthcare Community & State	$322.75
Rate for Payer: Wellpoint Medicaid Managed Care	$354.89

GRAFT CONTLATERL LIMB TFLE1271

Facility

$13,392.00

Hospital Charge Code	270633904
Hospital Revenue Code	278
Min. Negotiated Rate	$2,008.80
Max. Negotiated Rate	$3,240.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,678.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,946.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80

Know your out-of-pocket cost for care.

All Charges