Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT FILLER PRO-DENSE 2CC

Facility

$6,930.00

Service Code	HCPCS C1713
Hospital Charge Code	270700484
Hospital Revenue Code	278
Min. Negotiated Rate	$167.01
Max. Negotiated Rate	$3,465.00
Rate for Payer: Aetna Commercial	$2,633.40
Rate for Payer: Aetna Medicare Advantage	$2,079.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,767.15
Rate for Payer: Cigna Commercial	$3,465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50
Rate for Payer: UnitedHealthcare Community & State	$167.01
Rate for Payer: Wellpoint Medicaid Managed Care	$183.65

GRAFT FILLER PRO-DENSE 2CC

Facility

$6,930.00

Service Code	HCPCS C1713
Hospital Charge Code	270700484
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,677.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50

GRAFT FLIXENE 6MMX40CM

Facility

$5,695.65

Service Code	HCPCS C1768
Hospital Charge Code	270689834
Hospital Revenue Code	278
Min. Negotiated Rate	$854.35
Max. Negotiated Rate	$1,378.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,139.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,253.04
Rate for Payer: Qualcare PPO/HMO/WC	$854.35

GRAFT FLIXENE 6MMX40CM

Facility

$5,695.65

Service Code	HCPCS C1768
Hospital Charge Code	270689834
Hospital Revenue Code	278
Min. Negotiated Rate	$137.27
Max. Negotiated Rate	$2,847.82
Rate for Payer: Aetna Commercial	$2,164.35
Rate for Payer: Aetna Medicare Advantage	$1,708.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,452.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,452.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,139.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,452.39
Rate for Payer: Cigna Commercial	$2,847.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,253.04
Rate for Payer: Qualcare PPO/HMO/WC	$854.35
Rate for Payer: UnitedHealthcare Community & State	$137.27
Rate for Payer: Wellpoint Medicaid Managed Care	$150.93

GRAFT FLUENCY 6x40mm FTL06040

Facility

$10,975.00

Hospital Charge Code	270637376
Hospital Revenue Code	278
Min. Negotiated Rate	$1,646.25
Max. Negotiated Rate	$2,655.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,655.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,414.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,646.25

GRAFT FLUENCY 6x40mm FTL06040

Facility

$12,050.00

Hospital Charge Code	270637376V
Hospital Revenue Code	278
Min. Negotiated Rate	$290.40
Max. Negotiated Rate	$6,025.00
Rate for Payer: Aetna Commercial	$4,579.00
Rate for Payer: Aetna Medicare Advantage	$3,615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,072.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,072.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,072.75
Rate for Payer: Cigna Commercial	$6,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,916.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,651.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,807.50
Rate for Payer: UnitedHealthcare Community & State	$290.40
Rate for Payer: Wellpoint Medicaid Managed Care	$319.32

GRAFT FLUENCY 6x40mm FTL06040

Facility

$12,050.00

Hospital Charge Code	270637376V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,807.50
Max. Negotiated Rate	$2,916.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,916.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,651.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,807.50

GRAFT FLUENCY 6x40mm FTL06040

Facility

$10,975.00

Hospital Charge Code	270637376
Hospital Revenue Code	278
Min. Negotiated Rate	$264.50
Max. Negotiated Rate	$5,487.50
Rate for Payer: Aetna Commercial	$4,170.50
Rate for Payer: Aetna Medicare Advantage	$3,292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,798.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,798.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,798.62
Rate for Payer: Cigna Commercial	$5,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,655.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,414.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,646.25
Rate for Payer: UnitedHealthcare Community & State	$264.50
Rate for Payer: Wellpoint Medicaid Managed Care	$290.84

GRAFT GOR 12MMX40CM SBT1201

Facility

$4,310.25

Hospital Charge Code	270634307
Hospital Revenue Code	278
Min. Negotiated Rate	$103.88
Max. Negotiated Rate	$2,155.12
Rate for Payer: Aetna Commercial	$1,637.89
Rate for Payer: Aetna Medicare Advantage	$1,293.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,099.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,099.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,099.11
Rate for Payer: Cigna Commercial	$2,155.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,043.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$948.25
Rate for Payer: Qualcare PPO/HMO/WC	$646.54
Rate for Payer: UnitedHealthcare Community & State	$103.88
Rate for Payer: Wellpoint Medicaid Managed Care	$114.22

GRAFT GOR 12MMX40CM SBT1201

Facility

$4,310.25

Hospital Charge Code	270634307
Hospital Revenue Code	278
Min. Negotiated Rate	$646.54
Max. Negotiated Rate	$1,043.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,043.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$948.25
Rate for Payer: Qualcare PPO/HMO/WC	$646.54

GRAFT GORE 10 MM 80CM

Facility

$6,655.00

Service Code	HCPCS C1768
Hospital Charge Code	270660566
Hospital Revenue Code	278
Min. Negotiated Rate	$998.25
Max. Negotiated Rate	$1,610.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,331.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,610.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,464.10
Rate for Payer: Qualcare PPO/HMO/WC	$998.25

GRAFT GORE 10 MM 80CM

Facility

$6,655.00

Service Code	HCPCS C1768
Hospital Charge Code	270660566
Hospital Revenue Code	278
Min. Negotiated Rate	$160.39
Max. Negotiated Rate	$3,327.50
Rate for Payer: Aetna Commercial	$2,528.90
Rate for Payer: Aetna Medicare Advantage	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,697.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,697.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,697.03
Rate for Payer: Cigna Commercial	$3,327.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,610.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,464.10
Rate for Payer: Qualcare PPO/HMO/WC	$998.25
Rate for Payer: UnitedHealthcare Community & State	$160.39
Rate for Payer: Wellpoint Medicaid Managed Care	$176.36

GRAFT GORE-TEX 10MMX20CM

Facility

$4,100.00

Service Code	HCPCS C1768
Hospital Charge Code	270686063
Hospital Revenue Code	278
Min. Negotiated Rate	$615.00
Max. Negotiated Rate	$992.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$820.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$992.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$902.00
Rate for Payer: Qualcare PPO/HMO/WC	$615.00

GRAFT GORE-TEX 10MMX20CM

Facility

$4,100.00

Service Code	HCPCS C1768
Hospital Charge Code	270686063
Hospital Revenue Code	278
Min. Negotiated Rate	$98.81
Max. Negotiated Rate	$2,050.00
Rate for Payer: Aetna Commercial	$1,558.00
Rate for Payer: Aetna Medicare Advantage	$1,230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,045.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,045.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,045.50
Rate for Payer: Cigna Commercial	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$992.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$902.00
Rate for Payer: Qualcare PPO/HMO/WC	$615.00
Rate for Payer: UnitedHealthcare Community & State	$98.81
Rate for Payer: Wellpoint Medicaid Managed Care	$108.65

GRAFT GORE-TEX 12MMX30CM

Facility

$5,245.00

Service Code	HCPCS C1768
Hospital Charge Code	270640429
Hospital Revenue Code	278
Min. Negotiated Rate	$786.75
Max. Negotiated Rate	$1,269.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,153.90
Rate for Payer: Qualcare PPO/HMO/WC	$786.75

GRAFT GORE-TEX 12MMX30CM

Facility

$5,245.00

Service Code	HCPCS C1768
Hospital Charge Code	270640429
Hospital Revenue Code	278
Min. Negotiated Rate	$126.40
Max. Negotiated Rate	$2,622.50
Rate for Payer: Aetna Commercial	$1,993.10
Rate for Payer: Aetna Medicare Advantage	$1,573.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,337.47
Rate for Payer: Cigna Commercial	$2,622.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,153.90
Rate for Payer: Qualcare PPO/HMO/WC	$786.75
Rate for Payer: UnitedHealthcare Community & State	$126.40
Rate for Payer: Wellpoint Medicaid Managed Care	$138.99

GRAFT GORETEX 6mm 40cm

Facility

$2,095.00

Service Code	HCPCS C1768
Hospital Charge Code	270656771
Hospital Revenue Code	278
Min. Negotiated Rate	$50.49
Max. Negotiated Rate	$1,047.50
Rate for Payer: Aetna Commercial	$796.10
Rate for Payer: Aetna Medicare Advantage	$628.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$534.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$534.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$419.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$534.23
Rate for Payer: Cigna Commercial	$1,047.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$506.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$460.90
Rate for Payer: Qualcare PPO/HMO/WC	$314.25
Rate for Payer: UnitedHealthcare Community & State	$50.49
Rate for Payer: Wellpoint Medicaid Managed Care	$55.52

GRAFT GORETEX 6mm 40cm

Facility

$2,095.00

Service Code	HCPCS C1768
Hospital Charge Code	270656771
Hospital Revenue Code	278
Min. Negotiated Rate	$314.25
Max. Negotiated Rate	$506.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$419.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$506.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$460.90
Rate for Payer: Qualcare PPO/HMO/WC	$314.25

GRAFT GORETEX 6 X 20 CM

Facility

$1,615.00

Service Code	HCPCS L8670
Hospital Charge Code	270690317
Hospital Revenue Code	278
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$390.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$355.30
Rate for Payer: Qualcare PPO/HMO/WC	$242.25

GRAFT GORETEX 6 X 20 CM

Facility

$1,615.00

Service Code	HCPCS L8670
Hospital Charge Code	270690317
Hospital Revenue Code	278
Min. Negotiated Rate	$38.92
Max. Negotiated Rate	$807.50
Rate for Payer: Aetna Commercial	$613.70
Rate for Payer: Aetna Medicare Advantage	$484.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$411.82
Rate for Payer: Cigna Commercial	$807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$355.30
Rate for Payer: Qualcare PPO/HMO/WC	$242.25
Rate for Payer: UnitedHealthcare Community & State	$38.92
Rate for Payer: Wellpoint Medicaid Managed Care	$42.80

GRAFT GORE-TEX 8MM X40CM STRCH

Facility

$4,230.00

Service Code	HCPCS L8670
Hospital Charge Code	270701372
Hospital Revenue Code	278
Min. Negotiated Rate	$101.94
Max. Negotiated Rate	$2,115.00
Rate for Payer: Aetna Commercial	$1,607.40
Rate for Payer: Aetna Medicare Advantage	$1,269.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,078.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,078.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$846.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,078.65
Rate for Payer: Cigna Commercial	$2,115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,023.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$930.60
Rate for Payer: Qualcare PPO/HMO/WC	$634.50
Rate for Payer: UnitedHealthcare Community & State	$101.94
Rate for Payer: Wellpoint Medicaid Managed Care	$112.09

GRAFT GORE-TEX 8MM X40CM STRCH

Facility

$4,230.00

Service Code	HCPCS L8670
Hospital Charge Code	270701372
Hospital Revenue Code	278
Min. Negotiated Rate	$634.50
Max. Negotiated Rate	$1,023.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$846.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,023.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$930.60
Rate for Payer: Qualcare PPO/HMO/WC	$634.50

GRAFT GORE-TEX 8MM X70CM STRCH

Facility

$4,360.00

Service Code	HCPCS C1768
Hospital Charge Code	270658086
Hospital Revenue Code	278
Min. Negotiated Rate	$105.08
Max. Negotiated Rate	$2,180.00
Rate for Payer: Aetna Commercial	$1,656.80
Rate for Payer: Aetna Medicare Advantage	$1,308.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,111.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,111.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,111.80
Rate for Payer: Cigna Commercial	$2,180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,055.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$959.20
Rate for Payer: Qualcare PPO/HMO/WC	$654.00
Rate for Payer: UnitedHealthcare Community & State	$105.08
Rate for Payer: Wellpoint Medicaid Managed Care	$115.54

GRAFT GORE-TEX 8MM X70CM STRCH

Facility

$4,360.00

Service Code	HCPCS C1768
Hospital Charge Code	270658086
Hospital Revenue Code	278
Min. Negotiated Rate	$654.00
Max. Negotiated Rate	$1,055.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$872.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,055.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$959.20
Rate for Payer: Qualcare PPO/HMO/WC	$654.00

GRAFT GORE-TEX LINED4-6MMX40CM

Facility

$2,385.00

Service Code	HCPCS C1768
Hospital Charge Code	270650758
Hospital Revenue Code	278
Min. Negotiated Rate	$357.75
Max. Negotiated Rate	$577.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$477.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$577.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$524.70
Rate for Payer: Qualcare PPO/HMO/WC	$357.75

Know your out-of-pocket cost for care.

All Charges