Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT GORE-TEX LINED4-6MMX40CM

Facility

$2,385.00

Service Code	HCPCS C1768
Hospital Charge Code	270650758
Hospital Revenue Code	278
Min. Negotiated Rate	$57.48
Max. Negotiated Rate	$1,192.50
Rate for Payer: Aetna Commercial	$906.30
Rate for Payer: Aetna Medicare Advantage	$715.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$608.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$608.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$477.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$608.17
Rate for Payer: Cigna Commercial	$1,192.50
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
Rate for Payer: UnitedHealthcare Community & State	$57.48
Rate for Payer: Wellpoint Medicaid Managed Care	$63.20

GRAFT GORETEX LINED 8mm 70cm

Facility

$3,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270650757
Hospital Revenue Code	278
Min. Negotiated Rate	$524.25
Max. Negotiated Rate	$845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$845.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$768.90
Rate for Payer: Qualcare PPO/HMO/WC	$524.25

GRAFT GORETEX LINED 8mm 70cm

Facility

$3,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270650757
Hospital Revenue Code	278
Min. Negotiated Rate	$84.23
Max. Negotiated Rate	$1,747.50
Rate for Payer: Aetna Commercial	$1,328.10
Rate for Payer: Aetna Medicare Advantage	$1,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$891.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$891.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$891.23
Rate for Payer: Cigna Commercial	$1,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$845.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$768.90
Rate for Payer: Qualcare PPO/HMO/WC	$524.25
Rate for Payer: UnitedHealthcare Community & State	$84.23
Rate for Payer: Wellpoint Medicaid Managed Care	$92.62

GRAFT GORETEX PROPATEN 4-7mmID

Facility

$6,165.00

Service Code	HCPCS C1768
Hospital Charge Code	270643829
Hospital Revenue Code	278
Min. Negotiated Rate	$924.75
Max. Negotiated Rate	$1,491.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,233.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,491.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,356.30
Rate for Payer: Qualcare PPO/HMO/WC	$924.75

GRAFT GORETEX PROPATEN 4-7mmID

Facility

$6,165.00

Service Code	HCPCS C1768
Hospital Charge Code	270643829
Hospital Revenue Code	278
Min. Negotiated Rate	$148.58
Max. Negotiated Rate	$3,082.50
Rate for Payer: Aetna Commercial	$2,342.70
Rate for Payer: Aetna Medicare Advantage	$1,849.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,572.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,572.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,233.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,572.08
Rate for Payer: Cigna Commercial	$3,082.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,491.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,356.30
Rate for Payer: Qualcare PPO/HMO/WC	$924.75
Rate for Payer: UnitedHealthcare Community & State	$148.58
Rate for Payer: Wellpoint Medicaid Managed Care	$163.37

GRAFT GORE-TEX REM RG 6MM

Facility

$3,930.00

Hospital Charge Code	270657755
Hospital Revenue Code	278
Min. Negotiated Rate	$94.71
Max. Negotiated Rate	$1,965.00
Rate for Payer: Aetna Commercial	$1,493.40
Rate for Payer: Aetna Medicare Advantage	$1,179.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,002.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,002.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$786.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,002.15
Rate for Payer: Cigna Commercial	$1,965.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$951.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$864.60
Rate for Payer: Qualcare PPO/HMO/WC	$589.50
Rate for Payer: UnitedHealthcare Community & State	$94.71
Rate for Payer: Wellpoint Medicaid Managed Care	$104.14

GRAFT GORE-TEX REM RG 6MM

Facility

$3,930.00

Hospital Charge Code	270657755
Hospital Revenue Code	278
Min. Negotiated Rate	$589.50
Max. Negotiated Rate	$951.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$786.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$951.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$864.60
Rate for Payer: Qualcare PPO/HMO/WC	$589.50

GRAFT GORE-TEX REM RG T8MM 30C

Facility

$4,935.00

Hospital Charge Code	270658089
Hospital Revenue Code	278
Min. Negotiated Rate	$118.93
Max. Negotiated Rate	$2,467.50
Rate for Payer: Aetna Commercial	$1,875.30
Rate for Payer: Aetna Medicare Advantage	$1,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,258.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,258.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$987.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,258.42
Rate for Payer: Cigna Commercial	$2,467.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,194.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,085.70
Rate for Payer: Qualcare PPO/HMO/WC	$740.25
Rate for Payer: UnitedHealthcare Community & State	$118.93
Rate for Payer: Wellpoint Medicaid Managed Care	$130.78

GRAFT GORE-TEX REM RG T8MM 30C

Facility

$4,935.00

Hospital Charge Code	270658089
Hospital Revenue Code	278
Min. Negotiated Rate	$740.25
Max. Negotiated Rate	$1,194.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$987.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,194.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,085.70
Rate for Payer: Qualcare PPO/HMO/WC	$740.25

GRAFT GORETEX RINGED 6MM 80CM

Facility

$13,635.00

Service Code	HCPCS C1768
Hospital Charge Code	270645482
Hospital Revenue Code	278
Min. Negotiated Rate	$328.60
Max. Negotiated Rate	$6,817.50
Rate for Payer: Aetna Commercial	$5,181.30
Rate for Payer: Aetna Medicare Advantage	$4,090.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,476.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,476.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,727.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,476.93
Rate for Payer: Cigna Commercial	$6,817.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,299.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,999.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,045.25
Rate for Payer: UnitedHealthcare Community & State	$328.60
Rate for Payer: Wellpoint Medicaid Managed Care	$361.33

GRAFT GORETEX RINGED 6MM 80CM

Facility

$13,635.00

Service Code	HCPCS C1768
Hospital Charge Code	270645482
Hospital Revenue Code	278
Min. Negotiated Rate	$2,045.25
Max. Negotiated Rate	$3,299.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,727.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,299.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,999.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,045.25

GRAFT GORETEX RINGED 8mm 70cm

Facility

$14,045.00

Service Code	HCPCS C1768
Hospital Charge Code	270642368
Hospital Revenue Code	278
Min. Negotiated Rate	$338.48
Max. Negotiated Rate	$7,022.50
Rate for Payer: Aetna Commercial	$5,337.10
Rate for Payer: Aetna Medicare Advantage	$4,213.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,809.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,581.47
Rate for Payer: Cigna Commercial	$7,022.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,398.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,089.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,106.75
Rate for Payer: UnitedHealthcare Community & State	$338.48
Rate for Payer: Wellpoint Medicaid Managed Care	$372.19

GRAFT GORETEX RINGED 8mm 70cm

Facility

$14,045.00

Service Code	HCPCS C1768
Hospital Charge Code	270642368
Hospital Revenue Code	278
Min. Negotiated Rate	$2,106.75
Max. Negotiated Rate	$3,398.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,809.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,398.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,089.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,106.75

GRAFT GORETEX RING LINED 6MM

Facility

$3,905.00

Hospital Charge Code	270650756
Hospital Revenue Code	278
Min. Negotiated Rate	$94.11
Max. Negotiated Rate	$1,952.50
Rate for Payer: Aetna Commercial	$1,483.90
Rate for Payer: Aetna Medicare Advantage	$1,171.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$995.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$995.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$781.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$995.77
Rate for Payer: Cigna Commercial	$1,952.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$945.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$859.10
Rate for Payer: Qualcare PPO/HMO/WC	$585.75
Rate for Payer: UnitedHealthcare Community & State	$94.11
Rate for Payer: Wellpoint Medicaid Managed Care	$103.48

GRAFT GORETEX RING LINED 6MM

Facility

$3,905.00

Hospital Charge Code	270650756
Hospital Revenue Code	278
Min. Negotiated Rate	$585.75
Max. Negotiated Rate	$945.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$781.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$945.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$859.10
Rate for Payer: Qualcare PPO/HMO/WC	$585.75

GRAFT GORETEX RING LINED 8MM

Facility

$4,995.00

Hospital Charge Code	270650762
Hospital Revenue Code	278
Min. Negotiated Rate	$120.38
Max. Negotiated Rate	$2,497.50
Rate for Payer: Aetna Commercial	$1,898.10
Rate for Payer: Aetna Medicare Advantage	$1,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,273.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,273.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,273.72
Rate for Payer: Cigna Commercial	$2,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,098.90
Rate for Payer: Qualcare PPO/HMO/WC	$749.25
Rate for Payer: UnitedHealthcare Community & State	$120.38
Rate for Payer: Wellpoint Medicaid Managed Care	$132.37

GRAFT GORETEX RING LINED 8MM

Facility

$4,995.00

Hospital Charge Code	270650762
Hospital Revenue Code	278
Min. Negotiated Rate	$749.25
Max. Negotiated Rate	$1,208.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,098.90
Rate for Payer: Qualcare PPO/HMO/WC	$749.25

GRAFT GORE-TEX STANDARD WALL

Facility

$4,935.00

Service Code	HCPCS C1768
Hospital Charge Code	270658088
Hospital Revenue Code	278
Min. Negotiated Rate	$118.93
Max. Negotiated Rate	$2,467.50
Rate for Payer: Aetna Commercial	$1,875.30
Rate for Payer: Aetna Medicare Advantage	$1,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,258.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,258.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$987.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,258.42
Rate for Payer: Cigna Commercial	$2,467.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,194.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,085.70
Rate for Payer: Qualcare PPO/HMO/WC	$740.25
Rate for Payer: UnitedHealthcare Community & State	$118.93
Rate for Payer: Wellpoint Medicaid Managed Care	$130.78

GRAFT GORE-TEX STANDARD WALL

Facility

$4,935.00

Service Code	HCPCS C1768
Hospital Charge Code	270658088
Hospital Revenue Code	278
Min. Negotiated Rate	$740.25
Max. Negotiated Rate	$1,194.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$987.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,194.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,085.70
Rate for Payer: Qualcare PPO/HMO/WC	$740.25

GRAFT GORETEX STRETCH 6-30x70

Facility

$5,650.00

Service Code	HCPCS C1768
Hospital Charge Code	270656011
Hospital Revenue Code	278
Min. Negotiated Rate	$136.16
Max. Negotiated Rate	$2,825.00
Rate for Payer: Aetna Commercial	$2,147.00
Rate for Payer: Aetna Medicare Advantage	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,440.75
Rate for Payer: Cigna Commercial	$2,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,243.00
Rate for Payer: Qualcare PPO/HMO/WC	$847.50
Rate for Payer: UnitedHealthcare Community & State	$136.16
Rate for Payer: Wellpoint Medicaid Managed Care	$149.72

GRAFT GORETEX STRETCH 6-30x70

Facility

$5,650.00

Service Code	HCPCS C1768
Hospital Charge Code	270656011
Hospital Revenue Code	278
Min. Negotiated Rate	$847.50
Max. Negotiated Rate	$1,367.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,243.00
Rate for Payer: Qualcare PPO/HMO/WC	$847.50

GRAFT GORETEX STR LINED 6mm

Facility

$3,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270650759
Hospital Revenue Code	278
Min. Negotiated Rate	$524.25
Max. Negotiated Rate	$845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$845.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$768.90
Rate for Payer: Qualcare PPO/HMO/WC	$524.25

GRAFT GORETEX STR LINED 6mm

Facility

$3,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270650759
Hospital Revenue Code	278
Min. Negotiated Rate	$84.23
Max. Negotiated Rate	$1,747.50
Rate for Payer: Aetna Commercial	$1,328.10
Rate for Payer: Aetna Medicare Advantage	$1,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$891.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$891.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$891.23
Rate for Payer: Cigna Commercial	$1,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$845.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$768.90
Rate for Payer: Qualcare PPO/HMO/WC	$524.25
Rate for Payer: UnitedHealthcare Community & State	$84.23
Rate for Payer: Wellpoint Medicaid Managed Care	$92.62

GRAFT GORETEX TH/WALL 6mm

Facility

$5,955.00

Service Code	HCPCS C1768
Hospital Charge Code	270650755
Hospital Revenue Code	278
Min. Negotiated Rate	$893.25
Max. Negotiated Rate	$1,441.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,441.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,310.10
Rate for Payer: Qualcare PPO/HMO/WC	$893.25

GRAFT GORETEX TH/WALL 6mm

Facility

$5,955.00

Service Code	HCPCS C1768
Hospital Charge Code	270650755
Hospital Revenue Code	278
Min. Negotiated Rate	$143.52
Max. Negotiated Rate	$2,977.50
Rate for Payer: Aetna Commercial	$2,262.90
Rate for Payer: Aetna Medicare Advantage	$1,786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,518.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,518.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,191.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,518.53
Rate for Payer: Cigna Commercial	$2,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,441.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,310.10
Rate for Payer: Qualcare PPO/HMO/WC	$893.25
Rate for Payer: UnitedHealthcare Community & State	$143.52
Rate for Payer: Wellpoint Medicaid Managed Care	$157.81

Know your out-of-pocket cost for care.

All Charges