Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT GTX RG 8 60 R08050060L**

Facility

$1,163.00

Hospital Charge Code	1607159
Hospital Revenue Code	278
Min. Negotiated Rate	$28.03
Max. Negotiated Rate	$581.50
Rate for Payer: Aetna Commercial	$441.94
Rate for Payer: Aetna Medicare Advantage	$348.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.56
Rate for Payer: Cigna Commercial	$581.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$255.86
Rate for Payer: Qualcare PPO/HMO/WC	$174.45
Rate for Payer: UnitedHealthcare Community & State	$28.03
Rate for Payer: Wellpoint Medicaid Managed Care	$30.82

GRAFT GTX RG 8 60 R08050060L**

Facility

$1,163.00

Hospital Charge Code	1607159
Hospital Revenue Code	278
Min. Negotiated Rate	$174.45
Max. Negotiated Rate	$281.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$255.86
Rate for Payer: Qualcare PPO/HMO/WC	$174.45

GRAFT GTX RG 8 70 R08070070L**

Facility

$1,559.00

Hospital Charge Code	1607167
Hospital Revenue Code	278
Min. Negotiated Rate	$233.85
Max. Negotiated Rate	$377.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$311.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$342.98
Rate for Payer: Qualcare PPO/HMO/WC	$233.85

GRAFT GTX RG 8 70 R08070070L**

Facility

$1,559.00

Hospital Charge Code	1607167
Hospital Revenue Code	278
Min. Negotiated Rate	$37.57
Max. Negotiated Rate	$779.50
Rate for Payer: Aetna Commercial	$592.42
Rate for Payer: Aetna Medicare Advantage	$467.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$397.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$397.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$311.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$397.55
Rate for Payer: Cigna Commercial	$779.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$342.98
Rate for Payer: Qualcare PPO/HMO/WC	$233.85
Rate for Payer: UnitedHealthcare Community & State	$37.57
Rate for Payer: Wellpoint Medicaid Managed Care	$41.31

GRAFT GTX RG 8 70 R08070070L

Facility

$8,415.00

Hospital Charge Code	270601133
Hospital Revenue Code	278
Min. Negotiated Rate	$1,262.25
Max. Negotiated Rate	$2,036.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,683.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,036.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,851.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,262.25

GRAFT GTX RG 8 70 R08070070L

Facility

$8,415.00

Hospital Charge Code	270601133
Hospital Revenue Code	278
Min. Negotiated Rate	$202.80
Max. Negotiated Rate	$4,207.50
Rate for Payer: Aetna Commercial	$3,197.70
Rate for Payer: Aetna Medicare Advantage	$2,524.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,145.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,145.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,145.82
Rate for Payer: Cigna Commercial	$4,207.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,036.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,851.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,262.25
Rate for Payer: UnitedHealthcare Community & State	$202.80
Rate for Payer: Wellpoint Medicaid Managed Care	$223.00

GRAFT GTX RINGED*********

Facility

$1,559.00

Hospital Charge Code	1810050
Hospital Revenue Code	279
Min. Negotiated Rate	$37.57
Max. Negotiated Rate	$779.50
Rate for Payer: Aetna Commercial	$592.42
Rate for Payer: Aetna Medicare Advantage	$467.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$397.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$397.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$397.55
Rate for Payer: Cigna Commercial	$779.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.70
Rate for Payer: Oxford Commercial	$311.80
Rate for Payer: Qualcare PPO/HMO/WC	$233.85
Rate for Payer: UnitedHealthcare Commercial	$311.80
Rate for Payer: UnitedHealthcare Community & State	$37.57
Rate for Payer: Wellpoint Medicaid Managed Care	$41.31

GRAFT GTX RINGED*********

Facility

$1,559.00

Hospital Charge Code	1810050
Hospital Revenue Code	279
Min. Negotiated Rate	$233.85
Max. Negotiated Rate	$233.85
Rate for Payer: Qualcare PPO/HMO/WC	$233.85

GRAFT GTX RTW 8 70 RT08050070L

Facility

$6,985.00

Hospital Charge Code	270601134
Hospital Revenue Code	278
Min. Negotiated Rate	$1,047.75
Max. Negotiated Rate	$1,690.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,397.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,690.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,536.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,047.75

GRAFT GTX RTW 8 70 RT08050070L

Facility

$6,985.00

Hospital Charge Code	270601134
Hospital Revenue Code	278
Min. Negotiated Rate	$168.34
Max. Negotiated Rate	$3,492.50
Rate for Payer: Aetna Commercial	$2,654.30
Rate for Payer: Aetna Medicare Advantage	$2,095.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,781.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,781.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,781.17
Rate for Payer: Cigna Commercial	$3,492.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,690.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,536.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,047.75
Rate for Payer: UnitedHealthcare Community & State	$168.34
Rate for Payer: Wellpoint Medicaid Managed Care	$185.10

GRAFT GTX STR SR006005045L****

Facility

$938.00

Hospital Charge Code	1607183
Hospital Revenue Code	278
Min. Negotiated Rate	$22.61
Max. Negotiated Rate	$469.00
Rate for Payer: Aetna Commercial	$356.44
Rate for Payer: Aetna Medicare Advantage	$281.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$239.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$239.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$187.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$239.19
Rate for Payer: Cigna Commercial	$469.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$206.36
Rate for Payer: Qualcare PPO/HMO/WC	$140.70
Rate for Payer: UnitedHealthcare Community & State	$22.61
Rate for Payer: Wellpoint Medicaid Managed Care	$24.86

GRAFT GTX STR SR006005045L****

Facility

$938.00

Hospital Charge Code	1607183
Hospital Revenue Code	278
Min. Negotiated Rate	$140.70
Max. Negotiated Rate	$227.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$187.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$206.36
Rate for Payer: Qualcare PPO/HMO/WC	$140.70

GRAFT GTX T2-VT08080L *******

Facility

$1,131.00

Hospital Charge Code	1607175
Hospital Revenue Code	251
Min. Negotiated Rate	$169.65
Max. Negotiated Rate	$169.65
Rate for Payer: Qualcare PPO/HMO/WC	$169.65

GRAFT GTX T2-VT08080L *******

Facility

$1,131.00

Hospital Charge Code	1607175
Hospital Revenue Code	251
Min. Negotiated Rate	$27.26
Max. Negotiated Rate	$565.50
Rate for Payer: Aetna Commercial	$429.78
Rate for Payer: Aetna Medicare Advantage	$339.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$288.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$288.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$288.40
Rate for Payer: Cigna Commercial	$565.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.30
Rate for Payer: Oxford Commercial	$226.20
Rate for Payer: Qualcare PPO/HMO/WC	$169.65
Rate for Payer: UnitedHealthcare Commercial	$226.20
Rate for Payer: UnitedHealthcare Community & State	$27.26
Rate for Payer: Wellpoint Medicaid Managed Care	$29.97

GRAFT GTX TH WL 6 80 VT06080L*

Facility

$3,947.00

Hospital Charge Code	1604073
Hospital Revenue Code	278
Min. Negotiated Rate	$95.12
Max. Negotiated Rate	$1,973.50
Rate for Payer: Aetna Commercial	$1,499.86
Rate for Payer: Aetna Medicare Advantage	$1,184.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,006.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,006.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$789.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,006.49
Rate for Payer: Cigna Commercial	$1,973.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$955.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$868.34
Rate for Payer: Qualcare PPO/HMO/WC	$592.05
Rate for Payer: UnitedHealthcare Community & State	$95.12
Rate for Payer: Wellpoint Medicaid Managed Care	$104.60

GRAFT GTX TH WL 6 80 VT06080L*

Facility

$3,947.00

Hospital Charge Code	1604073
Hospital Revenue Code	278
Min. Negotiated Rate	$592.05
Max. Negotiated Rate	$955.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$789.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$955.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$868.34
Rate for Payer: Qualcare PPO/HMO/WC	$592.05

GRAFT GTX TH WL 6 80 VT06080L

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270601130
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

GRAFT GTX TH WL 6 80 VT06080L

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270601130
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 GTX TH WL 6 90 ********

Facility

$5,064.00

Hospital Charge Code	1604123
Hospital Revenue Code	278
Min. Negotiated Rate	$122.04
Max. Negotiated Rate	$2,532.00
Rate for Payer: Aetna Commercial	$1,924.32
Rate for Payer: Aetna Medicare Advantage	$1,519.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,291.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,291.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,012.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,291.32
Rate for Payer: Cigna Commercial	$2,532.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,225.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,114.08
Rate for Payer: Qualcare PPO/HMO/WC	$759.60
Rate for Payer: UnitedHealthcare Community & State	$122.04
Rate for Payer: Wellpoint Medicaid Managed Care	$134.20

GRAFT GTX TH WL 6 90 ********

Facility

$5,064.00

Hospital Charge Code	1604123
Hospital Revenue Code	278
Min. Negotiated Rate	$759.60
Max. Negotiated Rate	$1,225.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,012.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,225.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,114.08
Rate for Payer: Qualcare PPO/HMO/WC	$759.60

GRAFT GTX TH WL 8 80 VT08080L

Facility

$3,356.85

Hospital Charge Code	270605530
Hospital Revenue Code	278
Min. Negotiated Rate	$503.53
Max. Negotiated Rate	$812.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$671.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$812.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$738.51
Rate for Payer: Qualcare PPO/HMO/WC	$503.53

GRAFT GTX TH WL 8 80 VT08080L

Facility

$3,356.85

Hospital Charge Code	270605530
Hospital Revenue Code	278
Min. Negotiated Rate	$80.90
Max. Negotiated Rate	$1,678.42
Rate for Payer: Aetna Commercial	$1,275.60
Rate for Payer: Aetna Medicare Advantage	$1,007.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$856.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$856.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$671.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$856.00
Rate for Payer: Cigna Commercial	$1,678.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$812.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$738.51
Rate for Payer: Qualcare PPO/HMO/WC	$503.53
Rate for Payer: UnitedHealthcare Community & State	$80.90
Rate for Payer: Wellpoint Medicaid Managed Care	$88.96

GRAFT GTX TH WL R 8X70CM******

Facility

$4,441.00

Hospital Charge Code	1603935
Hospital Revenue Code	278
Min. Negotiated Rate	$107.03
Max. Negotiated Rate	$2,220.50
Rate for Payer: Aetna Commercial	$1,687.58
Rate for Payer: Aetna Medicare Advantage	$1,332.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,132.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,132.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$888.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,132.45
Rate for Payer: Cigna Commercial	$2,220.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,074.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$977.02
Rate for Payer: Qualcare PPO/HMO/WC	$666.15
Rate for Payer: UnitedHealthcare Community & State	$107.03
Rate for Payer: Wellpoint Medicaid Managed Care	$117.69

GRAFT GTX TH WL R 8X70CM******

Facility

$4,441.00

Hospital Charge Code	1603935
Hospital Revenue Code	278
Min. Negotiated Rate	$666.15
Max. Negotiated Rate	$1,074.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$888.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,074.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$977.02
Rate for Payer: Qualcare PPO/HMO/WC	$666.15

GRAFTGUN CARTRIDGE KIT

Facility

$6,875.00

Hospital Charge Code	270692127
Hospital Revenue Code	272
Min. Negotiated Rate	$165.69
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,612.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,062.50
Rate for Payer: Oxford Commercial	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25
Rate for Payer: UnitedHealthcare Commercial	$1,375.00
Rate for Payer: UnitedHealthcare Community & State	$165.69
Rate for Payer: Wellpoint Medicaid Managed Care	$182.19

Know your out-of-pocket cost for care.

All Charges