Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFTGUN CARTRIDGE KIT

Facility

$6,875.00

Hospital Charge Code	270692127
Hospital Revenue Code	272
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,031.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

GRAFTGUN UNIV GDS GRAFT DEL SY

Facility

$6,750.00

Service Code	HCPCS C1763
Hospital Charge Code	270691275
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

GRAFTGUN UNIV GDS GRAFT DEL SY

Facility

$6,750.00

Service Code	HCPCS C1763
Hospital Charge Code	270691275
Hospital Revenue Code	278
Min. Negotiated Rate	$162.68
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$162.68
Rate for Payer: Wellpoint Medicaid Managed Care	$178.88

GRAFT HARVEST

Facility

$8,500.00

Hospital Charge Code	270667378
Hospital Revenue Code	272
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$1,275.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

GRAFT HARVEST

Facility

$8,500.00

Hospital Charge Code	270667378
Hospital Revenue Code	272
Min. Negotiated Rate	$204.85
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,550.00
Rate for Payer: Oxford Commercial	$1,700.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Commercial	$1,700.00
Rate for Payer: UnitedHealthcare Community & State	$204.85
Rate for Payer: Wellpoint Medicaid Managed Care	$225.25

GRAFT HEMAGARD 20mmx10mmX50cm

Facility

$3,072.90

Service Code	HCPCS C1768
Hospital Charge Code	270679499
Hospital Revenue Code	278
Min. Negotiated Rate	$460.94
Max. Negotiated Rate	$743.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$743.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$676.04
Rate for Payer: Qualcare PPO/HMO/WC	$460.94

GRAFT HEMAGARD 20mmx10mmX50cm

Facility

$3,072.90

Service Code	HCPCS C1768
Hospital Charge Code	270679499
Hospital Revenue Code	278
Min. Negotiated Rate	$74.06
Max. Negotiated Rate	$1,536.45
Rate for Payer: Aetna Commercial	$1,167.70
Rate for Payer: Aetna Medicare Advantage	$921.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$783.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$783.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$783.59
Rate for Payer: Cigna Commercial	$1,536.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$743.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$676.04
Rate for Payer: Qualcare PPO/HMO/WC	$460.94
Rate for Payer: UnitedHealthcare Community & State	$74.06
Rate for Payer: Wellpoint Medicaid Managed Care	$81.43

GRAFT HEMAGARD 6MMX 20CM

Facility

$1,672.70

Service Code	HCPCS L8670
Hospital Charge Code	270690318
Hospital Revenue Code	278
Min. Negotiated Rate	$40.31
Max. Negotiated Rate	$836.35
Rate for Payer: Aetna Commercial	$635.63
Rate for Payer: Aetna Medicare Advantage	$501.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$426.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$426.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$334.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$426.54
Rate for Payer: Cigna Commercial	$836.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$404.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$367.99
Rate for Payer: Qualcare PPO/HMO/WC	$250.91
Rate for Payer: UnitedHealthcare Community & State	$40.31
Rate for Payer: Wellpoint Medicaid Managed Care	$44.33

GRAFT HEMAGARD 6MMX 20CM

Facility

$1,672.70

Service Code	HCPCS L8670
Hospital Charge Code	270690318
Hospital Revenue Code	278
Min. Negotiated Rate	$250.91
Max. Negotiated Rate	$404.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$334.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$404.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$367.99
Rate for Payer: Qualcare PPO/HMO/WC	$250.91

GRAFT HEMASHEILD 14mmX7mmX40cm

Facility

$3,277.75

Service Code	HCPCS C1768
Hospital Charge Code	270679500
Hospital Revenue Code	278
Min. Negotiated Rate	$491.66
Max. Negotiated Rate	$793.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$721.11
Rate for Payer: Qualcare PPO/HMO/WC	$491.66

GRAFT HEMASHEILD 14mmX7mmX40cm

Facility

$3,277.75

Service Code	HCPCS C1768
Hospital Charge Code	270679500
Hospital Revenue Code	278
Min. Negotiated Rate	$78.99
Max. Negotiated Rate	$1,638.88
Rate for Payer: Aetna Commercial	$1,245.55
Rate for Payer: Aetna Medicare Advantage	$983.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$835.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$835.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$835.83
Rate for Payer: Cigna Commercial	$1,638.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$721.11
Rate for Payer: Qualcare PPO/HMO/WC	$491.66
Rate for Payer: UnitedHealthcare Community & State	$78.99
Rate for Payer: Wellpoint Medicaid Managed Care	$86.86

GRAFT HEMASHIEDL DBL VELOUR

Facility

$630.00

Hospital Charge Code	270657728
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$152.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$138.60
Rate for Payer: Qualcare PPO/HMO/WC	$94.50

GRAFT HEMASHIEDL DBL VELOUR

Facility

$630.00

Hospital Charge Code	270657728
Hospital Revenue Code	278
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Commercial	$239.40
Rate for Payer: Aetna Medicare Advantage	$189.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.65
Rate for Payer: Cigna Commercial	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$138.60
Rate for Payer: Qualcare PPO/HMO/WC	$94.50
Rate for Payer: UnitedHealthcare Community & State	$15.18
Rate for Payer: Wellpoint Medicaid Managed Care	$16.70

GRAFT HEMASHIELD 16x8mm 40cm

Facility

$3,277.75

Service Code	HCPCS C1768
Hospital Charge Code	270617414
Hospital Revenue Code	278
Min. Negotiated Rate	$491.66
Max. Negotiated Rate	$793.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$721.11
Rate for Payer: Qualcare PPO/HMO/WC	$491.66

GRAFT HEMASHIELD 16x8mm 40cm

Facility

$3,277.75

Service Code	HCPCS C1768
Hospital Charge Code	270617414
Hospital Revenue Code	278
Min. Negotiated Rate	$78.99
Max. Negotiated Rate	$1,638.88
Rate for Payer: Aetna Commercial	$1,245.55
Rate for Payer: Aetna Medicare Advantage	$983.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$835.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$835.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$835.83
Rate for Payer: Cigna Commercial	$1,638.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$721.11
Rate for Payer: Qualcare PPO/HMO/WC	$491.66
Rate for Payer: UnitedHealthcare Community & State	$78.99
Rate for Payer: Wellpoint Medicaid Managed Care	$86.86

GRAFT HEMASHIELD 18MMx9MMx40CM

Facility

$4,060.00

Hospital Charge Code	270659991
Hospital Revenue Code	278
Min. Negotiated Rate	$97.85
Max. Negotiated Rate	$2,030.00
Rate for Payer: Aetna Commercial	$1,542.80
Rate for Payer: Aetna Medicare Advantage	$1,218.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,035.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,035.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,035.30
Rate for Payer: Cigna Commercial	$2,030.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$982.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$893.20
Rate for Payer: Qualcare PPO/HMO/WC	$609.00
Rate for Payer: UnitedHealthcare Community & State	$97.85
Rate for Payer: Wellpoint Medicaid Managed Care	$107.59

GRAFT HEMASHIELD 18MMx9MMx40CM

Facility

$4,060.00

Hospital Charge Code	270659991
Hospital Revenue Code	278
Min. Negotiated Rate	$609.00
Max. Negotiated Rate	$982.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$982.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$893.20
Rate for Payer: Qualcare PPO/HMO/WC	$609.00

GRAFT HEMASHIELD 20mmX10mmX50c

Facility

$3,072.90

Service Code	HCPCS C1768
Hospital Charge Code	270679501
Hospital Revenue Code	278
Min. Negotiated Rate	$74.06
Max. Negotiated Rate	$1,536.45
Rate for Payer: Aetna Commercial	$1,167.70
Rate for Payer: Aetna Medicare Advantage	$921.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$783.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$783.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$783.59
Rate for Payer: Cigna Commercial	$1,536.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$743.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$676.04
Rate for Payer: Qualcare PPO/HMO/WC	$460.94
Rate for Payer: UnitedHealthcare Community & State	$74.06
Rate for Payer: Wellpoint Medicaid Managed Care	$81.43

GRAFT HEMASHIELD 20mmX10mmX50c

Facility

$3,072.90

Service Code	HCPCS C1768
Hospital Charge Code	270679501
Hospital Revenue Code	278
Min. Negotiated Rate	$460.94
Max. Negotiated Rate	$743.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$743.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$676.04
Rate for Payer: Qualcare PPO/HMO/WC	$460.94

GRAFT HEMASHIELD 20x10MMx40CM

Facility

$4,060.00

Hospital Charge Code	270659992
Hospital Revenue Code	278
Min. Negotiated Rate	$97.85
Max. Negotiated Rate	$2,030.00
Rate for Payer: Aetna Commercial	$1,542.80
Rate for Payer: Aetna Medicare Advantage	$1,218.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,035.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,035.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,035.30
Rate for Payer: Cigna Commercial	$2,030.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$982.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$893.20
Rate for Payer: Qualcare PPO/HMO/WC	$609.00
Rate for Payer: UnitedHealthcare Community & State	$97.85
Rate for Payer: Wellpoint Medicaid Managed Care	$107.59

GRAFT HEMASHIELD 20x10MMx40CM

Facility

$4,060.00

Hospital Charge Code	270659992
Hospital Revenue Code	278
Min. Negotiated Rate	$609.00
Max. Negotiated Rate	$982.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$982.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$893.20
Rate for Payer: Qualcare PPO/HMO/WC	$609.00

GRAFT HEMASHIELD 24x12mm 40cm

Facility

$4,062.25

Service Code	HCPCS C1768
Hospital Charge Code	270657648
Hospital Revenue Code	278
Min. Negotiated Rate	$609.34
Max. Negotiated Rate	$983.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$983.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$893.70
Rate for Payer: Qualcare PPO/HMO/WC	$609.34

GRAFT HEMASHIELD 24x12mm 40cm

Facility

$4,062.25

Service Code	HCPCS C1768
Hospital Charge Code	270657648
Hospital Revenue Code	278
Min. Negotiated Rate	$97.90
Max. Negotiated Rate	$2,031.12
Rate for Payer: Aetna Commercial	$1,543.65
Rate for Payer: Aetna Medicare Advantage	$1,218.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,035.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,035.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,035.87
Rate for Payer: Cigna Commercial	$2,031.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$983.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$893.70
Rate for Payer: Qualcare PPO/HMO/WC	$609.34
Rate for Payer: UnitedHealthcare Community & State	$97.90
Rate for Payer: Wellpoint Medicaid Managed Care	$107.65

GRAFT HEMASHIELD 28X30 175428P

Facility

$2,941.85

Hospital Charge Code	270623781
Hospital Revenue Code	278
Min. Negotiated Rate	$441.28
Max. Negotiated Rate	$711.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$588.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$711.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$647.21
Rate for Payer: Qualcare PPO/HMO/WC	$441.28

GRAFT HEMASHIELD 28X30 175428P

Facility

$2,941.85

Hospital Charge Code	270623781
Hospital Revenue Code	278
Min. Negotiated Rate	$70.90
Max. Negotiated Rate	$1,470.92
Rate for Payer: Aetna Commercial	$1,117.90
Rate for Payer: Aetna Medicare Advantage	$882.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$750.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$750.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$588.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$750.17
Rate for Payer: Cigna Commercial	$1,470.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$711.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$647.21
Rate for Payer: Qualcare PPO/HMO/WC	$441.28
Rate for Payer: UnitedHealthcare Community & State	$70.90
Rate for Payer: Wellpoint Medicaid Managed Care	$77.96

Know your out-of-pocket cost for care.

All Charges