Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT HEMASHIELD 8 X 15

Facility

$2,950.00

Service Code	HCPCS C1768
Hospital Charge Code	270686403
Hospital Revenue Code	278
Min. Negotiated Rate	$71.09
Max. Negotiated Rate	$1,475.00
Rate for Payer: Aetna Commercial	$1,121.00
Rate for Payer: Aetna Medicare Advantage	$885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.25
Rate for Payer: Cigna Commercial	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$649.00
Rate for Payer: Qualcare PPO/HMO/WC	$442.50
Rate for Payer: UnitedHealthcare Community & State	$71.09
Rate for Payer: Wellpoint Medicaid Managed Care	$78.17

GRAFT HEMASHIELD 8 X 15

Facility

$2,950.00

Service Code	HCPCS C1768
Hospital Charge Code	270686403
Hospital Revenue Code	278
Min. Negotiated Rate	$442.50
Max. Negotiated Rate	$713.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$649.00
Rate for Payer: Qualcare PPO/HMO/WC	$442.50

GRAFT HEMASHIELD 8 X 30

Facility

$2,950.00

Service Code	HCPCS C1768
Hospital Charge Code	270686402
Hospital Revenue Code	278
Min. Negotiated Rate	$71.09
Max. Negotiated Rate	$1,475.00
Rate for Payer: Aetna Commercial	$1,121.00
Rate for Payer: Aetna Medicare Advantage	$885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.25
Rate for Payer: Cigna Commercial	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$649.00
Rate for Payer: Qualcare PPO/HMO/WC	$442.50
Rate for Payer: UnitedHealthcare Community & State	$71.09
Rate for Payer: Wellpoint Medicaid Managed Care	$78.17

GRAFT HEMASHIELD 8 X 30

Facility

$2,950.00

Service Code	HCPCS C1768
Hospital Charge Code	270686402
Hospital Revenue Code	278
Min. Negotiated Rate	$442.50
Max. Negotiated Rate	$713.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$649.00
Rate for Payer: Qualcare PPO/HMO/WC	$442.50

GRAFT HEMASHIELD DBL 12X7MM

Facility

$2,952.40

Hospital Charge Code	270654636
Hospital Revenue Code	278
Min. Negotiated Rate	$442.86
Max. Negotiated Rate	$714.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$714.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$649.53
Rate for Payer: Qualcare PPO/HMO/WC	$442.86

GRAFT HEMASHIELD DBL 12X7MM

Facility

$2,952.40

Hospital Charge Code	270654636
Hospital Revenue Code	278
Min. Negotiated Rate	$71.15
Max. Negotiated Rate	$1,476.20
Rate for Payer: Aetna Commercial	$1,121.91
Rate for Payer: Aetna Medicare Advantage	$885.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.86
Rate for Payer: Cigna Commercial	$1,476.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$714.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$649.53
Rate for Payer: Qualcare PPO/HMO/WC	$442.86
Rate for Payer: UnitedHealthcare Community & State	$71.15
Rate for Payer: Wellpoint Medicaid Managed Care	$78.24

GRAFT HEMASHIELD DBL 14X7MM

Facility

$2,952.40

Service Code	HCPCS C1768
Hospital Charge Code	270654637
Hospital Revenue Code	278
Min. Negotiated Rate	$71.15
Max. Negotiated Rate	$1,476.20
Rate for Payer: Aetna Commercial	$1,121.91
Rate for Payer: Aetna Medicare Advantage	$885.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.86
Rate for Payer: Cigna Commercial	$1,476.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$714.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$649.53
Rate for Payer: Qualcare PPO/HMO/WC	$442.86
Rate for Payer: UnitedHealthcare Community & State	$71.15
Rate for Payer: Wellpoint Medicaid Managed Care	$78.24

GRAFT HEMASHIELD DBL 14X7MM

Facility

$2,952.40

Service Code	HCPCS C1768
Hospital Charge Code	270654637
Hospital Revenue Code	278
Min. Negotiated Rate	$442.86
Max. Negotiated Rate	$714.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$714.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$649.53
Rate for Payer: Qualcare PPO/HMO/WC	$442.86

GRAFT HEMASHIELD DBL 7mm 60cm

Facility

$2,950.00

Hospital Charge Code	270655936
Hospital Revenue Code	278
Min. Negotiated Rate	$71.09
Max. Negotiated Rate	$1,475.00
Rate for Payer: Aetna Commercial	$1,121.00
Rate for Payer: Aetna Medicare Advantage	$885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.25
Rate for Payer: Cigna Commercial	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$649.00
Rate for Payer: Qualcare PPO/HMO/WC	$442.50
Rate for Payer: UnitedHealthcare Community & State	$71.09
Rate for Payer: Wellpoint Medicaid Managed Care	$78.17

GRAFT HEMASHIELD DBL 7mm 60cm

Facility

$2,950.00

Hospital Charge Code	270655936
Hospital Revenue Code	278
Min. Negotiated Rate	$442.50
Max. Negotiated Rate	$713.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$649.00
Rate for Payer: Qualcare PPO/HMO/WC	$442.50

GRAFT HEMASHIELD GOLD D 14X8MM

Facility

$4,062.25

Service Code	HCPCS C1768
Hospital Charge Code	270659527
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 GOLD D 14X8MM

Facility

$4,062.25

Service Code	HCPCS C1768
Hospital Charge Code	270659527
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 HEMASHLD GOLD 22/11 40cm

Facility

$3,277.75

Service Code	HCPCS C1768
Hospital Charge Code	270601119
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 HEMASHLD GOLD 22/11 40cm

Facility

$3,277.75

Service Code	HCPCS C1768
Hospital Charge Code	270601119
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 HEMASH PLATINUM 28MM60CM

Facility

$3,482.60

Hospital Charge Code	270678250
Hospital Revenue Code	278
Min. Negotiated Rate	$522.39
Max. Negotiated Rate	$842.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$696.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$842.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$766.17
Rate for Payer: Qualcare PPO/HMO/WC	$522.39

GRAFT HEMASH PLATINUM 28MM60CM

Facility

$3,482.60

Hospital Charge Code	270678250
Hospital Revenue Code	278
Min. Negotiated Rate	$83.93
Max. Negotiated Rate	$1,741.30
Rate for Payer: Aetna Commercial	$1,323.39
Rate for Payer: Aetna Medicare Advantage	$1,044.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$888.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$888.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$696.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$888.06
Rate for Payer: Cigna Commercial	$1,741.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$842.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$766.17
Rate for Payer: Qualcare PPO/HMO/WC	$522.39
Rate for Payer: UnitedHealthcare Community & State	$83.93
Rate for Payer: Wellpoint Medicaid Managed Care	$92.29

GRAFT HEMOSHILD PLATINUM 20MM

Facility

$2,575.75

Hospital Charge Code	270663695
Hospital Revenue Code	278
Min. Negotiated Rate	$386.36
Max. Negotiated Rate	$623.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$515.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$623.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$566.66
Rate for Payer: Qualcare PPO/HMO/WC	$386.36

GRAFT HEMOSHILD PLATINUM 20MM

Facility

$2,575.75

Hospital Charge Code	270663695
Hospital Revenue Code	278
Min. Negotiated Rate	$62.08
Max. Negotiated Rate	$1,287.88
Rate for Payer: Aetna Commercial	$978.78
Rate for Payer: Aetna Medicare Advantage	$772.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$656.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$656.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$515.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$656.82
Rate for Payer: Cigna Commercial	$1,287.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$623.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$566.66
Rate for Payer: Qualcare PPO/HMO/WC	$386.36
Rate for Payer: UnitedHealthcare Community & State	$62.08
Rate for Payer: Wellpoint Medicaid Managed Care	$68.26

GRAFT HERN REPAIR 20x20 G29683

Facility

$7,415.25

Hospital Charge Code	270635029
Hospital Revenue Code	278
Min. Negotiated Rate	$1,112.29
Max. Negotiated Rate	$1,794.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,483.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,794.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,631.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,112.29

GRAFT HERN REPAIR 20x20 G29683

Facility

$7,415.25

Hospital Charge Code	270635029
Hospital Revenue Code	278
Min. Negotiated Rate	$178.71
Max. Negotiated Rate	$3,707.62
Rate for Payer: Aetna Commercial	$2,817.80
Rate for Payer: Aetna Medicare Advantage	$2,224.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,890.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,890.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,483.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,890.89
Rate for Payer: Cigna Commercial	$3,707.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,794.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,631.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,112.29
Rate for Payer: UnitedHealthcare Community & State	$178.71
Rate for Payer: Wellpoint Medicaid Managed Care	$196.50

GRAFT HMASHLD WDF 30X30 175430

Facility

$2,624.85

Hospital Charge Code	270623783
Hospital Revenue Code	278
Min. Negotiated Rate	$63.26
Max. Negotiated Rate	$1,312.42
Rate for Payer: Aetna Commercial	$997.44
Rate for Payer: Aetna Medicare Advantage	$787.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$524.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.34
Rate for Payer: Cigna Commercial	$1,312.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$577.47
Rate for Payer: Qualcare PPO/HMO/WC	$393.73
Rate for Payer: UnitedHealthcare Community & State	$63.26
Rate for Payer: Wellpoint Medicaid Managed Care	$69.56

GRAFT HMASHLD WDF 30X30 175430

Facility

$2,624.85

Hospital Charge Code	270623783
Hospital Revenue Code	278
Min. Negotiated Rate	$393.73
Max. Negotiated Rate	$635.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$524.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$577.47
Rate for Payer: Qualcare PPO/HMO/WC	$393.73

GRAFT HUMAN 3MM X 3CM

Facility

$10,625.00

Hospital Charge Code	270665996
Hospital Revenue Code	278
Min. Negotiated Rate	$1,593.75
Max. Negotiated Rate	$2,571.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,337.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75

GRAFT HUMAN 3MM X 3CM

Facility

$10,625.00

Hospital Charge Code	270665996
Hospital Revenue Code	278
Min. Negotiated Rate	$256.06
Max. Negotiated Rate	$5,312.50
Rate for Payer: Aetna Commercial	$4,037.50
Rate for Payer: Aetna Medicare Advantage	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,709.38
Rate for Payer: Cigna Commercial	$5,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,337.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75
Rate for Payer: UnitedHealthcare Community & State	$256.06
Rate for Payer: Wellpoint Medicaid Managed Care	$281.56

GRAFT HYBRD VASC 0650HYB0905A

Facility

$12,555.00

Hospital Charge Code	270658659
Hospital Revenue Code	278
Min. Negotiated Rate	$302.58
Max. Negotiated Rate	$6,277.50
Rate for Payer: Aetna Commercial	$4,770.90
Rate for Payer: Aetna Medicare Advantage	$3,766.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,201.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,201.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,511.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,201.53
Rate for Payer: Cigna Commercial	$6,277.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,038.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,762.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,883.25
Rate for Payer: UnitedHealthcare Community & State	$302.58
Rate for Payer: Wellpoint Medicaid Managed Care	$332.71

Know your out-of-pocket cost for care.

All Charges