Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT JACKET 4x4 86TM4X4

Facility

$6,423.25

Hospital Charge Code	270634533
Hospital Revenue Code	272
Min. Negotiated Rate	$963.49
Max. Negotiated Rate	$963.49
Rate for Payer: Qualcare PPO/HMO/WC	$963.49

GRAFT JACKET 4 X 8 MM

Facility

$12,795.00

Hospital Charge Code	270689582
Hospital Revenue Code	272
Min. Negotiated Rate	$1,919.25
Max. Negotiated Rate	$1,919.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,919.25

GRAFT JACKET 4 X 8 MM

Facility

$12,795.00

Hospital Charge Code	270689582
Hospital Revenue Code	272
Min. Negotiated Rate	$308.36
Max. Negotiated Rate	$6,397.50
Rate for Payer: Aetna Commercial	$4,862.10
Rate for Payer: Aetna Medicare Advantage	$3,838.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,262.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,262.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,262.72
Rate for Payer: Cigna Commercial	$6,397.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,838.50
Rate for Payer: Oxford Commercial	$2,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,919.25
Rate for Payer: UnitedHealthcare Commercial	$2,559.00
Rate for Payer: UnitedHealthcare Community & State	$308.36
Rate for Payer: Wellpoint Medicaid Managed Care	$339.07

GRAFTJACKET EXPRESS 2CC

Facility

$11,000.00

Service Code	HCPCS Q4113
Hospital Charge Code	270659717
Hospital Revenue Code	278
Min. Negotiated Rate	$265.10
Max. Negotiated Rate	$5,500.00
Rate for Payer: Aetna Commercial	$4,180.00
Rate for Payer: Aetna Medicare Advantage	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,805.00
Rate for Payer: Cigna Commercial	$5,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,662.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00
Rate for Payer: UnitedHealthcare Community & State	$265.10
Rate for Payer: Wellpoint Medicaid Managed Care	$291.50

GRAFTJACKET EXPRESS 2CC

Facility

$11,000.00

Service Code	HCPCS Q4113
Hospital Charge Code	270659717
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$2,662.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,662.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00

GRAFTJACKET EXPRESS 2CC/1CCJW

Facility

$5,500.00

Hospital Charge Code	270659717W
Hospital Revenue Code	636
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

GRAFTJACKET EXPRESS 2CC/1CCJW

Facility

$5,500.00

Hospital Charge Code	270659717W
Hospital Revenue Code	636
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

GRAFT JACKET NOW STANDARD 4X4C

Facility

$11,535.00

Service Code	HCPCS Q4107
Hospital Charge Code	270687972
Hospital Revenue Code	278
Min. Negotiated Rate	$1,730.25
Max. Negotiated Rate	$2,791.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,307.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,791.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,537.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,730.25

GRAFT JACKET NOW STANDARD 4X4C

Facility

$11,535.00

Service Code	HCPCS Q4107
Hospital Charge Code	270687972
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,791.47
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,307.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,791.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,537.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,730.25
Rate for Payer: UnitedHealthcare Community & State	$277.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$305.68

GRAFTJACKET TISSUE 4 X 7

Facility

$10,710.00

Service Code	HCPCS Q4107
Hospital Charge Code	270652320
Hospital Revenue Code	278
Min. Negotiated Rate	$1,606.50
Max. Negotiated Rate	$2,591.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,142.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,591.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,356.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,606.50

GRAFTJACKET TISSUE 4 X 7

Facility

$10,710.00

Service Code	HCPCS Q4107
Hospital Charge Code	270652320
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,591.82
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,142.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,591.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,356.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,606.50
Rate for Payer: UnitedHealthcare Community & State	$258.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$283.81

GRAFTJACKET TISSUE 5 X 5

Facility

$9,765.00

Service Code	HCPCS Q4107
Hospital Charge Code	270652321
Hospital Revenue Code	278
Min. Negotiated Rate	$1,464.75
Max. Negotiated Rate	$2,363.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,953.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,363.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,148.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,464.75

GRAFTJACKET TISSUE 5 X 5

Facility

$9,765.00

Service Code	HCPCS Q4107
Hospital Charge Code	270652321
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,363.13
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,953.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,363.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,148.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,464.75
Rate for Payer: UnitedHealthcare Community & State	$235.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$258.77

GRAFT LC ALLODERM 4X5 102025

Facility

$1,289.65

Hospital Charge Code	270628039
Hospital Revenue Code	636
Min. Negotiated Rate	$31.08
Max. Negotiated Rate	$644.83
Rate for Payer: Aetna Commercial	$490.07
Rate for Payer: Aetna Medicare Advantage	$386.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$328.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$328.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$328.86
Rate for Payer: Cigna Commercial	$644.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$312.10
Rate for Payer: Qualcare PPO/HMO/WC	$193.45
Rate for Payer: UnitedHealthcare Community & State	$31.08
Rate for Payer: Wellpoint Medicaid Managed Care	$34.18

GRAFT LC ALLODERM 4X5 102025

Facility

$1,289.65

Hospital Charge Code	270628039
Hospital Revenue Code	636
Min. Negotiated Rate	$193.45
Max. Negotiated Rate	$312.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$312.10
Rate for Payer: Qualcare PPO/HMO/WC	$193.45

GRAFT LC ALLODERM 6X8 101010

Facility

$2,235.65

Hospital Charge Code	270623614
Hospital Revenue Code	636
Min. Negotiated Rate	$53.88
Max. Negotiated Rate	$1,117.83
Rate for Payer: Aetna Commercial	$849.55
Rate for Payer: Aetna Medicare Advantage	$670.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.09
Rate for Payer: Cigna Commercial	$1,117.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$541.03
Rate for Payer: Qualcare PPO/HMO/WC	$335.35
Rate for Payer: UnitedHealthcare Community & State	$53.88
Rate for Payer: Wellpoint Medicaid Managed Care	$59.24

GRAFT LC ALLODERM 6X8 101010

Facility

$2,235.65

Hospital Charge Code	270623614
Hospital Revenue Code	636
Min. Negotiated Rate	$335.35
Max. Negotiated Rate	$541.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$541.03
Rate for Payer: Qualcare PPO/HMO/WC	$335.35

GRAFT LENEVA 1.5CC

Facility

$5,937.50

Service Code	HCPCS J3590
Hospital Charge Code	270701098
Hospital Revenue Code	278
Min. Negotiated Rate	$143.09
Max. Negotiated Rate	$2,968.75
Rate for Payer: Aetna Commercial	$2,256.25
Rate for Payer: Aetna Medicare Advantage	$1,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,514.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,514.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,514.06
Rate for Payer: Cigna Commercial	$2,968.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,436.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,306.25
Rate for Payer: Qualcare PPO/HMO/WC	$890.62
Rate for Payer: UnitedHealthcare Community & State	$143.09
Rate for Payer: Wellpoint Medicaid Managed Care	$157.34

GRAFT LENEVA 1.5CC

Facility

$5,937.50

Service Code	HCPCS J3590
Hospital Charge Code	270701098
Hospital Revenue Code	278
Min. Negotiated Rate	$890.62
Max. Negotiated Rate	$1,436.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,436.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,306.25
Rate for Payer: Qualcare PPO/HMO/WC	$890.62

GRAFT LENEVA ADIPOSE MATRIX3CC

Facility

$11,850.00

Service Code	HCPCS J3590
Hospital Charge Code	270697048
Hospital Revenue Code	636
Min. Negotiated Rate	$1,777.50
Max. Negotiated Rate	$2,867.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,867.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,777.50

GRAFT LENEVA ADIPOSE MATRIX3CC

Facility

$11,850.00

Service Code	HCPCS J3590
Hospital Charge Code	270697048
Hospital Revenue Code	636
Min. Negotiated Rate	$285.58
Max. Negotiated Rate	$5,925.00
Rate for Payer: Aetna Commercial	$4,503.00
Rate for Payer: Aetna Medicare Advantage	$3,555.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,021.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,021.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,021.75
Rate for Payer: Cigna Commercial	$5,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,867.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,777.50
Rate for Payer: UnitedHealthcare Community & State	$285.58
Rate for Payer: Wellpoint Medicaid Managed Care	$314.02

GRAFT LG AAA ILI ZENH TFLE2054

Facility

$13,392.00

Hospital Charge Code	270633656
Hospital Revenue Code	278
Min. Negotiated Rate	$322.75
Max. Negotiated Rate	$6,696.00
Rate for Payer: Aetna Commercial	$5,088.96
Rate for Payer: Aetna Medicare Advantage	$4,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,678.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,414.96
Rate for Payer: Cigna Commercial	$6,696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,946.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80
Rate for Payer: UnitedHealthcare Community & State	$322.75
Rate for Payer: Wellpoint Medicaid Managed Care	$354.89

GRAFT LG AAA ILI ZENH TFLE2054

Facility

$13,392.00

Hospital Charge Code	270633656
Hospital Revenue Code	278
Min. Negotiated Rate	$2,008.80
Max. Negotiated Rate	$3,240.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,678.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,946.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80

GRAFT LG AAA ILI ZENH TFLE2071

Facility

$13,392.00

Hospital Charge Code	270633657
Hospital Revenue Code	278
Min. Negotiated Rate	$322.75
Max. Negotiated Rate	$6,696.00
Rate for Payer: Aetna Commercial	$5,088.96
Rate for Payer: Aetna Medicare Advantage	$4,017.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,414.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,678.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,414.96
Rate for Payer: Cigna Commercial	$6,696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,946.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80
Rate for Payer: UnitedHealthcare Community & State	$322.75
Rate for Payer: Wellpoint Medicaid Managed Care	$354.89

GRAFT LG AAA ILI ZENH TFLE2071

Facility

$13,392.00

Hospital Charge Code	270633657
Hospital Revenue Code	278
Min. Negotiated Rate	$2,008.80
Max. Negotiated Rate	$3,240.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,678.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,946.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,008.80

Know your out-of-pocket cost for care.

All Charges