Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT LIM AFXZ 16X16X55 CM

Facility

$16,450.00

Service Code	HCPCS C1768
Hospital Charge Code	270684062
Hospital Revenue Code	278
Min. Negotiated Rate	$396.44
Max. Negotiated Rate	$8,225.00
Rate for Payer: Aetna Commercial	$6,251.00
Rate for Payer: Aetna Medicare Advantage	$4,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,194.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,194.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,194.75
Rate for Payer: Cigna Commercial	$8,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,980.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,619.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,467.50
Rate for Payer: UnitedHealthcare Community & State	$396.44
Rate for Payer: Wellpoint Medicaid Managed Care	$435.93

GRAFT LIM AFXZ 16X16X55 CM

Facility

$16,450.00

Service Code	HCPCS C1768
Hospital Charge Code	270684062
Hospital Revenue Code	278
Min. Negotiated Rate	$2,467.50
Max. Negotiated Rate	$3,980.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,980.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,619.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,467.50

GRAFT LIM AFXZ 16X 16 X 88

Facility

$16,450.00

Service Code	HCPCS C1768
Hospital Charge Code	270684071
Hospital Revenue Code	278
Min. Negotiated Rate	$396.44
Max. Negotiated Rate	$8,225.00
Rate for Payer: Aetna Commercial	$6,251.00
Rate for Payer: Aetna Medicare Advantage	$4,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,194.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,194.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,194.75
Rate for Payer: Cigna Commercial	$8,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,980.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,619.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,467.50
Rate for Payer: UnitedHealthcare Community & State	$396.44
Rate for Payer: Wellpoint Medicaid Managed Care	$435.93

GRAFT LIM AFXZ 16X 16 X 88

Facility

$16,450.00

Service Code	HCPCS C1768
Hospital Charge Code	270684071
Hospital Revenue Code	278
Min. Negotiated Rate	$2,467.50
Max. Negotiated Rate	$3,980.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,980.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,619.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,467.50

GRAFT LIMB EXTN 20mmx13x88mm

Facility

$16,450.00

Service Code	HCPCS C1768
Hospital Charge Code	270680044
Hospital Revenue Code	278
Min. Negotiated Rate	$396.44
Max. Negotiated Rate	$8,225.00
Rate for Payer: Aetna Commercial	$6,251.00
Rate for Payer: Aetna Medicare Advantage	$4,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,194.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,194.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,194.75
Rate for Payer: Cigna Commercial	$8,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,980.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,619.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,467.50
Rate for Payer: UnitedHealthcare Community & State	$396.44
Rate for Payer: Wellpoint Medicaid Managed Care	$435.93

GRAFT LIMB EXTN 20mmx13x88mm

Facility

$16,450.00

Service Code	HCPCS C1768
Hospital Charge Code	270680044
Hospital Revenue Code	278
Min. Negotiated Rate	$2,467.50
Max. Negotiated Rate	$3,980.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,980.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,619.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,467.50

GRAFTLINK PREP ATTACH

Facility

$2,615.00

Hospital Charge Code	270676220
Hospital Revenue Code	272
Min. Negotiated Rate	$392.25
Max. Negotiated Rate	$392.25
Rate for Payer: Qualcare PPO/HMO/WC	$392.25

GRAFTLINK PREP ATTACH

Facility

$2,615.00

Hospital Charge Code	270676220
Hospital Revenue Code	272
Min. Negotiated Rate	$63.02
Max. Negotiated Rate	$1,307.50
Rate for Payer: Aetna Commercial	$993.70
Rate for Payer: Aetna Medicare Advantage	$784.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$666.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$666.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$666.83
Rate for Payer: Cigna Commercial	$1,307.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$784.50
Rate for Payer: Oxford Commercial	$523.00
Rate for Payer: Qualcare PPO/HMO/WC	$392.25
Rate for Payer: UnitedHealthcare Commercial	$523.00
Rate for Payer: UnitedHealthcare Community & State	$63.02
Rate for Payer: Wellpoint Medicaid Managed Care	$69.30

GRAFTLINK PREP ATT W/TENSIONER

Facility

$4,590.00

Hospital Charge Code	270676221
Hospital Revenue Code	272
Min. Negotiated Rate	$110.62
Max. Negotiated Rate	$2,295.00
Rate for Payer: Aetna Commercial	$1,744.20
Rate for Payer: Aetna Medicare Advantage	$1,377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,170.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,170.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,170.45
Rate for Payer: Cigna Commercial	$2,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,377.00
Rate for Payer: Oxford Commercial	$918.00
Rate for Payer: Qualcare PPO/HMO/WC	$688.50
Rate for Payer: UnitedHealthcare Commercial	$918.00
Rate for Payer: UnitedHealthcare Community & State	$110.62
Rate for Payer: Wellpoint Medicaid Managed Care	$121.64

GRAFTLINK PREP ATT W/TENSIONER

Facility

$4,590.00

Hospital Charge Code	270676221
Hospital Revenue Code	272
Min. Negotiated Rate	$688.50
Max. Negotiated Rate	$688.50
Rate for Payer: Qualcare PPO/HMO/WC	$688.50

GRAFTLINK XL

Facility

$12,500.00

Hospital Charge Code	270677863
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

GRAFTLINK XL

Facility

$12,500.00

Hospital Charge Code	270677863
Hospital Revenue Code	278
Min. Negotiated Rate	$301.25
Max. Negotiated Rate	$6,250.00
Rate for Payer: Aetna Commercial	$4,750.00
Rate for Payer: Aetna Medicare Advantage	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,187.50
Rate for Payer: Cigna Commercial	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00
Rate for Payer: UnitedHealthcare Community & State	$301.25
Rate for Payer: Wellpoint Medicaid Managed Care	$331.25

GRAFT MAG EX GRAFT DELIVERY SY

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704715
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

GRAFT MAG EX GRAFT DELIVERY SY

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704715
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

GRAFT MAIN BODY

Facility

$53,975.00

Hospital Charge Code	270645999
Hospital Revenue Code	278
Min. Negotiated Rate	$8,096.25
Max. Negotiated Rate	$13,061.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,061.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,874.50
Rate for Payer: Qualcare PPO/HMO/WC	$8,096.25

GRAFT MAIN BODY

Facility

$53,975.00

Hospital Charge Code	270645999
Hospital Revenue Code	278
Min. Negotiated Rate	$1,300.80
Max. Negotiated Rate	$26,987.50
Rate for Payer: Aetna Commercial	$20,510.50
Rate for Payer: Aetna Medicare Advantage	$16,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,763.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,763.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,763.62
Rate for Payer: Cigna Commercial	$26,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,061.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,874.50
Rate for Payer: Qualcare PPO/HMO/WC	$8,096.25
Rate for Payer: UnitedHealthcare Community & State	$1,300.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,430.34

GRAFT MAIN BODY 20MM

Facility

$56,395.00

Hospital Charge Code	270683414
Hospital Revenue Code	278
Min. Negotiated Rate	$1,359.12
Max. Negotiated Rate	$28,197.50
Rate for Payer: Aetna Commercial	$21,430.10
Rate for Payer: Aetna Medicare Advantage	$16,918.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,380.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,380.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,279.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,380.73
Rate for Payer: Cigna Commercial	$28,197.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,647.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,406.90
Rate for Payer: Qualcare PPO/HMO/WC	$8,459.25
Rate for Payer: UnitedHealthcare Community & State	$1,359.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1,494.47

GRAFT MAIN BODY 20MM

Facility

$56,395.00

Hospital Charge Code	270683414
Hospital Revenue Code	278
Min. Negotiated Rate	$8,459.25
Max. Negotiated Rate	$13,647.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,279.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,647.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,406.90
Rate for Payer: Qualcare PPO/HMO/WC	$8,459.25

GRAFT MAIN BODY 25x100

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270678152
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.66
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$1,585.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1,743.57

GRAFT MAIN BODY 25x100

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270678152
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT MAIN BODY 28x100

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270677223
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT MAIN BODY 28x100

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270677223
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.66
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$1,585.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1,743.57

GRAFT MAIN BODY 28x80

Facility

$65,795.00

Hospital Charge Code	270677194
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.66
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$1,585.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1,743.57

GRAFT MAIN BODY 28x80

Facility

$65,795.00

Hospital Charge Code	270677194
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,474.90
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT MAIN BODY 29MM

Facility

$56,395.00

Service Code	HCPCS C1768
Hospital Charge Code	270677356
Hospital Revenue Code	278
Min. Negotiated Rate	$1,359.12
Max. Negotiated Rate	$28,197.50
Rate for Payer: Aetna Commercial	$21,430.10
Rate for Payer: Aetna Medicare Advantage	$16,918.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,380.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,380.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,279.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,380.73
Rate for Payer: Cigna Commercial	$28,197.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,647.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,406.90
Rate for Payer: Qualcare PPO/HMO/WC	$8,459.25
Rate for Payer: UnitedHealthcare Community & State	$1,359.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1,494.47

Know your out-of-pocket cost for care.

All Charges