Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT MAIN BODY 29MM

Facility

$56,395.00

Service Code	HCPCS C1768
Hospital Charge Code	270677356
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 AAA TFB-28-88

Facility

$37,000.00

Hospital Charge Code	270636177V
Hospital Revenue Code	278
Min. Negotiated Rate	$891.70
Max. Negotiated Rate	$18,500.00
Rate for Payer: Aetna Commercial	$14,060.00
Rate for Payer: Aetna Medicare Advantage	$11,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,435.00
Rate for Payer: Cigna Commercial	$18,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,954.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,140.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,550.00
Rate for Payer: UnitedHealthcare Community & State	$891.70
Rate for Payer: Wellpoint Medicaid Managed Care	$980.50

GRAFT MAIN BODY AAA TFB-28-88

Facility

$37,000.00

Hospital Charge Code	270636177V
Hospital Revenue Code	278
Min. Negotiated Rate	$5,550.00
Max. Negotiated Rate	$8,954.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,954.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,140.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,550.00

GRAFT MAIN BODY AAA TFB-28-88

Facility

$36,704.00

Hospital Charge Code	270636177
Hospital Revenue Code	278
Min. Negotiated Rate	$5,505.60
Max. Negotiated Rate	$8,882.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,340.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,882.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,074.88
Rate for Payer: Qualcare PPO/HMO/WC	$5,505.60

GRAFT MAIN BODY AAA TFB-28-88

Facility

$36,704.00

Hospital Charge Code	270636177
Hospital Revenue Code	278
Min. Negotiated Rate	$884.57
Max. Negotiated Rate	$18,352.00
Rate for Payer: Aetna Commercial	$13,947.52
Rate for Payer: Aetna Medicare Advantage	$11,011.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,359.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,359.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,340.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,359.52
Rate for Payer: Cigna Commercial	$18,352.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,882.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,074.88
Rate for Payer: Qualcare PPO/HMO/WC	$5,505.60
Rate for Payer: UnitedHealthcare Community & State	$884.57
Rate for Payer: Wellpoint Medicaid Managed Care	$972.66

GRAFT MAIN BODY AFX2 16 X 40CM

Facility

$65,795.00

Service Code	HCPCS C1889
Hospital Charge Code	270684061
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 AFX2 16 X 40CM

Facility

$65,795.00

Service Code	HCPCS C1889
Hospital Charge Code	270684061
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 PXT231218

Facility

$35,600.00

Hospital Charge Code	270635532V
Hospital Revenue Code	278
Min. Negotiated Rate	$857.96
Max. Negotiated Rate	$17,800.00
Rate for Payer: Aetna Commercial	$13,528.00
Rate for Payer: Aetna Medicare Advantage	$10,680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,078.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,078.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,078.00
Rate for Payer: Cigna Commercial	$17,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,615.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,832.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,340.00
Rate for Payer: UnitedHealthcare Community & State	$857.96
Rate for Payer: Wellpoint Medicaid Managed Care	$943.40

GRAFT MAIN BODY PXT231218

Facility

$35,600.00

Hospital Charge Code	270635532V
Hospital Revenue Code	278
Min. Negotiated Rate	$5,340.00
Max. Negotiated Rate	$8,615.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,615.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,832.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,340.00

GRAFT MAIN BODY PXT231218

Facility

$35,315.25

Hospital Charge Code	270635532
Hospital Revenue Code	278
Min. Negotiated Rate	$5,297.29
Max. Negotiated Rate	$8,546.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,063.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,546.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,769.35
Rate for Payer: Qualcare PPO/HMO/WC	$5,297.29

GRAFT MAIN BODY PXT231218

Facility

$35,315.25

Hospital Charge Code	270635532
Hospital Revenue Code	278
Min. Negotiated Rate	$851.10
Max. Negotiated Rate	$17,657.62
Rate for Payer: Aetna Commercial	$13,419.80
Rate for Payer: Aetna Medicare Advantage	$10,594.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,005.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,005.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,063.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,005.39
Rate for Payer: Cigna Commercial	$17,657.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,546.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,769.35
Rate for Payer: Qualcare PPO/HMO/WC	$5,297.29
Rate for Payer: UnitedHealthcare Community & State	$851.10
Rate for Payer: Wellpoint Medicaid Managed Care	$935.85

GRAFT MAIN BODY ZENITH TFB3088

Facility

$36,704.00

Hospital Charge Code	270633654
Hospital Revenue Code	278
Min. Negotiated Rate	$884.57
Max. Negotiated Rate	$18,352.00
Rate for Payer: Aetna Commercial	$13,947.52
Rate for Payer: Aetna Medicare Advantage	$11,011.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,359.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,359.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,340.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,359.52
Rate for Payer: Cigna Commercial	$18,352.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,882.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,074.88
Rate for Payer: Qualcare PPO/HMO/WC	$5,505.60
Rate for Payer: UnitedHealthcare Community & State	$884.57
Rate for Payer: Wellpoint Medicaid Managed Care	$972.66

GRAFT MAIN BODY ZENITH TFB3088

Facility

$36,704.00

Hospital Charge Code	270633654
Hospital Revenue Code	278
Min. Negotiated Rate	$5,505.60
Max. Negotiated Rate	$8,882.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,340.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,882.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,074.88
Rate for Payer: Qualcare PPO/HMO/WC	$5,505.60

GRAFT MAIN BODY ZENTH TFB32117

Facility

$36,704.00

Hospital Charge Code	270633869
Hospital Revenue Code	278
Min. Negotiated Rate	$5,505.60
Max. Negotiated Rate	$8,882.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,340.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,882.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,074.88
Rate for Payer: Qualcare PPO/HMO/WC	$5,505.60

GRAFT MAIN BODY ZENTH TFB32117

Facility

$36,704.00

Hospital Charge Code	270633869
Hospital Revenue Code	278
Min. Negotiated Rate	$884.57
Max. Negotiated Rate	$18,352.00
Rate for Payer: Aetna Commercial	$13,947.52
Rate for Payer: Aetna Medicare Advantage	$11,011.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,359.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,359.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,340.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,359.52
Rate for Payer: Cigna Commercial	$18,352.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,882.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,074.88
Rate for Payer: Qualcare PPO/HMO/WC	$5,505.60
Rate for Payer: UnitedHealthcare Community & State	$884.57
Rate for Payer: Wellpoint Medicaid Managed Care	$972.66

GRAFT MANIPULATION EXP BRAID

Facility

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	270662947
Hospital Revenue Code	278
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

GRAFT MANIPULATION EXP BRAID

Facility

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	270662947
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

GRAFT MANPULATION EXPRESS BRAI

Facility

$450.00

Hospital Charge Code	270668499
Hospital Revenue Code	278
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

GRAFT MANPULATION EXPRESS BRAI

Facility

$450.00

Hospital Charge Code	270668499
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

GRAFT MATRIX 8.0X3.0 cm

Facility

$15,475.00

Service Code	HCPCS Q4148
Hospital Charge Code	270680389
Hospital Revenue Code	278
Min. Negotiated Rate	$2,321.25
Max. Negotiated Rate	$3,744.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,744.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,404.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,321.25

GRAFT MATRIX 8.0X3.0 cm

Facility

$15,475.00

Service Code	HCPCS Q4148
Hospital Charge Code	270680389
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,744.95
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	$3,095.00
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	$3,744.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,404.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,321.25
Rate for Payer: UnitedHealthcare Community & State	$372.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$410.09

GRAFT MATRIX OSTEO 10CC

Facility

$25,795.00

Service Code	HCPCS C1713
Hospital Charge Code	270698432
Hospital Revenue Code	278
Min. Negotiated Rate	$621.66
Max. Negotiated Rate	$12,897.50
Rate for Payer: Aetna Commercial	$9,802.10
Rate for Payer: Aetna Medicare Advantage	$7,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,577.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,577.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,577.73
Rate for Payer: Cigna Commercial	$12,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,242.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,674.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,869.25
Rate for Payer: UnitedHealthcare Community & State	$621.66
Rate for Payer: Wellpoint Medicaid Managed Care	$683.57

GRAFT MATRIX OSTEO 10CC

Facility

$25,795.00

Service Code	HCPCS C1713
Hospital Charge Code	270698432
Hospital Revenue Code	278
Min. Negotiated Rate	$3,869.25
Max. Negotiated Rate	$6,242.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,242.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,674.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,869.25

GRAFT MATRIX REINFORCE 4X7 CM

Facility

$10,140.00

Service Code	HCPCS C1763
Hospital Charge Code	270684064
Hospital Revenue Code	278
Min. Negotiated Rate	$1,521.00
Max. Negotiated Rate	$2,453.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,028.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,453.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,230.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,521.00

GRAFT MATRIX REINFORCE 4X7 CM

Facility

$10,140.00

Service Code	HCPCS C1763
Hospital Charge Code	270684064
Hospital Revenue Code	278
Min. Negotiated Rate	$244.37
Max. Negotiated Rate	$5,070.00
Rate for Payer: Aetna Commercial	$3,853.20
Rate for Payer: Aetna Medicare Advantage	$3,042.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,585.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,585.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,028.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,585.70
Rate for Payer: Cigna Commercial	$5,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,453.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,230.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,521.00
Rate for Payer: UnitedHealthcare Community & State	$244.37
Rate for Payer: Wellpoint Medicaid Managed Care	$268.71

Know your out-of-pocket cost for care.

All Charges