Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT MATRIX REINFORCE 5X10CM

Facility

$11,427.50

Service Code	HCPCS C1763
Hospital Charge Code	270684065
Hospital Revenue Code	278
Min. Negotiated Rate	$275.40
Max. Negotiated Rate	$5,713.75
Rate for Payer: Aetna Commercial	$4,342.45
Rate for Payer: Aetna Medicare Advantage	$3,428.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,914.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,914.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,285.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,914.01
Rate for Payer: Cigna Commercial	$5,713.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,765.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,514.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,714.12
Rate for Payer: UnitedHealthcare Community & State	$275.40
Rate for Payer: Wellpoint Medicaid Managed Care	$302.83

GRAFT MATRIX REINFORCE 5X10CM

Facility

$11,427.50

Service Code	HCPCS C1763
Hospital Charge Code	270684065
Hospital Revenue Code	278
Min. Negotiated Rate	$1,714.12
Max. Negotiated Rate	$2,765.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,285.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,765.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,514.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,714.12

GRAFT MATRIX WND 6X3CM

Facility

$9,975.00

Service Code	HCPCS Q4148
Hospital Charge Code	270673866
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,413.95
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	$1,995.00
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	$2,413.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,194.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25
Rate for Payer: UnitedHealthcare Community & State	$240.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$264.34

GRAFT MATRIX WND 6X3CM

Facility

$9,975.00

Service Code	HCPCS Q4148
Hospital Charge Code	270673866
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,194.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

GRAFT MATRIX WND 6X3CM/SQCM JW

Facility

$887.19

Hospital Charge Code	270673866W
Hospital Revenue Code	636
Min. Negotiated Rate	$21.38
Max. Negotiated Rate	$443.60
Rate for Payer: Aetna Commercial	$337.13
Rate for Payer: Aetna Medicare Advantage	$266.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$226.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$226.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$226.23
Rate for Payer: Cigna Commercial	$443.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.70
Rate for Payer: Qualcare PPO/HMO/WC	$133.08
Rate for Payer: UnitedHealthcare Community & State	$21.38
Rate for Payer: Wellpoint Medicaid Managed Care	$23.51

GRAFT MATRIX WND 6X3CM/SQCM JW

Facility

$887.19

Hospital Charge Code	270673866W
Hospital Revenue Code	636
Min. Negotiated Rate	$133.08
Max. Negotiated Rate	$214.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.70
Rate for Payer: Qualcare PPO/HMO/WC	$133.08

GRAFT MCVL BIF 18/9MM/40CM

Facility

$4,991.25

Hospital Charge Code	270601120
Hospital Revenue Code	278
Min. Negotiated Rate	$120.29
Max. Negotiated Rate	$2,495.62
Rate for Payer: Aetna Commercial	$1,896.67
Rate for Payer: Aetna Medicare Advantage	$1,497.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,272.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,272.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,272.77
Rate for Payer: Cigna Commercial	$2,495.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,207.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,098.08
Rate for Payer: Qualcare PPO/HMO/WC	$748.69
Rate for Payer: UnitedHealthcare Community & State	$120.29
Rate for Payer: Wellpoint Medicaid Managed Care	$132.27

GRAFT MCVL BIF 18/9MM/40CM

Facility

$4,991.25

Hospital Charge Code	270601120
Hospital Revenue Code	278
Min. Negotiated Rate	$748.69
Max. Negotiated Rate	$1,207.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,207.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,098.08
Rate for Payer: Qualcare PPO/HMO/WC	$748.69

GRAFT MCVL BIF 20/10MM/40CM

Facility

$4,991.25

Hospital Charge Code	270601126
Hospital Revenue Code	278
Min. Negotiated Rate	$748.69
Max. Negotiated Rate	$1,207.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,207.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,098.08
Rate for Payer: Qualcare PPO/HMO/WC	$748.69

GRAFT MCVL BIF 20/10MM/40CM

Facility

$4,991.25

Hospital Charge Code	270601126
Hospital Revenue Code	278
Min. Negotiated Rate	$120.29
Max. Negotiated Rate	$2,495.62
Rate for Payer: Aetna Commercial	$1,896.67
Rate for Payer: Aetna Medicare Advantage	$1,497.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,272.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,272.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,272.77
Rate for Payer: Cigna Commercial	$2,495.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,207.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,098.08
Rate for Payer: Qualcare PPO/HMO/WC	$748.69
Rate for Payer: UnitedHealthcare Community & State	$120.29
Rate for Payer: Wellpoint Medicaid Managed Care	$132.27

GRAFT MCVL BIF 24/12MM/40CM

Facility

$3,074.45

Hospital Charge Code	270601142
Hospital Revenue Code	278
Min. Negotiated Rate	$74.09
Max. Negotiated Rate	$1,537.22
Rate for Payer: Aetna Commercial	$1,168.29
Rate for Payer: Aetna Medicare Advantage	$922.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$783.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$783.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$783.98
Rate for Payer: Cigna Commercial	$1,537.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$744.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$676.38
Rate for Payer: Qualcare PPO/HMO/WC	$461.17
Rate for Payer: UnitedHealthcare Community & State	$74.09
Rate for Payer: Wellpoint Medicaid Managed Care	$81.47

GRAFT MCVL BIF 24/12MM/40CM

Facility

$3,074.45

Hospital Charge Code	270601142
Hospital Revenue Code	278
Min. Negotiated Rate	$461.17
Max. Negotiated Rate	$744.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$744.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$676.38
Rate for Payer: Qualcare PPO/HMO/WC	$461.17

GRAFT MCVL DBL ST

Facility

$820.00

Hospital Charge Code	1607134
Hospital Revenue Code	251
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$123.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.00

GRAFT MCVL DBL ST

Facility

$820.00

Hospital Charge Code	1607134
Hospital Revenue Code	251
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$410.00
Rate for Payer: Aetna Commercial	$311.60
Rate for Payer: Aetna Medicare Advantage	$246.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.10
Rate for Payer: Cigna Commercial	$410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.00
Rate for Payer: Oxford Commercial	$164.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.00
Rate for Payer: UnitedHealthcare Commercial	$164.00
Rate for Payer: UnitedHealthcare Community & State	$19.76
Rate for Payer: Wellpoint Medicaid Managed Care	$21.73

GRAFT MCVL DBL VELR *******

Facility

$3,015.00

Hospital Charge Code	1604115
Hospital Revenue Code	278
Min. Negotiated Rate	$452.25
Max. Negotiated Rate	$729.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$603.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$663.30
Rate for Payer: Qualcare PPO/HMO/WC	$452.25

GRAFT MCVL DBL VELR *******

Facility

$3,015.00

Hospital Charge Code	1604115
Hospital Revenue Code	278
Min. Negotiated Rate	$72.66
Max. Negotiated Rate	$1,507.50
Rate for Payer: Aetna Commercial	$1,145.70
Rate for Payer: Aetna Medicare Advantage	$904.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$603.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.83
Rate for Payer: Cigna Commercial	$1,507.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$663.30
Rate for Payer: Qualcare PPO/HMO/WC	$452.25
Rate for Payer: UnitedHealthcare Community & State	$72.66
Rate for Payer: Wellpoint Medicaid Managed Care	$79.90

GRAFT MCVL DBL VELR 10/60CM***

Facility

$1,944.00

Hospital Charge Code	1604149
Hospital Revenue Code	278
Min. Negotiated Rate	$46.85
Max. Negotiated Rate	$972.00
Rate for Payer: Aetna Commercial	$738.72
Rate for Payer: Aetna Medicare Advantage	$583.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$495.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$495.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$495.72
Rate for Payer: Cigna Commercial	$972.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$470.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$427.68
Rate for Payer: Qualcare PPO/HMO/WC	$291.60
Rate for Payer: UnitedHealthcare Community & State	$46.85
Rate for Payer: Wellpoint Medicaid Managed Care	$51.52

GRAFT MCVL DBL VELR 10/60CM***

Facility

$1,944.00

Hospital Charge Code	1604149
Hospital Revenue Code	278
Min. Negotiated Rate	$291.60
Max. Negotiated Rate	$470.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$388.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$470.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$427.68
Rate for Payer: Qualcare PPO/HMO/WC	$291.60

GRAFT MCVL DBL VELR 16/8MM ***

Facility

$3,015.00

Hospital Charge Code	1604065
Hospital Revenue Code	278
Min. Negotiated Rate	$72.66
Max. Negotiated Rate	$1,507.50
Rate for Payer: Aetna Commercial	$1,145.70
Rate for Payer: Aetna Medicare Advantage	$904.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$603.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.83
Rate for Payer: Cigna Commercial	$1,507.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$663.30
Rate for Payer: Qualcare PPO/HMO/WC	$452.25
Rate for Payer: UnitedHealthcare Community & State	$72.66
Rate for Payer: Wellpoint Medicaid Managed Care	$79.90

GRAFT MCVL DBL VELR 16/8MM ***

Facility

$3,015.00

Hospital Charge Code	1604065
Hospital Revenue Code	278
Min. Negotiated Rate	$452.25
Max. Negotiated Rate	$729.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$603.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$663.30
Rate for Payer: Qualcare PPO/HMO/WC	$452.25

GRAFT MCVL DBL VELR 16MM *****

Facility

$1,994.00

Hospital Charge Code	1604156
Hospital Revenue Code	278
Min. Negotiated Rate	$299.10
Max. Negotiated Rate	$482.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$398.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$482.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$438.68
Rate for Payer: Qualcare PPO/HMO/WC	$299.10

GRAFT MCVL DBL VELR 16MM *****

Facility

$1,994.00

Hospital Charge Code	1604156
Hospital Revenue Code	278
Min. Negotiated Rate	$48.06
Max. Negotiated Rate	$997.00
Rate for Payer: Aetna Commercial	$757.72
Rate for Payer: Aetna Medicare Advantage	$598.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$508.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$508.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$398.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$508.47
Rate for Payer: Cigna Commercial	$997.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$482.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$438.68
Rate for Payer: Qualcare PPO/HMO/WC	$299.10
Rate for Payer: UnitedHealthcare Community & State	$48.06
Rate for Payer: Wellpoint Medicaid Managed Care	$52.84

GRAFT MCVL DBL VELR 18/9CM ***

Facility

$3,015.00

Hospital Charge Code	1604081
Hospital Revenue Code	278
Min. Negotiated Rate	$452.25
Max. Negotiated Rate	$729.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$603.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$663.30
Rate for Payer: Qualcare PPO/HMO/WC	$452.25

GRAFT MCVL DBL VELR 18/9CM ***

Facility

$3,015.00

Hospital Charge Code	1604081
Hospital Revenue Code	278
Min. Negotiated Rate	$72.66
Max. Negotiated Rate	$1,507.50
Rate for Payer: Aetna Commercial	$1,145.70
Rate for Payer: Aetna Medicare Advantage	$904.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$603.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.83
Rate for Payer: Cigna Commercial	$1,507.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$663.30
Rate for Payer: Qualcare PPO/HMO/WC	$452.25
Rate for Payer: UnitedHealthcare Community & State	$72.66
Rate for Payer: Wellpoint Medicaid Managed Care	$79.90

GRAFT MCVL DBL VELR 22/11CM**

Facility

$2,716.00

Hospital Charge Code	1604180
Hospital Revenue Code	278
Min. Negotiated Rate	$65.46
Max. Negotiated Rate	$1,358.00
Rate for Payer: Aetna Commercial	$1,032.08
Rate for Payer: Aetna Medicare Advantage	$814.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$692.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$692.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$543.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$692.58
Rate for Payer: Cigna Commercial	$1,358.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$657.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$597.52
Rate for Payer: Qualcare PPO/HMO/WC	$407.40
Rate for Payer: UnitedHealthcare Community & State	$65.46
Rate for Payer: Wellpoint Medicaid Managed Care	$71.97

Know your out-of-pocket cost for care.

All Charges