Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT OMNIGRAFT 4CM X 4 CM

Facility

$4,375.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684012W
Hospital Revenue Code	636
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

GRAFT OMNIGRAFT 4CM X 4 CM

Facility

$4,375.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684012W
Hospital Revenue Code	636
Min. Negotiated Rate	$105.44
Max. Negotiated Rate	$1,058.75
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	$156.71
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	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Community & State	$105.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$115.94

GRAFT OMNIGRAFT 7 CM X 7 CM

Facility

$8,750.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684013
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

GRAFT OMNIGRAFT 7 CM X 7 CM

Facility

$8,750.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684013
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,117.50
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	$1,750.00
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	$2,117.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50
Rate for Payer: UnitedHealthcare Community & State	$210.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$231.88

GRAFTON 1CC GEL

Facility

$1,145.00

Hospital Charge Code	270665043
Hospital Revenue Code	270
Min. Negotiated Rate	$171.75
Max. Negotiated Rate	$171.75
Rate for Payer: Qualcare PPO/HMO/WC	$171.75

GRAFTON 1CC GEL

Facility

$1,145.00

Hospital Charge Code	270665043
Hospital Revenue Code	270
Min. Negotiated Rate	$27.59
Max. Negotiated Rate	$572.50
Rate for Payer: Aetna Commercial	$435.10
Rate for Payer: Aetna Medicare Advantage	$343.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$291.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$291.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$291.98
Rate for Payer: Cigna Commercial	$572.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$343.50
Rate for Payer: Oxford Commercial	$229.00
Rate for Payer: Qualcare PPO/HMO/WC	$171.75
Rate for Payer: UnitedHealthcare Commercial	$229.00
Rate for Payer: UnitedHealthcare Community & State	$27.59
Rate for Payer: Wellpoint Medicaid Managed Care	$30.34

GRAFTON GEL DIVERTED FILL TUBE

Facility

$405.00

Hospital Charge Code	270335296
Hospital Revenue Code	272
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

GRAFTON GEL DIVERTED FILL TUBE

Facility

$405.00

Hospital Charge Code	270335296
Hospital Revenue Code	272
Min. Negotiated Rate	$9.76
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$153.90
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.50
Rate for Payer: Oxford Commercial	$81.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Commercial	$81.00
Rate for Payer: UnitedHealthcare Community & State	$9.76
Rate for Payer: Wellpoint Medicaid Managed Care	$10.73

GRAFTON GEL MUSCULOSKELET 1CC

Facility

$378.00

Hospital Charge Code	270335506
Hospital Revenue Code	278
Min. Negotiated Rate	$9.11
Max. Negotiated Rate	$189.00
Rate for Payer: Aetna Commercial	$143.64
Rate for Payer: Aetna Medicare Advantage	$113.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.39
Rate for Payer: Cigna Commercial	$189.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$83.16
Rate for Payer: Qualcare PPO/HMO/WC	$56.70
Rate for Payer: UnitedHealthcare Community & State	$9.11
Rate for Payer: Wellpoint Medicaid Managed Care	$10.02

GRAFTON GEL MUSCULOSKELET 1CC

Facility

$378.00

Hospital Charge Code	270335506
Hospital Revenue Code	278
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$91.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$83.16
Rate for Payer: Qualcare PPO/HMO/WC	$56.70

GRAFTON GEL STRAIGHT FILL TUBE

Facility

$301.00

Hospital Charge Code	270335297
Hospital Revenue Code	272
Min. Negotiated Rate	$45.15
Max. Negotiated Rate	$45.15
Rate for Payer: Qualcare PPO/HMO/WC	$45.15

GRAFTON GEL STRAIGHT FILL TUBE

Facility

$301.00

Hospital Charge Code	270335297
Hospital Revenue Code	272
Min. Negotiated Rate	$7.25
Max. Negotiated Rate	$150.50
Rate for Payer: Aetna Commercial	$114.38
Rate for Payer: Aetna Medicare Advantage	$90.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.75
Rate for Payer: Cigna Commercial	$150.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.30
Rate for Payer: Oxford Commercial	$60.20
Rate for Payer: Qualcare PPO/HMO/WC	$45.15
Rate for Payer: UnitedHealthcare Commercial	$60.20
Rate for Payer: UnitedHealthcare Community & State	$7.25
Rate for Payer: Wellpoint Medicaid Managed Care	$7.98

GRAFT OSTEO-LINK DBM 10CC

Facility

$10,530.00

Service Code	HCPCS C1713
Hospital Charge Code	270698876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.50
Max. Negotiated Rate	$2,548.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,106.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.50

GRAFT OSTEO-LINK DBM 10CC

Facility

$10,530.00

Service Code	HCPCS C1713
Hospital Charge Code	270698876
Hospital Revenue Code	278
Min. Negotiated Rate	$253.77
Max. Negotiated Rate	$5,265.00
Rate for Payer: Aetna Commercial	$4,001.40
Rate for Payer: Aetna Medicare Advantage	$3,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,106.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.15
Rate for Payer: Cigna Commercial	$5,265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.50
Rate for Payer: UnitedHealthcare Community & State	$253.77
Rate for Payer: Wellpoint Medicaid Managed Care	$279.05

GRAFT OSTEO-LINK DBM 2.5CC

Facility

$4,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270698826
Hospital Revenue Code	278
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$998.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$618.75

GRAFT OSTEO-LINK DBM 2.5CC

Facility

$4,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270698826
Hospital Revenue Code	278
Min. Negotiated Rate	$99.41
Max. Negotiated Rate	$2,062.50
Rate for Payer: Aetna Commercial	$1,567.50
Rate for Payer: Aetna Medicare Advantage	$1,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.88
Rate for Payer: Cigna Commercial	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$618.75
Rate for Payer: UnitedHealthcare Community & State	$99.41
Rate for Payer: Wellpoint Medicaid Managed Care	$109.31

GRAFT OVATION ILIAC EXT 16x45

Facility

$22,495.00

Hospital Charge Code	270678256
Hospital Revenue Code	278
Min. Negotiated Rate	$3,374.25
Max. Negotiated Rate	$5,443.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,499.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,443.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,948.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,374.25

GRAFT OVATION ILIAC EXT 16x45

Facility

$22,495.00

Hospital Charge Code	270678256
Hospital Revenue Code	278
Min. Negotiated Rate	$542.13
Max. Negotiated Rate	$11,247.50
Rate for Payer: Aetna Commercial	$8,548.10
Rate for Payer: Aetna Medicare Advantage	$6,748.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,736.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,736.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,499.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,736.23
Rate for Payer: Cigna Commercial	$11,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,443.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,948.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,374.25
Rate for Payer: UnitedHealthcare Community & State	$542.13
Rate for Payer: Wellpoint Medicaid Managed Care	$596.12

GRAFT OVATION ILIAC EXTENSION

Facility

$22,495.00

Hospital Charge Code	270677831
Hospital Revenue Code	278
Min. Negotiated Rate	$3,374.25
Max. Negotiated Rate	$5,443.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,499.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,443.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,948.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,374.25

GRAFT OVATION ILIAC EXTENSION

Facility

$22,495.00

Hospital Charge Code	270677831
Hospital Revenue Code	278
Min. Negotiated Rate	$542.13
Max. Negotiated Rate	$11,247.50
Rate for Payer: Aetna Commercial	$8,548.10
Rate for Payer: Aetna Medicare Advantage	$6,748.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,736.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,736.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,499.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,736.23
Rate for Payer: Cigna Commercial	$11,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,443.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,948.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,374.25
Rate for Payer: UnitedHealthcare Community & State	$542.13
Rate for Payer: Wellpoint Medicaid Managed Care	$596.12

GRAFT OVATION ILIAC LIMB

Facility

$18,750.00

Service Code	HCPCS C1768
Hospital Charge Code	270676754
Hospital Revenue Code	278
Min. Negotiated Rate	$451.88
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$7,125.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50
Rate for Payer: UnitedHealthcare Community & State	$451.88
Rate for Payer: Wellpoint Medicaid Managed Care	$496.88

GRAFT OVATION ILIAC LIMB

Facility

$18,750.00

Service Code	HCPCS C1768
Hospital Charge Code	270676754
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

GRAFT OVATION IX 12 X 160 MM

Facility

$56,395.00

Service Code	HCPCS C1768
Hospital Charge Code	270686737
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 OVATION IX 12 X 160 MM

Facility

$56,395.00

Service Code	HCPCS C1768
Hospital Charge Code	270686737
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 OVATION IX ILIAC 12X

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270686738
Hospital Revenue Code	278
Min. Negotiated Rate	$566.23
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$8,928.10
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,168.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25
Rate for Payer: UnitedHealthcare Community & State	$566.23
Rate for Payer: Wellpoint Medicaid Managed Care	$622.62

Know your out-of-pocket cost for care.

All Charges