Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT SKIN CARRIER

Facility

$2,858.25

Hospital Charge Code	270662746
Hospital Revenue Code	272
Min. Negotiated Rate	$428.74
Max. Negotiated Rate	$428.74
Rate for Payer: Qualcare PPO/HMO/WC	$428.74

GRAFT SKIN CARRIER

Facility

$2,858.25

Hospital Charge Code	270662756
Hospital Revenue Code	278
Min. Negotiated Rate	$68.88
Max. Negotiated Rate	$1,429.12
Rate for Payer: Aetna Commercial	$1,086.13
Rate for Payer: Aetna Medicare Advantage	$857.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$728.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$728.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$571.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$728.85
Rate for Payer: Cigna Commercial	$1,429.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$691.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$628.82
Rate for Payer: Qualcare PPO/HMO/WC	$428.74
Rate for Payer: UnitedHealthcare Community & State	$68.88
Rate for Payer: Wellpoint Medicaid Managed Care	$75.74

GRAFT STD WALL 4/7mm 45cm

Facility

$3,480.00

Service Code	HCPCS C1768
Hospital Charge Code	270605392
Hospital Revenue Code	278
Min. Negotiated Rate	$83.87
Max. Negotiated Rate	$1,740.00
Rate for Payer: Aetna Commercial	$1,322.40
Rate for Payer: Aetna Medicare Advantage	$1,044.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$887.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$887.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$696.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$887.40
Rate for Payer: Cigna Commercial	$1,740.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$842.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$765.60
Rate for Payer: Qualcare PPO/HMO/WC	$522.00
Rate for Payer: UnitedHealthcare Community & State	$83.87
Rate for Payer: Wellpoint Medicaid Managed Care	$92.22

GRAFT STD WALL 4/7mm 45cm

Facility

$3,480.00

Service Code	HCPCS C1768
Hospital Charge Code	270605392
Hospital Revenue Code	278
Min. Negotiated Rate	$522.00
Max. Negotiated Rate	$842.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$842.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$765.60
Rate for Payer: Qualcare PPO/HMO/WC	$522.00

GRAFT STD WALL 8mm 70cm

Facility

$4,845.00

Hospital Charge Code	270618553
Hospital Revenue Code	278
Min. Negotiated Rate	$116.76
Max. Negotiated Rate	$2,422.50
Rate for Payer: Aetna Commercial	$1,841.10
Rate for Payer: Aetna Medicare Advantage	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,235.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,235.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$969.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,235.47
Rate for Payer: Cigna Commercial	$2,422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,172.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,065.90
Rate for Payer: Qualcare PPO/HMO/WC	$726.75
Rate for Payer: UnitedHealthcare Community & State	$116.76
Rate for Payer: Wellpoint Medicaid Managed Care	$128.39

GRAFT STD WALL 8mm 70cm

Facility

$4,845.00

Hospital Charge Code	270618553
Hospital Revenue Code	278
Min. Negotiated Rate	$726.75
Max. Negotiated Rate	$1,172.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$969.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,172.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,065.90
Rate for Payer: Qualcare PPO/HMO/WC	$726.75

GRAFT STD WALL 8mm 90cm

Facility

$4,235.00

Service Code	HCPCS C1768
Hospital Charge Code	270601145
Hospital Revenue Code	278
Min. Negotiated Rate	$635.25
Max. Negotiated Rate	$1,024.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$847.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,024.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$931.70
Rate for Payer: Qualcare PPO/HMO/WC	$635.25

GRAFT STD WALL 8mm 90cm

Facility

$4,235.00

Service Code	HCPCS C1768
Hospital Charge Code	270601145
Hospital Revenue Code	278
Min. Negotiated Rate	$102.06
Max. Negotiated Rate	$2,117.50
Rate for Payer: Aetna Commercial	$1,609.30
Rate for Payer: Aetna Medicare Advantage	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,079.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,079.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,079.92
Rate for Payer: Cigna Commercial	$2,117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,024.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$931.70
Rate for Payer: Qualcare PPO/HMO/WC	$635.25
Rate for Payer: UnitedHealthcare Community & State	$102.06
Rate for Payer: Wellpoint Medicaid Managed Care	$112.23

GRAFT STD WALL RINGED 8mm 70cm

Facility

$5,890.00

Hospital Charge Code	270601141
Hospital Revenue Code	278
Min. Negotiated Rate	$141.95
Max. Negotiated Rate	$2,945.00
Rate for Payer: Aetna Commercial	$2,238.20
Rate for Payer: Aetna Medicare Advantage	$1,767.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,501.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,501.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,501.95
Rate for Payer: Cigna Commercial	$2,945.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,295.80
Rate for Payer: Qualcare PPO/HMO/WC	$883.50
Rate for Payer: UnitedHealthcare Community & State	$141.95
Rate for Payer: Wellpoint Medicaid Managed Care	$156.09

GRAFT STD WALL RINGED 8mm 70cm

Facility

$5,890.00

Hospital Charge Code	270601141
Hospital Revenue Code	278
Min. Negotiated Rate	$883.50
Max. Negotiated Rate	$1,425.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,178.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,295.80
Rate for Payer: Qualcare PPO/HMO/WC	$883.50

GRAFT STENT 14x8.5 YRIRHX1485

Facility

$11,184.85

Hospital Charge Code	270633953
Hospital Revenue Code	278
Min. Negotiated Rate	$269.55
Max. Negotiated Rate	$5,592.43
Rate for Payer: Aetna Commercial	$4,250.24
Rate for Payer: Aetna Medicare Advantage	$3,355.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,852.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,852.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,236.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,852.14
Rate for Payer: Cigna Commercial	$5,592.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,706.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,460.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,677.73
Rate for Payer: UnitedHealthcare Community & State	$269.55
Rate for Payer: Wellpoint Medicaid Managed Care	$296.40

GRAFT STENT 14x8.5 YRIRHX1485

Facility

$11,184.85

Hospital Charge Code	270633953
Hospital Revenue Code	278
Min. Negotiated Rate	$1,677.73
Max. Negotiated Rate	$2,706.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,236.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,706.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,460.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,677.73

GRAFT STENT 26MM OVATION IX

Facility

$12,214.90

Service Code	HCPCS C1768
Hospital Charge Code	270686736
Hospital Revenue Code	278
Min. Negotiated Rate	$294.38
Max. Negotiated Rate	$6,107.45
Rate for Payer: Aetna Commercial	$4,641.66
Rate for Payer: Aetna Medicare Advantage	$3,664.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,114.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,114.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,442.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,114.80
Rate for Payer: Cigna Commercial	$6,107.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,956.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,687.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,832.23
Rate for Payer: UnitedHealthcare Community & State	$294.38
Rate for Payer: Wellpoint Medicaid Managed Care	$323.69

GRAFT STENT 26MM OVATION IX

Facility

$12,214.90

Service Code	HCPCS C1768
Hospital Charge Code	270686736
Hospital Revenue Code	278
Min. Negotiated Rate	$1,832.23
Max. Negotiated Rate	$2,956.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,442.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,956.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,687.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,832.23

GRAFT STENT 38X100MM

Facility

$112,500.00

Service Code	HCPCS L8699
Hospital Charge Code	270697990
Hospital Revenue Code	278
Min. Negotiated Rate	$2,711.25
Max. Negotiated Rate	$56,250.00
Rate for Payer: Aetna Commercial	$42,750.00
Rate for Payer: Aetna Medicare Advantage	$33,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,687.50
Rate for Payer: Cigna Commercial	$56,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27,225.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$24,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,875.00
Rate for Payer: UnitedHealthcare Community & State	$2,711.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2,981.25

GRAFT STENT 38X100MM

Facility

$112,500.00

Service Code	HCPCS L8699
Hospital Charge Code	270697990
Hospital Revenue Code	278
Min. Negotiated Rate	$16,875.00
Max. Negotiated Rate	$27,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27,225.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$24,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,875.00

GRAFT STENT AAA AFX 28x90/20x3

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270680043
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 STENT AAA AFX 28x90/20x3

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270680043
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 STENT ALTO ABD 34 MM

Facility

$69,995.00

Service Code	HCPCS C1874
Hospital Charge Code	270690647
Hospital Revenue Code	278
Min. Negotiated Rate	$10,499.25
Max. Negotiated Rate	$16,938.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,938.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15,398.90
Rate for Payer: Qualcare PPO/HMO/WC	$10,499.25

GRAFT STENT ALTO ABD 34 MM

Facility

$69,995.00

Service Code	HCPCS C1874
Hospital Charge Code	270690647
Hospital Revenue Code	278
Min. Negotiated Rate	$1,686.88
Max. Negotiated Rate	$34,997.50
Rate for Payer: Aetna Commercial	$26,598.10
Rate for Payer: Aetna Medicare Advantage	$20,998.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,848.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,848.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,848.72
Rate for Payer: Cigna Commercial	$34,997.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,938.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15,398.90
Rate for Payer: Qualcare PPO/HMO/WC	$10,499.25
Rate for Payer: UnitedHealthcare Community & State	$1,686.88
Rate for Payer: Wellpoint Medicaid Managed Care	$1,854.87

GRAFT STENT AORTIC BODY 23MM X

Facility

$69,995.00

Service Code	HCPCS C1874
Hospital Charge Code	270690650
Hospital Revenue Code	278
Min. Negotiated Rate	$10,499.25
Max. Negotiated Rate	$16,938.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,938.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15,398.90
Rate for Payer: Qualcare PPO/HMO/WC	$10,499.25

GRAFT STENT AORTIC BODY 23MM X

Facility

$69,995.00

Service Code	HCPCS C1874
Hospital Charge Code	270690650
Hospital Revenue Code	278
Min. Negotiated Rate	$1,686.88
Max. Negotiated Rate	$34,997.50
Rate for Payer: Aetna Commercial	$26,598.10
Rate for Payer: Aetna Medicare Advantage	$20,998.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,848.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,848.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,848.72
Rate for Payer: Cigna Commercial	$34,997.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,938.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$15,398.90
Rate for Payer: Qualcare PPO/HMO/WC	$10,499.25
Rate for Payer: UnitedHealthcare Community & State	$1,686.88
Rate for Payer: Wellpoint Medicaid Managed Care	$1,854.87

GRAFT STENT BIF 28x90/16x30mm

Facility

$65,795.00

Hospital Charge Code	270680053
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 STENT BIF 28x90/16x30mm

Facility

$65,795.00

Hospital Charge Code	270680053
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 STENT ILIAC 14X14120

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270690574
Hospital Revenue Code	278
Min. Negotiated Rate	$686.73
Max. Negotiated Rate	$14,247.50
Rate for Payer: Aetna Commercial	$10,828.10
Rate for Payer: Aetna Medicare Advantage	$8,548.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,266.23
Rate for Payer: Cigna Commercial	$14,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,268.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25
Rate for Payer: UnitedHealthcare Community & State	$686.73
Rate for Payer: Wellpoint Medicaid Managed Care	$755.12

Know your out-of-pocket cost for care.

All Charges