Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT SV VASC 6 40 S40S06S

Facility

$2,252.85

Hospital Charge Code	270623939
Hospital Revenue Code	278
Min. Negotiated Rate	$54.29
Max. Negotiated Rate	$1,126.42
Rate for Payer: Aetna Commercial	$856.08
Rate for Payer: Aetna Medicare Advantage	$675.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$574.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$574.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$574.48
Rate for Payer: Cigna Commercial	$1,126.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$545.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.63
Rate for Payer: Qualcare PPO/HMO/WC	$337.93
Rate for Payer: UnitedHealthcare Community & State	$54.29
Rate for Payer: Wellpoint Medicaid Managed Care	$59.70

GRAFT SV VASC 6 40 S40S06S

Facility

$2,252.85

Hospital Charge Code	270623939
Hospital Revenue Code	278
Min. Negotiated Rate	$337.93
Max. Negotiated Rate	$545.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$545.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.63
Rate for Payer: Qualcare PPO/HMO/WC	$337.93

GRAFT SZR 4-7X40 S40ST0407S

Facility

$2,451.25

Hospital Charge Code	270626543
Hospital Revenue Code	278
Min. Negotiated Rate	$367.69
Max. Negotiated Rate	$593.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$593.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.27
Rate for Payer: Qualcare PPO/HMO/WC	$367.69

GRAFT SZR 4-7X40 S40ST0407S

Facility

$2,451.25

Hospital Charge Code	270626543
Hospital Revenue Code	278
Min. Negotiated Rate	$59.08
Max. Negotiated Rate	$1,225.62
Rate for Payer: Aetna Commercial	$931.48
Rate for Payer: Aetna Medicare Advantage	$735.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$625.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$625.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$625.07
Rate for Payer: Cigna Commercial	$1,225.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$593.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$539.27
Rate for Payer: Qualcare PPO/HMO/WC	$367.69
Rate for Payer: UnitedHealthcare Community & State	$59.08
Rate for Payer: Wellpoint Medicaid Managed Care	$64.96

GRAFT TENDON TIBIAL 9.5x350

Facility

$9,750.00

Hospital Charge Code	270654925
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$2,359.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,145.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

GRAFT TENDON TIBIAL 9.5x350

Facility

$9,750.00

Hospital Charge Code	270654925
Hospital Revenue Code	278
Min. Negotiated Rate	$234.97
Max. Negotiated Rate	$4,875.00
Rate for Payer: Aetna Commercial	$3,705.00
Rate for Payer: Aetna Medicare Advantage	$2,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,486.25
Rate for Payer: Cigna Commercial	$4,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,145.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50
Rate for Payer: UnitedHealthcare Community & State	$234.97
Rate for Payer: Wellpoint Medicaid Managed Care	$258.38

GRAFT THERAGENESIS 4CM X 3 CM

Facility

$7,000.00

Hospital Charge Code	270695637
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

GRAFT THERAGENESIS 4CM X 3 CM

Facility

$7,000.00

Hospital Charge Code	270695637
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

GRAFT THERAGENSIS 8X 12 CM

Facility

$16,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270695640
Hospital Revenue Code	278
Min. Negotiated Rate	$385.60
Max. Negotiated Rate	$8,000.00
Rate for Payer: Aetna Commercial	$6,080.00
Rate for Payer: Aetna Medicare Advantage	$4,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,080.00
Rate for Payer: Cigna Commercial	$8,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00
Rate for Payer: UnitedHealthcare Community & State	$385.60
Rate for Payer: Wellpoint Medicaid Managed Care	$424.00

GRAFT THERAGENSIS 8X 12 CM

Facility

$16,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270695640
Hospital Revenue Code	278
Min. Negotiated Rate	$2,400.00
Max. Negotiated Rate	$3,872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00

GRAFT THERASKIN 3X6IN

Facility

$14,225.00

Service Code	HCPCS Q4121
Hospital Charge Code	270690262
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,442.45
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	$2,845.00
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	$3,442.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,129.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,133.75
Rate for Payer: UnitedHealthcare Community & State	$342.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$376.96

GRAFT THERASKIN 3X6IN

Facility

$14,225.00

Service Code	HCPCS Q4121
Hospital Charge Code	270690262
Hospital Revenue Code	278
Min. Negotiated Rate	$2,133.75
Max. Negotiated Rate	$3,442.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,845.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,442.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,129.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,133.75

GRAFT THINWALL 10mm70cm

Facility

$6,230.00

Service Code	HCPCS C1768
Hospital Charge Code	270640440
Hospital Revenue Code	278
Min. Negotiated Rate	$150.14
Max. Negotiated Rate	$3,115.00
Rate for Payer: Aetna Commercial	$2,367.40
Rate for Payer: Aetna Medicare Advantage	$1,869.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,588.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,588.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,246.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,588.65
Rate for Payer: Cigna Commercial	$3,115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,507.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,370.60
Rate for Payer: Qualcare PPO/HMO/WC	$934.50
Rate for Payer: UnitedHealthcare Community & State	$150.14
Rate for Payer: Wellpoint Medicaid Managed Care	$165.09

GRAFT THINWALL 10mm70cm

Facility

$6,230.00

Service Code	HCPCS C1768
Hospital Charge Code	270640440
Hospital Revenue Code	278
Min. Negotiated Rate	$934.50
Max. Negotiated Rate	$1,507.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,246.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,507.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,370.60
Rate for Payer: Qualcare PPO/HMO/WC	$934.50

GRAFT THINWALL 8mm 80cm

Facility

$5,500.00

Service Code	HCPCS C1768
Hospital Charge Code	270601122
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

GRAFT THINWALL 8mm 80cm

Facility

$5,500.00

Service Code	HCPCS C1768
Hospital Charge Code	270601122
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

GRAFT TIBIAL CORT STRUT 450571

Facility

$3,540.00

Hospital Charge Code	270640532
Hospital Revenue Code	278
Min. Negotiated Rate	$85.31
Max. Negotiated Rate	$1,770.00
Rate for Payer: Aetna Commercial	$1,345.20
Rate for Payer: Aetna Medicare Advantage	$1,062.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$902.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$902.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$708.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$902.70
Rate for Payer: Cigna Commercial	$1,770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$856.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$778.80
Rate for Payer: Qualcare PPO/HMO/WC	$531.00
Rate for Payer: UnitedHealthcare Community & State	$85.31
Rate for Payer: Wellpoint Medicaid Managed Care	$93.81

GRAFT TIBIAL CORT STRUT 450571

Facility

$3,540.00

Hospital Charge Code	270640532
Hospital Revenue Code	278
Min. Negotiated Rate	$531.00
Max. Negotiated Rate	$856.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$708.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$856.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$778.80
Rate for Payer: Qualcare PPO/HMO/WC	$531.00

GRAFT TRUNK GORE3 28X14X16

Facility

$49,675.00

Hospital Charge Code	270645163
Hospital Revenue Code	278
Min. Negotiated Rate	$7,451.25
Max. Negotiated Rate	$12,021.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,021.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10,928.50
Rate for Payer: Qualcare PPO/HMO/WC	$7,451.25

GRAFT TRUNK GORE3 28X14X16

Facility

$49,675.00

Hospital Charge Code	270645163
Hospital Revenue Code	278
Min. Negotiated Rate	$1,197.17
Max. Negotiated Rate	$24,837.50
Rate for Payer: Aetna Commercial	$18,876.50
Rate for Payer: Aetna Medicare Advantage	$14,902.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,667.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,667.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,667.12
Rate for Payer: Cigna Commercial	$24,837.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,021.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10,928.50
Rate for Payer: Qualcare PPO/HMO/WC	$7,451.25
Rate for Payer: UnitedHealthcare Community & State	$1,197.17
Rate for Payer: Wellpoint Medicaid Managed Care	$1,316.39

GRAFT VASC 6mmDIAx40cm AG640

Facility

$4,518.85

Hospital Charge Code	270635597
Hospital Revenue Code	278
Min. Negotiated Rate	$677.83
Max. Negotiated Rate	$1,093.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$903.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,093.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$994.15
Rate for Payer: Qualcare PPO/HMO/WC	$677.83

GRAFT VASC 6mmDIAx40cm AG640

Facility

$4,518.85

Hospital Charge Code	270635597
Hospital Revenue Code	278
Min. Negotiated Rate	$108.90
Max. Negotiated Rate	$2,259.43
Rate for Payer: Aetna Commercial	$1,717.16
Rate for Payer: Aetna Medicare Advantage	$1,355.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,152.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,152.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$903.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,152.31
Rate for Payer: Cigna Commercial	$2,259.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,093.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$994.15
Rate for Payer: Qualcare PPO/HMO/WC	$677.83
Rate for Payer: UnitedHealthcare Community & State	$108.90
Rate for Payer: Wellpoint Medicaid Managed Care	$119.75

GRAFT VASCULAR 4-7MM 45CM

Facility

$6,300.00

Service Code	HCPCS C1768
Hospital Charge Code	270647607
Hospital Revenue Code	278
Min. Negotiated Rate	$151.83
Max. Negotiated Rate	$3,150.00
Rate for Payer: Aetna Commercial	$2,394.00
Rate for Payer: Aetna Medicare Advantage	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,606.50
Rate for Payer: Cigna Commercial	$3,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,386.00
Rate for Payer: Qualcare PPO/HMO/WC	$945.00
Rate for Payer: UnitedHealthcare Community & State	$151.83
Rate for Payer: Wellpoint Medicaid Managed Care	$166.95

GRAFT VASCULAR 4-7MM 45CM

Facility

$6,300.00

Service Code	HCPCS C1768
Hospital Charge Code	270647607
Hospital Revenue Code	278
Min. Negotiated Rate	$945.00
Max. Negotiated Rate	$1,524.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,386.00
Rate for Payer: Qualcare PPO/HMO/WC	$945.00

GRAFT VASCULAR 4-7MM 45CM

Facility

$3,380.00

Hospital Charge Code	270647608
Hospital Revenue Code	278
Min. Negotiated Rate	$507.00
Max. Negotiated Rate	$817.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$676.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$817.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$743.60
Rate for Payer: Qualcare PPO/HMO/WC	$507.00

Know your out-of-pocket cost for care.

All Charges