Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT VASCULAR 4-7MM 45CM

Facility

$3,380.00

Hospital Charge Code	270647608
Hospital Revenue Code	278
Min. Negotiated Rate	$81.46
Max. Negotiated Rate	$1,690.00
Rate for Payer: Aetna Commercial	$1,284.40
Rate for Payer: Aetna Medicare Advantage	$1,014.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$861.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$861.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$676.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$861.90
Rate for Payer: Cigna Commercial	$1,690.00
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
Rate for Payer: UnitedHealthcare Community & State	$81.46
Rate for Payer: Wellpoint Medicaid Managed Care	$89.57

GRAFT VASCULAR 6MM 30CMRS 40CM

Facility

$3,260.00

Service Code	HCPCS C1768
Hospital Charge Code	270645781
Hospital Revenue Code	278
Min. Negotiated Rate	$489.00
Max. Negotiated Rate	$788.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$652.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$788.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$717.20
Rate for Payer: Qualcare PPO/HMO/WC	$489.00

GRAFT VASCULAR 6MM 30CMRS 40CM

Facility

$3,260.00

Service Code	HCPCS C1768
Hospital Charge Code	270645781
Hospital Revenue Code	278
Min. Negotiated Rate	$78.57
Max. Negotiated Rate	$1,630.00
Rate for Payer: Aetna Commercial	$1,238.80
Rate for Payer: Aetna Medicare Advantage	$978.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$831.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$831.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$652.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$831.30
Rate for Payer: Cigna Commercial	$1,630.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$788.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$717.20
Rate for Payer: Qualcare PPO/HMO/WC	$489.00
Rate for Payer: UnitedHealthcare Community & State	$78.57
Rate for Payer: Wellpoint Medicaid Managed Care	$86.39

GRAFT VASCULAR 6MM 30CM RS 70C

Facility

$4,485.00

Service Code	HCPCS C1768
Hospital Charge Code	270618552
Hospital Revenue Code	278
Min. Negotiated Rate	$672.75
Max. Negotiated Rate	$1,085.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$897.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,085.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$986.70
Rate for Payer: Qualcare PPO/HMO/WC	$672.75

GRAFT VASCULAR 6MM 30CM RS 70C

Facility

$4,485.00

Service Code	HCPCS C1768
Hospital Charge Code	270618552
Hospital Revenue Code	278
Min. Negotiated Rate	$108.09
Max. Negotiated Rate	$2,242.50
Rate for Payer: Aetna Commercial	$1,704.30
Rate for Payer: Aetna Medicare Advantage	$1,345.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,143.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,143.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$897.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,143.67
Rate for Payer: Cigna Commercial	$2,242.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,085.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$986.70
Rate for Payer: Qualcare PPO/HMO/WC	$672.75
Rate for Payer: UnitedHealthcare Community & State	$108.09
Rate for Payer: Wellpoint Medicaid Managed Care	$118.85

GRAFT VASCULAR 6MM 70CM

Facility

$5,855.00

Service Code	HCPCS C1768
Hospital Charge Code	270676759
Hospital Revenue Code	278
Min. Negotiated Rate	$141.11
Max. Negotiated Rate	$2,927.50
Rate for Payer: Aetna Commercial	$2,224.90
Rate for Payer: Aetna Medicare Advantage	$1,756.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,493.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,493.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,493.03
Rate for Payer: Cigna Commercial	$2,927.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,416.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,288.10
Rate for Payer: Qualcare PPO/HMO/WC	$878.25
Rate for Payer: UnitedHealthcare Community & State	$141.11
Rate for Payer: Wellpoint Medicaid Managed Care	$155.16

GRAFT VASCULAR 6MM 70CM

Facility

$5,855.00

Service Code	HCPCS C1768
Hospital Charge Code	270676759
Hospital Revenue Code	278
Min. Negotiated Rate	$878.25
Max. Negotiated Rate	$1,416.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,171.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,416.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,288.10
Rate for Payer: Qualcare PPO/HMO/WC	$878.25

GRAFT VASCULAR 6x40MM

Facility

$5,195.00

Service Code	HCPCS C1768
Hospital Charge Code	270660347
Hospital Revenue Code	278
Min. Negotiated Rate	$779.25
Max. Negotiated Rate	$1,257.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,257.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,142.90
Rate for Payer: Qualcare PPO/HMO/WC	$779.25

GRAFT VASCULAR 6x40MM

Facility

$5,195.00

Service Code	HCPCS C1768
Hospital Charge Code	270660347
Hospital Revenue Code	278
Min. Negotiated Rate	$125.20
Max. Negotiated Rate	$2,597.50
Rate for Payer: Aetna Commercial	$1,974.10
Rate for Payer: Aetna Medicare Advantage	$1,558.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,324.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,324.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,324.72
Rate for Payer: Cigna Commercial	$2,597.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,257.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,142.90
Rate for Payer: Qualcare PPO/HMO/WC	$779.25
Rate for Payer: UnitedHealthcare Community & State	$125.20
Rate for Payer: Wellpoint Medicaid Managed Care	$137.67

GRAFT VASCULAR BIFUR 16x8X40cm

Facility

$3,277.75

Service Code	HCPCS C1768
Hospital Charge Code	270682468
Hospital Revenue Code	278
Min. Negotiated Rate	$78.99
Max. Negotiated Rate	$1,638.88
Rate for Payer: Aetna Commercial	$1,245.55
Rate for Payer: Aetna Medicare Advantage	$983.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$835.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$835.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$835.83
Rate for Payer: Cigna Commercial	$1,638.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$721.11
Rate for Payer: Qualcare PPO/HMO/WC	$491.66
Rate for Payer: UnitedHealthcare Community & State	$78.99
Rate for Payer: Wellpoint Medicaid Managed Care	$86.86

GRAFT VASCULAR BIFUR 16x8X40cm

Facility

$3,277.75

Service Code	HCPCS C1768
Hospital Charge Code	270682468
Hospital Revenue Code	278
Min. Negotiated Rate	$491.66
Max. Negotiated Rate	$793.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$721.11
Rate for Payer: Qualcare PPO/HMO/WC	$491.66

GRAFT VASCULAR HYBRID 7MMx5CM

Facility

$12,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270659998
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,695.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

GRAFT VASCULAR HYBRID 7MMx5CM

Facility

$12,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270659998
Hospital Revenue Code	278
Min. Negotiated Rate	$295.23
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$4,655.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,695.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50
Rate for Payer: UnitedHealthcare Community & State	$295.23
Rate for Payer: Wellpoint Medicaid Managed Care	$324.62

GRAFT VASCULAR PROPATEN

Facility

$12,475.00

Service Code	HCPCS C1768
Hospital Charge Code	270658084
Hospital Revenue Code	278
Min. Negotiated Rate	$1,871.25
Max. Negotiated Rate	$3,018.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,018.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,744.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,871.25

GRAFT VASCULAR PROPATEN

Facility

$12,475.00

Service Code	HCPCS C1768
Hospital Charge Code	270658084
Hospital Revenue Code	278
Min. Negotiated Rate	$300.65
Max. Negotiated Rate	$6,237.50
Rate for Payer: Aetna Commercial	$4,740.50
Rate for Payer: Aetna Medicare Advantage	$3,742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,181.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,181.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,181.12
Rate for Payer: Cigna Commercial	$6,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,018.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,744.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,871.25
Rate for Payer: UnitedHealthcare Community & State	$300.65
Rate for Payer: Wellpoint Medicaid Managed Care	$330.59

GRAFT VASCULAR PROPATEN 6X70CM

Facility

$11,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270660005
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

GRAFT VASCULAR PROPATEN 6X70CM

Facility

$11,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270660005
Hospital Revenue Code	278
Min. Negotiated Rate	$271.12
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50
Rate for Payer: UnitedHealthcare Community & State	$271.12
Rate for Payer: Wellpoint Medicaid Managed Care	$298.12

GRAFT VASCULAR STITCH 6X40****

Facility

$1,994.00

Hospital Charge Code	1605823
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 VASCULAR STITCH 6X40****

Facility

$1,994.00

Hospital Charge Code	1605823
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 VASCULAR ULTRA .8x7.6CM

Facility

$500.30

Service Code	HCPCS C1768
Hospital Charge Code	270680258
Hospital Revenue Code	278
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$250.15
Rate for Payer: Aetna Commercial	$190.11
Rate for Payer: Aetna Medicare Advantage	$150.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.58
Rate for Payer: Cigna Commercial	$250.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.07
Rate for Payer: Qualcare PPO/HMO/WC	$75.05
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: Wellpoint Medicaid Managed Care	$13.26

GRAFT VASCULAR ULTRA .8x7.6CM

Facility

$500.30

Service Code	HCPCS C1768
Hospital Charge Code	270680258
Hospital Revenue Code	278
Min. Negotiated Rate	$75.05
Max. Negotiated Rate	$121.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.07
Rate for Payer: Qualcare PPO/HMO/WC	$75.05

GRAFT VASCULAR WOVEN DOUBLE VE

Facility

$2,483.25

Service Code	HCPCS C1768
Hospital Charge Code	270663688
Hospital Revenue Code	278
Min. Negotiated Rate	$59.85
Max. Negotiated Rate	$1,241.62
Rate for Payer: Aetna Commercial	$943.63
Rate for Payer: Aetna Medicare Advantage	$744.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$633.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$633.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$496.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$633.23
Rate for Payer: Cigna Commercial	$1,241.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$546.32
Rate for Payer: Qualcare PPO/HMO/WC	$372.49
Rate for Payer: UnitedHealthcare Community & State	$59.85
Rate for Payer: Wellpoint Medicaid Managed Care	$65.81

GRAFT VASCULAR WOVEN DOUBLE VE

Facility

$3,336.25

Hospital Charge Code	270663689
Hospital Revenue Code	278
Min. Negotiated Rate	$80.40
Max. Negotiated Rate	$1,668.12
Rate for Payer: Aetna Commercial	$1,267.78
Rate for Payer: Aetna Medicare Advantage	$1,000.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$850.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$850.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$667.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$850.74
Rate for Payer: Cigna Commercial	$1,668.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$807.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$733.98
Rate for Payer: Qualcare PPO/HMO/WC	$500.44
Rate for Payer: UnitedHealthcare Community & State	$80.40
Rate for Payer: Wellpoint Medicaid Managed Care	$88.41

GRAFT VASCULAR WOVEN DOUBLE VE

Facility

$2,483.25

Service Code	HCPCS C1768
Hospital Charge Code	270663688
Hospital Revenue Code	278
Min. Negotiated Rate	$372.49
Max. Negotiated Rate	$600.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$496.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$546.32
Rate for Payer: Qualcare PPO/HMO/WC	$372.49

GRAFT VASCULAR WOVEN DOUBLE VE

Facility

$3,336.25

Hospital Charge Code	270663689
Hospital Revenue Code	278
Min. Negotiated Rate	$500.44
Max. Negotiated Rate	$807.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$667.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$807.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$733.98
Rate for Payer: Qualcare PPO/HMO/WC	$500.44

Know your out-of-pocket cost for care.

All Charges