Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WALLGRAFT 10x50 ENDOPROST 7050

Facility

$10,675.00

Hospital Charge Code	270623517V
Hospital Revenue Code	278
Min. Negotiated Rate	$257.27
Max. Negotiated Rate	$5,337.50
Rate for Payer: Aetna Commercial	$4,056.50
Rate for Payer: Aetna Medicare Advantage	$3,202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,722.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,722.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,722.12
Rate for Payer: Cigna Commercial	$5,337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,348.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.25
Rate for Payer: UnitedHealthcare Community & State	$257.27
Rate for Payer: Wellpoint Medicaid Managed Care	$282.89

WALLGRAFT 14 X 50 70545

Facility

$9,672.00

Hospital Charge Code	270632221
Hospital Revenue Code	278
Min. Negotiated Rate	$1,450.80
Max. Negotiated Rate	$2,340.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,934.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,340.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,127.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,450.80

WALLGRAFT 14 X 50 70545

Facility

$9,672.00

Hospital Charge Code	270632221
Hospital Revenue Code	278
Min. Negotiated Rate	$233.10
Max. Negotiated Rate	$4,836.00
Rate for Payer: Aetna Commercial	$3,675.36
Rate for Payer: Aetna Medicare Advantage	$2,901.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,466.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,466.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,934.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,466.36
Rate for Payer: Cigna Commercial	$4,836.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,340.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,127.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,450.80
Rate for Payer: UnitedHealthcare Community & State	$233.10
Rate for Payer: Wellpoint Medicaid Managed Care	$256.31

WALLGRAFT 14 X 70 70547

Facility

$11,036.00

Hospital Charge Code	270632222
Hospital Revenue Code	278
Min. Negotiated Rate	$1,655.40
Max. Negotiated Rate	$2,670.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,207.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,670.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,427.92
Rate for Payer: Qualcare PPO/HMO/WC	$1,655.40

WALLGRAFT 14 X 70 70547

Facility

$11,036.00

Hospital Charge Code	270632222
Hospital Revenue Code	278
Min. Negotiated Rate	$265.97
Max. Negotiated Rate	$5,518.00
Rate for Payer: Aetna Commercial	$4,193.68
Rate for Payer: Aetna Medicare Advantage	$3,310.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,814.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,814.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,207.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,814.18
Rate for Payer: Cigna Commercial	$5,518.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,670.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,427.92
Rate for Payer: Qualcare PPO/HMO/WC	$1,655.40
Rate for Payer: UnitedHealthcare Community & State	$265.97
Rate for Payer: Wellpoint Medicaid Managed Care	$292.45

WALLGRAFT 8x50 ENDOPROST 70585

Facility

$9,750.00

Hospital Charge Code	270623516V
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

WALLGRAFT 8x50 ENDOPROST 70585

Facility

$9,750.00

Hospital Charge Code	270623516V
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

WALL HIGH G7 LONGEVITY 36MM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270692343
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

WALL HIGH G7 LONGEVITY 36MM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270692343
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

WALL MAXILLO FACIAL FRACTURE

Facility

$54.00

Hospital Charge Code	270332245
Hospital Revenue Code	278
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.88
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

WALL MAXILLO FACIAL FRACTURE

Facility

$54.00

Hospital Charge Code	270332245
Hospital Revenue Code	278
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$20.52
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.77
Rate for Payer: Cigna Commercial	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.88
Rate for Payer: Qualcare PPO/HMO/WC	$8.10
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

WALLSTENT 10FR 14x60mm 100cm

Facility

$5,250.00

Hospital Charge Code	270626883
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

WALLSTENT 10FR 14x60mm 100cm

Facility

$5,250.00

Hospital Charge Code	270626883
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

WALLSTENT 10FR 22X90MM 230CM

Facility

$8,625.00

Hospital Charge Code	270629357
Hospital Revenue Code	278
Min. Negotiated Rate	$1,293.75
Max. Negotiated Rate	$2,087.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,087.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,897.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,293.75

WALLSTENT 10FR 22X90MM 230CM

Facility

$8,625.00

Hospital Charge Code	270629357
Hospital Revenue Code	278
Min. Negotiated Rate	$207.86
Max. Negotiated Rate	$4,312.50
Rate for Payer: Aetna Commercial	$3,277.50
Rate for Payer: Aetna Medicare Advantage	$2,587.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,199.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,199.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,199.38
Rate for Payer: Cigna Commercial	$4,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,087.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,897.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,293.75
Rate for Payer: UnitedHealthcare Community & State	$207.86
Rate for Payer: Wellpoint Medicaid Managed Care	$228.56

WALLSTENT 11FR 18x60mm 75cm

Facility

$6,800.65

Service Code	HCPCS C1876
Hospital Charge Code	270636322
Hospital Revenue Code	278
Min. Negotiated Rate	$163.90
Max. Negotiated Rate	$3,400.32
Rate for Payer: Aetna Commercial	$2,584.25
Rate for Payer: Aetna Medicare Advantage	$2,040.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,734.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,734.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,360.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,734.17
Rate for Payer: Cigna Commercial	$3,400.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,645.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,496.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.10
Rate for Payer: UnitedHealthcare Community & State	$163.90
Rate for Payer: Wellpoint Medicaid Managed Care	$180.22

WALLSTENT 11FR 18x60mm 75cm

Facility

$6,800.65

Service Code	HCPCS C1876
Hospital Charge Code	270636322
Hospital Revenue Code	278
Min. Negotiated Rate	$1,020.10
Max. Negotiated Rate	$1,645.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,360.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,645.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,496.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.10

WALLSTENT 12/60 8FR 75cm 40212

Facility

$5,401.15

Hospital Charge Code	270626882V
Hospital Revenue Code	278
Min. Negotiated Rate	$810.17
Max. Negotiated Rate	$1,307.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,080.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,307.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,188.25
Rate for Payer: Qualcare PPO/HMO/WC	$810.17

WALLSTENT 12/60 8FR 75cm 40212

Facility

$5,401.15

Hospital Charge Code	270626882V
Hospital Revenue Code	278
Min. Negotiated Rate	$130.17
Max. Negotiated Rate	$2,700.57
Rate for Payer: Aetna Commercial	$2,052.44
Rate for Payer: Aetna Medicare Advantage	$1,620.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,377.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,377.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,080.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,377.29
Rate for Payer: Cigna Commercial	$2,700.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,307.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,188.25
Rate for Payer: Qualcare PPO/HMO/WC	$810.17
Rate for Payer: UnitedHealthcare Community & State	$130.17
Rate for Payer: Wellpoint Medicaid Managed Care	$143.13

WALLSTENT 12/60 9FR 100cm

Facility

$5,250.00

Hospital Charge Code	270626882
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

WALLSTENT 12/60 9FR 100cm

Facility

$5,250.00

Hospital Charge Code	270626882
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

WALLSTENT 12/90 9FR 100cm

Facility

$8,500.00

Hospital Charge Code	270627567
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

WALLSTENT 12/90 9FR 100cm

Facility

$8,500.00

Hospital Charge Code	270627567
Hospital Revenue Code	278
Min. Negotiated Rate	$204.85
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Community & State	$204.85
Rate for Payer: Wellpoint Medicaid Managed Care	$225.25

WALLSTENT 14/40 9FR 75cm 40311

Facility

$5,148.50

Hospital Charge Code	270624967
Hospital Revenue Code	278
Min. Negotiated Rate	$772.27
Max. Negotiated Rate	$1,245.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,029.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,245.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,132.67
Rate for Payer: Qualcare PPO/HMO/WC	$772.27

WALLSTENT 14/40 9FR 75cm 40311

Facility

$5,148.50

Hospital Charge Code	270624967
Hospital Revenue Code	278
Min. Negotiated Rate	$124.08
Max. Negotiated Rate	$2,574.25
Rate for Payer: Aetna Commercial	$1,956.43
Rate for Payer: Aetna Medicare Advantage	$1,544.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,312.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,312.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,029.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,312.87
Rate for Payer: Cigna Commercial	$2,574.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,245.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,132.67
Rate for Payer: Qualcare PPO/HMO/WC	$772.27
Rate for Payer: UnitedHealthcare Community & State	$124.08
Rate for Payer: Wellpoint Medicaid Managed Care	$136.44

Know your out-of-pocket cost for care.

All Charges