Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BONE FILLER 10 CC

Facility

$19,337.50

Service Code	HCPCS C1713
Hospital Charge Code	270701671
Hospital Revenue Code	278
Min. Negotiated Rate	$2,900.62
Max. Negotiated Rate	$4,679.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,867.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,679.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,254.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,900.62

BONE FILLER 5ML CERAMENT

Facility

$6,525.00

Service Code	HCPCS C1713
Hospital Charge Code	270690281
Hospital Revenue Code	278
Min. Negotiated Rate	$978.75
Max. Negotiated Rate	$1,579.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,579.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,435.50
Rate for Payer: Qualcare PPO/HMO/WC	$978.75

BONE FILLER 5ML CERAMENT

Facility

$6,525.00

Service Code	HCPCS C1713
Hospital Charge Code	270690281
Hospital Revenue Code	278
Min. Negotiated Rate	$157.25
Max. Negotiated Rate	$3,262.50
Rate for Payer: Aetna Commercial	$2,479.50
Rate for Payer: Aetna Medicare Advantage	$1,957.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,663.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,663.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,305.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,663.88
Rate for Payer: Cigna Commercial	$3,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,579.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,435.50
Rate for Payer: Qualcare PPO/HMO/WC	$978.75
Rate for Payer: UnitedHealthcare Community & State	$157.25
Rate for Payer: Wellpoint Medicaid Managed Care	$172.91

BONE GRAFT 10CC INJECTABLE

Facility

$14,615.00

Hospital Charge Code	270667747
Hospital Revenue Code	278
Min. Negotiated Rate	$352.22
Max. Negotiated Rate	$7,307.50
Rate for Payer: Aetna Commercial	$5,553.70
Rate for Payer: Aetna Medicare Advantage	$4,384.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,726.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,726.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,923.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,726.82
Rate for Payer: Cigna Commercial	$7,307.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,536.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,215.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.25
Rate for Payer: UnitedHealthcare Community & State	$352.22
Rate for Payer: Wellpoint Medicaid Managed Care	$387.30

BONE GRAFT 10CC INJECTABLE

Facility

$14,615.00

Hospital Charge Code	270667747
Hospital Revenue Code	278
Min. Negotiated Rate	$2,192.25
Max. Negotiated Rate	$3,536.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,923.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,536.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,215.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.25

BONE GRAFT 4CC INJECTABLE

Facility

$7,230.00

Service Code	HCPCS C1713
Hospital Charge Code	270656818
Hospital Revenue Code	278
Min. Negotiated Rate	$1,084.50
Max. Negotiated Rate	$1,749.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,446.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,749.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,590.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,084.50

BONE GRAFT 4CC INJECTABLE

Facility

$7,230.00

Service Code	HCPCS C1713
Hospital Charge Code	270656818
Hospital Revenue Code	278
Min. Negotiated Rate	$174.24
Max. Negotiated Rate	$3,615.00
Rate for Payer: Aetna Commercial	$2,747.40
Rate for Payer: Aetna Medicare Advantage	$2,169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,843.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,843.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,446.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,843.65
Rate for Payer: Cigna Commercial	$3,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,749.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,590.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,084.50
Rate for Payer: UnitedHealthcare Community & State	$174.24
Rate for Payer: Wellpoint Medicaid Managed Care	$191.59

BONE GRAFT 5CC

Facility

$8,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270692660
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

BONE GRAFT 5CC

Facility

$8,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270692660
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

BONE GRAFT DELIV TUBE 10 CC

Facility

$693.00

Hospital Charge Code	270339051
Hospital Revenue Code	272
Min. Negotiated Rate	$16.70
Max. Negotiated Rate	$346.50
Rate for Payer: Aetna Commercial	$263.34
Rate for Payer: Aetna Medicare Advantage	$207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.72
Rate for Payer: Cigna Commercial	$346.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.90
Rate for Payer: Oxford Commercial	$138.60
Rate for Payer: Qualcare PPO/HMO/WC	$103.95
Rate for Payer: UnitedHealthcare Commercial	$138.60
Rate for Payer: UnitedHealthcare Community & State	$16.70
Rate for Payer: Wellpoint Medicaid Managed Care	$18.36

BONE GRAFT DELIV TUBE 10 CC

Facility

$693.00

Hospital Charge Code	270339051
Hospital Revenue Code	272
Min. Negotiated Rate	$103.95
Max. Negotiated Rate	$103.95
Rate for Payer: Qualcare PPO/HMO/WC	$103.95

BONE GRAFT GRAINS 10CC

Facility

$4,275.00

Hospital Charge Code	270671737
Hospital Revenue Code	278
Min. Negotiated Rate	$103.03
Max. Negotiated Rate	$2,137.50
Rate for Payer: Aetna Commercial	$1,624.50
Rate for Payer: Aetna Medicare Advantage	$1,282.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,090.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,090.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,090.12
Rate for Payer: Cigna Commercial	$2,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$940.50
Rate for Payer: Qualcare PPO/HMO/WC	$641.25
Rate for Payer: UnitedHealthcare Community & State	$103.03
Rate for Payer: Wellpoint Medicaid Managed Care	$113.29

BONE GRAFT GRAINS 10CC

Facility

$4,275.00

Hospital Charge Code	270671737
Hospital Revenue Code	278
Min. Negotiated Rate	$641.25
Max. Negotiated Rate	$1,034.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$940.50
Rate for Payer: Qualcare PPO/HMO/WC	$641.25

BONE GRAFT GRAINS 30CC

Facility

$13,000.00

Hospital Charge Code	270671738
Hospital Revenue Code	278
Min. Negotiated Rate	$313.30
Max. Negotiated Rate	$6,500.00
Rate for Payer: Aetna Commercial	$4,940.00
Rate for Payer: Aetna Medicare Advantage	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,315.00
Rate for Payer: Cigna Commercial	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,860.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00
Rate for Payer: UnitedHealthcare Community & State	$313.30
Rate for Payer: Wellpoint Medicaid Managed Care	$344.50

BONE GRAFT GRAINS 30CC

Facility

$13,000.00

Hospital Charge Code	270671738
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$3,146.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,860.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00

BONE GRAFT GRAINS 5CC

Facility

$2,250.00

Hospital Charge Code	270671736
Hospital Revenue Code	278
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

BONE GRAFT GRAINS 5CC

Facility

$2,250.00

Hospital Charge Code	270671736
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

BONE GRAFT INQU GRANULES 10CC

Facility

$6,465.00

Hospital Charge Code	270671739
Hospital Revenue Code	278
Min. Negotiated Rate	$155.81
Max. Negotiated Rate	$3,232.50
Rate for Payer: Aetna Commercial	$2,456.70
Rate for Payer: Aetna Medicare Advantage	$1,939.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,648.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,648.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,293.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,648.58
Rate for Payer: Cigna Commercial	$3,232.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,564.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,422.30
Rate for Payer: Qualcare PPO/HMO/WC	$969.75
Rate for Payer: UnitedHealthcare Community & State	$155.81
Rate for Payer: Wellpoint Medicaid Managed Care	$171.32

BONE GRAFT INQU GRANULES 10CC

Facility

$6,465.00

Hospital Charge Code	270671739
Hospital Revenue Code	278
Min. Negotiated Rate	$969.75
Max. Negotiated Rate	$1,564.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,293.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,564.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,422.30
Rate for Payer: Qualcare PPO/HMO/WC	$969.75

BONE GRAFT INQU GRANULES 30CC

Facility

$14,940.00

Hospital Charge Code	270671740
Hospital Revenue Code	278
Min. Negotiated Rate	$2,241.00
Max. Negotiated Rate	$3,615.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,988.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,615.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,286.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,241.00

BONE GRAFT INQU GRANULES 30CC

Facility

$14,940.00

Hospital Charge Code	270671740
Hospital Revenue Code	278
Min. Negotiated Rate	$360.05
Max. Negotiated Rate	$7,470.00
Rate for Payer: Aetna Commercial	$5,677.20
Rate for Payer: Aetna Medicare Advantage	$4,482.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,809.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,809.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,988.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,809.70
Rate for Payer: Cigna Commercial	$7,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,615.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,286.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,241.00
Rate for Payer: UnitedHealthcare Community & State	$360.05
Rate for Payer: Wellpoint Medicaid Managed Care	$395.91

BONE GRAFT KIT 10CC

Facility

$10,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270688355
Hospital Revenue Code	278
Min. Negotiated Rate	$262.09
Max. Negotiated Rate	$5,437.50
Rate for Payer: Aetna Commercial	$4,132.50
Rate for Payer: Aetna Medicare Advantage	$3,262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,773.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,773.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,773.12
Rate for Payer: Cigna Commercial	$5,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,631.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,392.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,631.25
Rate for Payer: UnitedHealthcare Community & State	$262.09
Rate for Payer: Wellpoint Medicaid Managed Care	$288.19

BONE GRAFT KIT 10CC

Facility

$10,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270688355
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.25
Max. Negotiated Rate	$2,631.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,631.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,392.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,631.25

BONE GRAFT KIT 8CC

Facility

$27,845.00

Service Code	HCPCS C1763
Hospital Charge Code	270652415
Hospital Revenue Code	278
Min. Negotiated Rate	$671.06
Max. Negotiated Rate	$13,922.50
Rate for Payer: Aetna Commercial	$10,581.10
Rate for Payer: Aetna Medicare Advantage	$8,353.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,100.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,100.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,569.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,100.48
Rate for Payer: Cigna Commercial	$13,922.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,738.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,125.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,176.75
Rate for Payer: UnitedHealthcare Community & State	$671.06
Rate for Payer: Wellpoint Medicaid Managed Care	$737.89

BONE GRAFT KIT 8CC

Facility

$27,845.00

Service Code	HCPCS C1763
Hospital Charge Code	270652415
Hospital Revenue Code	278
Min. Negotiated Rate	$4,176.75
Max. Negotiated Rate	$6,738.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,569.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,738.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,125.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,176.75

Know your out-of-pocket cost for care.

All Charges