Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BONE GRAFT KIT INFUSE XX SMALL

Facility

$4,775.00

Service Code	HCPCS L8699
Hospital Charge Code	270692241
Hospital Revenue Code	278
Min. Negotiated Rate	$115.08
Max. Negotiated Rate	$2,387.50
Rate for Payer: Aetna Commercial	$1,814.50
Rate for Payer: Aetna Medicare Advantage	$1,432.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,217.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,217.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,217.62
Rate for Payer: Cigna Commercial	$2,387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,155.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,050.50
Rate for Payer: Qualcare PPO/HMO/WC	$716.25
Rate for Payer: UnitedHealthcare Community & State	$115.08
Rate for Payer: Wellpoint Medicaid Managed Care	$126.54

BONE GRAFT KIT INFUSE XX SMALL

Facility

$4,775.00

Service Code	HCPCS L8699
Hospital Charge Code	270692241
Hospital Revenue Code	278
Min. Negotiated Rate	$716.25
Max. Negotiated Rate	$1,155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,155.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,050.50
Rate for Payer: Qualcare PPO/HMO/WC	$716.25

BONE GRAFT MATRIX 5X5CM 17.5CC

Facility

$15,665.00

Hospital Charge Code	270671746
Hospital Revenue Code	278
Min. Negotiated Rate	$377.53
Max. Negotiated Rate	$7,832.50
Rate for Payer: Aetna Commercial	$5,952.70
Rate for Payer: Aetna Medicare Advantage	$4,699.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,994.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,994.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,133.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,994.57
Rate for Payer: Cigna Commercial	$7,832.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,790.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,446.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,349.75
Rate for Payer: UnitedHealthcare Community & State	$377.53
Rate for Payer: Wellpoint Medicaid Managed Care	$415.12

BONE GRAFT MATRIX 5X5CM 17.5CC

Facility

$15,665.00

Hospital Charge Code	270671746
Hospital Revenue Code	278
Min. Negotiated Rate	$2,349.75
Max. Negotiated Rate	$3,790.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,790.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,446.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,349.75

BONE GRAFT MATRIX 5X5CM 8.75CC

Facility

$9,395.00

Hospital Charge Code	270671745
Hospital Revenue Code	278
Min. Negotiated Rate	$1,409.25
Max. Negotiated Rate	$2,273.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,879.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,273.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,066.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,409.25

BONE GRAFT MATRIX 5X5CM 8.75CC

Facility

$9,395.00

Hospital Charge Code	270671745
Hospital Revenue Code	278
Min. Negotiated Rate	$226.42
Max. Negotiated Rate	$4,697.50
Rate for Payer: Aetna Commercial	$3,570.10
Rate for Payer: Aetna Medicare Advantage	$2,818.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,395.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,395.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,879.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,395.72
Rate for Payer: Cigna Commercial	$4,697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,273.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,066.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,409.25
Rate for Payer: UnitedHealthcare Community & State	$226.42
Rate for Payer: Wellpoint Medicaid Managed Care	$248.97

BONE GRAFT PASTE MIX PLUS 10CC

Facility

$9,755.00

Hospital Charge Code	270671744
Hospital Revenue Code	278
Min. Negotiated Rate	$235.10
Max. Negotiated Rate	$4,877.50
Rate for Payer: Aetna Commercial	$3,706.90
Rate for Payer: Aetna Medicare Advantage	$2,926.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,487.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,487.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,951.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,487.53
Rate for Payer: Cigna Commercial	$4,877.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,360.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,146.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,463.25
Rate for Payer: UnitedHealthcare Community & State	$235.10
Rate for Payer: Wellpoint Medicaid Managed Care	$258.51

BONE GRAFT PASTE MIX PLUS 10CC

Facility

$9,755.00

Hospital Charge Code	270671744
Hospital Revenue Code	278
Min. Negotiated Rate	$1,463.25
Max. Negotiated Rate	$2,360.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,951.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,360.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,146.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,463.25

BONE GRAFT PASTE MIX PLUS 1.25

Facility

$2,615.00

Hospital Charge Code	270671741
Hospital Revenue Code	278
Min. Negotiated Rate	$63.02
Max. Negotiated Rate	$1,307.50
Rate for Payer: Aetna Commercial	$993.70
Rate for Payer: Aetna Medicare Advantage	$784.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$666.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$666.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$523.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$666.83
Rate for Payer: Cigna Commercial	$1,307.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$632.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$575.30
Rate for Payer: Qualcare PPO/HMO/WC	$392.25
Rate for Payer: UnitedHealthcare Community & State	$63.02
Rate for Payer: Wellpoint Medicaid Managed Care	$69.30

BONE GRAFT PASTE MIX PLUS 1.25

Facility

$2,615.00

Hospital Charge Code	270671741
Hospital Revenue Code	278
Min. Negotiated Rate	$392.25
Max. Negotiated Rate	$632.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$523.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$632.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$575.30
Rate for Payer: Qualcare PPO/HMO/WC	$392.25

BONE GRAFT PASTE MIX PLUS 2.5

Facility

$3,615.00

Hospital Charge Code	270671742
Hospital Revenue Code	278
Min. Negotiated Rate	$542.25
Max. Negotiated Rate	$874.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$723.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$874.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$795.30
Rate for Payer: Qualcare PPO/HMO/WC	$542.25

BONE GRAFT PASTE MIX PLUS 2.5

Facility

$3,615.00

Hospital Charge Code	270671742
Hospital Revenue Code	278
Min. Negotiated Rate	$87.12
Max. Negotiated Rate	$1,807.50
Rate for Payer: Aetna Commercial	$1,373.70
Rate for Payer: Aetna Medicare Advantage	$1,084.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$921.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$921.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$723.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$921.83
Rate for Payer: Cigna Commercial	$1,807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$874.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$795.30
Rate for Payer: Qualcare PPO/HMO/WC	$542.25
Rate for Payer: UnitedHealthcare Community & State	$87.12
Rate for Payer: Wellpoint Medicaid Managed Care	$95.80

BONE GRAFT PASTE MIX PLUS 5CC

Facility

$5,845.00

Hospital Charge Code	270671743
Hospital Revenue Code	278
Min. Negotiated Rate	$876.75
Max. Negotiated Rate	$1,414.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,169.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,414.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,285.90
Rate for Payer: Qualcare PPO/HMO/WC	$876.75

BONE GRAFT PASTE MIX PLUS 5CC

Facility

$5,845.00

Hospital Charge Code	270671743
Hospital Revenue Code	278
Min. Negotiated Rate	$140.86
Max. Negotiated Rate	$2,922.50
Rate for Payer: Aetna Commercial	$2,221.10
Rate for Payer: Aetna Medicare Advantage	$1,753.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,490.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,490.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,490.47
Rate for Payer: Cigna Commercial	$2,922.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,414.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,285.90
Rate for Payer: Qualcare PPO/HMO/WC	$876.75
Rate for Payer: UnitedHealthcare Community & State	$140.86
Rate for Payer: Wellpoint Medicaid Managed Care	$154.89

BONE GRAFT STRIP 12x12x12MM

Facility

$2,700.00

Hospital Charge Code	270671734
Hospital Revenue Code	278
Min. Negotiated Rate	$65.07
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$653.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$594.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Community & State	$65.07
Rate for Payer: Wellpoint Medicaid Managed Care	$71.55

BONE GRAFT STRIP 12x12x12MM

Facility

$2,700.00

Hospital Charge Code	270671734
Hospital Revenue Code	278
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$653.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$653.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$594.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

BONE GRAFT STRIP 14x14x14MM

Facility

$3,600.00

Hospital Charge Code	270671735
Hospital Revenue Code	278
Min. Negotiated Rate	$540.00
Max. Negotiated Rate	$871.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$792.00
Rate for Payer: Qualcare PPO/HMO/WC	$540.00

BONE GRAFT STRIP 14x14x14MM

Facility

$3,600.00

Hospital Charge Code	270671735
Hospital Revenue Code	278
Min. Negotiated Rate	$86.76
Max. Negotiated Rate	$1,800.00
Rate for Payer: Aetna Commercial	$1,368.00
Rate for Payer: Aetna Medicare Advantage	$1,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$918.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$918.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$918.00
Rate for Payer: Cigna Commercial	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$792.00
Rate for Payer: Qualcare PPO/HMO/WC	$540.00
Rate for Payer: UnitedHealthcare Community & State	$86.76
Rate for Payer: Wellpoint Medicaid Managed Care	$95.40

BONE GRAFT STRIP 26x19x7MM

Facility

$6,300.00

Hospital Charge Code	270671727
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

BONE GRAFT STRIP 26x19x7MM

Facility

$6,300.00

Hospital Charge Code	270671727
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

BONE GRAFT STRIP 50x10x7MM

Facility

$6,300.00

Hospital Charge Code	270671726
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

BONE GRAFT STRIP 50x10x7MM

Facility

$6,300.00

Hospital Charge Code	270671726
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

BONE GRAFT STRIP 50x15x7MM

Facility

$9,335.00

Service Code	HCPCS C1713
Hospital Charge Code	270671728
Hospital Revenue Code	278
Min. Negotiated Rate	$224.97
Max. Negotiated Rate	$4,667.50
Rate for Payer: Aetna Commercial	$3,547.30
Rate for Payer: Aetna Medicare Advantage	$2,800.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,380.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,380.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,380.43
Rate for Payer: Cigna Commercial	$4,667.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,259.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,053.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,400.25
Rate for Payer: UnitedHealthcare Community & State	$224.97
Rate for Payer: Wellpoint Medicaid Managed Care	$247.38

BONE GRAFT STRIP 50x15x7MM

Facility

$9,335.00

Service Code	HCPCS C1713
Hospital Charge Code	270671728
Hospital Revenue Code	278
Min. Negotiated Rate	$1,400.25
Max. Negotiated Rate	$2,259.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,867.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,259.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,053.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,400.25

BONE GRAFT SUB PRO OSTEN 2RG15

Facility

$5,232.85

Hospital Charge Code	270632401
Hospital Revenue Code	272
Min. Negotiated Rate	$126.11
Max. Negotiated Rate	$2,616.43
Rate for Payer: Aetna Commercial	$1,988.48
Rate for Payer: Aetna Medicare Advantage	$1,569.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,334.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,334.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,334.38
Rate for Payer: Cigna Commercial	$2,616.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,569.86
Rate for Payer: Oxford Commercial	$1,046.57
Rate for Payer: Qualcare PPO/HMO/WC	$784.93
Rate for Payer: UnitedHealthcare Commercial	$1,046.57
Rate for Payer: UnitedHealthcare Community & State	$126.11
Rate for Payer: Wellpoint Medicaid Managed Care	$138.67

Know your out-of-pocket cost for care.

All Charges