Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CEMENT BONE DOUGH *****

Facility

$140.00

Hospital Charge Code	1601657
Hospital Revenue Code	272
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.00
Rate for Payer: Oxford Commercial	$28.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Commercial	$28.00
Rate for Payer: UnitedHealthcare Community & State	$3.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.71

CEMENT BONE DOUGH *****

Facility

$140.00

Hospital Charge Code	1601657
Hospital Revenue Code	272
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

CEMENT BONE DOUGH REGULAR

Facility

$653.00

Hospital Charge Code	270335159
Hospital Revenue Code	278
Min. Negotiated Rate	$97.95
Max. Negotiated Rate	$158.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.66
Rate for Payer: Qualcare PPO/HMO/WC	$97.95

CEMENT BONE DOUGH REGULAR

Facility

$653.00

Hospital Charge Code	270335159
Hospital Revenue Code	278
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$326.50
Rate for Payer: Aetna Commercial	$248.14
Rate for Payer: Aetna Medicare Advantage	$195.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.51
Rate for Payer: Cigna Commercial	$326.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.66
Rate for Payer: Qualcare PPO/HMO/WC	$97.95
Rate for Payer: UnitedHealthcare Community & State	$15.74
Rate for Payer: Wellpoint Medicaid Managed Care	$17.30

CEMENT BONE HYDROSET XT 10CC

Facility

$25,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696729
Hospital Revenue Code	278
Min. Negotiated Rate	$614.55
Max. Negotiated Rate	$12,750.00
Rate for Payer: Aetna Commercial	$9,690.00
Rate for Payer: Aetna Medicare Advantage	$7,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,502.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,502.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,502.50
Rate for Payer: Cigna Commercial	$12,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,171.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,610.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,825.00
Rate for Payer: UnitedHealthcare Community & State	$614.55
Rate for Payer: Wellpoint Medicaid Managed Care	$675.75

CEMENT BONE HYDROSET XT 10CC

Facility

$25,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696729
Hospital Revenue Code	278
Min. Negotiated Rate	$3,825.00
Max. Negotiated Rate	$6,171.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,171.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,610.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,825.00

CEMENT BONE LVC ******

Facility

$204.00

Hospital Charge Code	1601665
Hospital Revenue Code	272
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Commercial	$77.52
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.20
Rate for Payer: Oxford Commercial	$40.80
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$40.80
Rate for Payer: UnitedHealthcare Community & State	$4.92
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

CEMENT BONE LVC ******

Facility

$204.00

Hospital Charge Code	1601665
Hospital Revenue Code	272
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

CEMENT BONE MIMIX 10 GRAM

Facility

$9,125.00

Hospital Charge Code	270662163
Hospital Revenue Code	278
Min. Negotiated Rate	$1,368.75
Max. Negotiated Rate	$2,208.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,208.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,007.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,368.75

CEMENT BONE MIMIX 10 GRAM

Facility

$9,125.00

Hospital Charge Code	270662163
Hospital Revenue Code	278
Min. Negotiated Rate	$219.91
Max. Negotiated Rate	$4,562.50
Rate for Payer: Aetna Commercial	$3,467.50
Rate for Payer: Aetna Medicare Advantage	$2,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,326.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,326.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,326.88
Rate for Payer: Cigna Commercial	$4,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,208.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,007.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,368.75
Rate for Payer: UnitedHealthcare Community & State	$219.91
Rate for Payer: Wellpoint Medicaid Managed Care	$241.81

CEMENT BONE MIXER PACK

Facility

$1,474.00

Hospital Charge Code	270669783O
Hospital Revenue Code	272
Min. Negotiated Rate	$35.52
Max. Negotiated Rate	$737.00
Rate for Payer: Aetna Commercial	$560.12
Rate for Payer: Aetna Medicare Advantage	$442.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.87
Rate for Payer: Cigna Commercial	$737.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.20
Rate for Payer: Oxford Commercial	$294.80
Rate for Payer: Qualcare PPO/HMO/WC	$221.10
Rate for Payer: UnitedHealthcare Commercial	$294.80
Rate for Payer: UnitedHealthcare Community & State	$35.52
Rate for Payer: Wellpoint Medicaid Managed Care	$39.06

CEMENT BONE MIXER PACK

Facility

$1,236.15

Hospital Charge Code	270669783
Hospital Revenue Code	272
Min. Negotiated Rate	$29.79
Max. Negotiated Rate	$618.08
Rate for Payer: Aetna Commercial	$469.74
Rate for Payer: Aetna Medicare Advantage	$370.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$315.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$315.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$315.22
Rate for Payer: Cigna Commercial	$618.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$370.85
Rate for Payer: Oxford Commercial	$247.23
Rate for Payer: Qualcare PPO/HMO/WC	$185.42
Rate for Payer: UnitedHealthcare Commercial	$247.23
Rate for Payer: UnitedHealthcare Community & State	$29.79
Rate for Payer: Wellpoint Medicaid Managed Care	$32.76

CEMENT BONE MIXER PACK

Facility

$1,474.00

Hospital Charge Code	270669783O
Hospital Revenue Code	272
Min. Negotiated Rate	$221.10
Max. Negotiated Rate	$221.10
Rate for Payer: Qualcare PPO/HMO/WC	$221.10

CEMENT BONE MIXER PACK

Facility

$1,236.15

Hospital Charge Code	270669783
Hospital Revenue Code	272
Min. Negotiated Rate	$185.42
Max. Negotiated Rate	$185.42
Rate for Payer: Qualcare PPO/HMO/WC	$185.42

CEMENT BONE MIXING BOWL

Facility

$274.05

Service Code	HCPCS C1713
Hospital Charge Code	270658120
Hospital Revenue Code	278
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$137.03
Rate for Payer: Aetna Commercial	$104.14
Rate for Payer: Aetna Medicare Advantage	$82.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.88
Rate for Payer: Cigna Commercial	$137.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$60.29
Rate for Payer: Qualcare PPO/HMO/WC	$41.11
Rate for Payer: UnitedHealthcare Community & State	$6.60
Rate for Payer: Wellpoint Medicaid Managed Care	$7.26

CEMENT BONE MIXING BOWL

Facility

$274.05

Service Code	HCPCS C1713
Hospital Charge Code	270658120
Hospital Revenue Code	278
Min. Negotiated Rate	$41.11
Max. Negotiated Rate	$66.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$60.29
Rate for Payer: Qualcare PPO/HMO/WC	$41.11

CEMENT BONE PLACOS G 424810

Facility

$1,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270635590
Hospital Revenue Code	278
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$987.50
Rate for Payer: Aetna Commercial	$750.50
Rate for Payer: Aetna Medicare Advantage	$592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.62
Rate for Payer: Cigna Commercial	$987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$477.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$434.50
Rate for Payer: Qualcare PPO/HMO/WC	$296.25
Rate for Payer: UnitedHealthcare Community & State	$47.60
Rate for Payer: Wellpoint Medicaid Managed Care	$52.34

CEMENT BONE PLACOS G 424810

Facility

$1,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270635590
Hospital Revenue Code	278
Min. Negotiated Rate	$296.25
Max. Negotiated Rate	$477.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$477.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$434.50
Rate for Payer: Qualcare PPO/HMO/WC	$296.25

CEMENT BONE RADIOPQUE HVR C01A

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	270633797
Hospital Revenue Code	278
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Community & State	$15.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.23

CEMENT BONE RADIOPQUE HVR C01A

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	270633797
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

CEMENT BONESYNC 5CC PHOSPHATE

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270692085
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

CEMENT BONESYNC 5CC PHOSPHATE

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270692085
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

CEMENT COBALT 402432

Facility

$545.00

Hospital Charge Code	270638690
Hospital Revenue Code	278
Min. Negotiated Rate	$81.75
Max. Negotiated Rate	$131.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$119.90
Rate for Payer: Qualcare PPO/HMO/WC	$81.75

CEMENT COBALT 402432

Facility

$545.00

Hospital Charge Code	270638690
Hospital Revenue Code	278
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$272.50
Rate for Payer: Aetna Commercial	$207.10
Rate for Payer: Aetna Medicare Advantage	$163.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.97
Rate for Payer: Cigna Commercial	$272.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$119.90
Rate for Payer: Qualcare PPO/HMO/WC	$81.75
Rate for Payer: UnitedHealthcare Community & State	$13.13
Rate for Payer: Wellpoint Medicaid Managed Care	$14.44

CEMENT COBALT W/ANTIB 402433

Facility

$1,975.00

Hospital Charge Code	270638571
Hospital Revenue Code	278
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$987.50
Rate for Payer: Aetna Commercial	$750.50
Rate for Payer: Aetna Medicare Advantage	$592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.62
Rate for Payer: Cigna Commercial	$987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$477.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$434.50
Rate for Payer: Qualcare PPO/HMO/WC	$296.25
Rate for Payer: UnitedHealthcare Community & State	$47.60
Rate for Payer: Wellpoint Medicaid Managed Care	$52.34

Know your out-of-pocket cost for care.

All Charges