Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CEMENT MIXING BOWL COMPACT VAC

Facility

$1,425.00

Hospital Charge Code	270678378
Hospital Revenue Code	272
Min. Negotiated Rate	$213.75
Max. Negotiated Rate	$213.75
Rate for Payer: Qualcare PPO/HMO/WC	$213.75

CEMENT MIXING BOWL COMPACT VAC

Facility

$1,425.00

Hospital Charge Code	270678378
Hospital Revenue Code	272
Min. Negotiated Rate	$34.34
Max. Negotiated Rate	$712.50
Rate for Payer: Aetna Commercial	$541.50
Rate for Payer: Aetna Medicare Advantage	$427.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$363.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$363.38
Rate for Payer: Cigna Commercial	$712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$427.50
Rate for Payer: Oxford Commercial	$285.00
Rate for Payer: Qualcare PPO/HMO/WC	$213.75
Rate for Payer: UnitedHealthcare Commercial	$285.00
Rate for Payer: UnitedHealthcare Community & State	$34.34
Rate for Payer: Wellpoint Medicaid Managed Care	$37.76

CEMENT MIXING/DELIVERY SYSTEM

Facility

$568.75

Service Code	HCPCS C1713
Hospital Charge Code	270677293
Hospital Revenue Code	278
Min. Negotiated Rate	$13.71
Max. Negotiated Rate	$284.38
Rate for Payer: Aetna Commercial	$216.12
Rate for Payer: Aetna Medicare Advantage	$170.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.03
Rate for Payer: Cigna Commercial	$284.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$125.12
Rate for Payer: Qualcare PPO/HMO/WC	$85.31
Rate for Payer: UnitedHealthcare Community & State	$13.71
Rate for Payer: Wellpoint Medicaid Managed Care	$15.07

CEMENT MIXING/DELIVERY SYSTEM

Facility

$568.75

Service Code	HCPCS C1713
Hospital Charge Code	270677293
Hospital Revenue Code	278
Min. Negotiated Rate	$85.31
Max. Negotiated Rate	$137.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$125.12
Rate for Payer: Qualcare PPO/HMO/WC	$85.31

CEMENT MIXING SYSTEM

Facility

$352.00

Hospital Charge Code	270335504
Hospital Revenue Code	272
Min. Negotiated Rate	$8.48
Max. Negotiated Rate	$176.00
Rate for Payer: Aetna Commercial	$133.76
Rate for Payer: Aetna Medicare Advantage	$105.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.76
Rate for Payer: Cigna Commercial	$176.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.60
Rate for Payer: Oxford Commercial	$70.40
Rate for Payer: Qualcare PPO/HMO/WC	$52.80
Rate for Payer: UnitedHealthcare Commercial	$70.40
Rate for Payer: UnitedHealthcare Community & State	$8.48
Rate for Payer: Wellpoint Medicaid Managed Care	$9.33

CEMENT MIXING SYSTEM

Facility

$352.00

Hospital Charge Code	270335504
Hospital Revenue Code	272
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$52.80

CEMENT MVX PLUS 10CC

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270699969
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

CEMENT MVX PLUS 10CC

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270699969
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CEMENT OSSILIX FIL 10CC

Facility

$11,985.00

Service Code	HCPCS C1713
Hospital Charge Code	270682056
Hospital Revenue Code	278
Min. Negotiated Rate	$1,797.75
Max. Negotiated Rate	$2,900.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,397.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,900.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,636.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,797.75

CEMENT OSSILIX FIL 10CC

Facility

$11,985.00

Service Code	HCPCS C1713
Hospital Charge Code	270682056
Hospital Revenue Code	278
Min. Negotiated Rate	$288.84
Max. Negotiated Rate	$5,992.50
Rate for Payer: Aetna Commercial	$4,554.30
Rate for Payer: Aetna Medicare Advantage	$3,595.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,056.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,056.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,056.18
Rate for Payer: Cigna Commercial	$5,992.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,900.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,636.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,797.75
Rate for Payer: UnitedHealthcare Community & State	$288.84
Rate for Payer: Wellpoint Medicaid Managed Care	$317.60

CEMENT PALACOS BONE 424800

Facility

$545.00

Service Code	HCPCS C1713
Hospital Charge Code	270618650
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 PALACOS BONE 424800

Facility

$545.00

Service Code	HCPCS C1713
Hospital Charge Code	270618650
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 PALACOS LOW VISCOSIT

Facility

$502.50

Hospital Charge Code	270660974
Hospital Revenue Code	278
Min. Negotiated Rate	$75.38
Max. Negotiated Rate	$121.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.55
Rate for Payer: Qualcare PPO/HMO/WC	$75.38

CEMENT PALACOS LOW VISCOSIT

Facility

$502.50

Hospital Charge Code	270660974
Hospital Revenue Code	278
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$251.25
Rate for Payer: Aetna Commercial	$190.95
Rate for Payer: Aetna Medicare Advantage	$150.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.14
Rate for Payer: Cigna Commercial	$251.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.55
Rate for Payer: Qualcare PPO/HMO/WC	$75.38
Rate for Payer: UnitedHealthcare Community & State	$12.11
Rate for Payer: Wellpoint Medicaid Managed Care	$13.32

CEMENT PALACOS LOW VISCOSITY W

Facility

$1,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270660975
Hospital Revenue Code	278
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$356.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$324.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

CEMENT PALACOS LOW VISCOSITY W

Facility

$1,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270660975
Hospital Revenue Code	278
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$324.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$39.09

CEMENT PALACOS R+G SINGLE

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270679667
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

CEMENT PALACOS R+G SINGLE

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270679667
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

CEMENT PREP KIT FEMORAL BONE

Facility

$1,032.00

Hospital Charge Code	270635406
Hospital Revenue Code	272
Min. Negotiated Rate	$154.80
Max. Negotiated Rate	$154.80
Rate for Payer: Qualcare PPO/HMO/WC	$154.80

CEMENT PREP KIT FEMORAL BONE

Facility

$1,032.00

Hospital Charge Code	270635406
Hospital Revenue Code	272
Min. Negotiated Rate	$24.87
Max. Negotiated Rate	$516.00
Rate for Payer: Aetna Commercial	$392.16
Rate for Payer: Aetna Medicare Advantage	$309.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.16
Rate for Payer: Cigna Commercial	$516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$309.60
Rate for Payer: Oxford Commercial	$206.40
Rate for Payer: Qualcare PPO/HMO/WC	$154.80
Rate for Payer: UnitedHealthcare Commercial	$206.40
Rate for Payer: UnitedHealthcare Community & State	$24.87
Rate for Payer: Wellpoint Medicaid Managed Care	$27.35

CEMENT REFOBACIN BC R 40 GM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270682312
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

CEMENT REFOBACIN BC R 40 GM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270682312
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CEMENT RESTRICTOR

Facility

$395.00

Service Code	HCPCS C1776
Hospital Charge Code	270691681
Hospital Revenue Code	278
Min. Negotiated Rate	$59.25
Max. Negotiated Rate	$95.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$86.90
Rate for Payer: Qualcare PPO/HMO/WC	$59.25

CEMENT RESTRICTOR

Facility

$395.00

Service Code	HCPCS C1776
Hospital Charge Code	270691681
Hospital Revenue Code	278
Min. Negotiated Rate	$9.52
Max. Negotiated Rate	$197.50
Rate for Payer: Aetna Commercial	$150.10
Rate for Payer: Aetna Medicare Advantage	$118.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.72
Rate for Payer: Cigna Commercial	$197.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$86.90
Rate for Payer: Qualcare PPO/HMO/WC	$59.25
Rate for Payer: UnitedHealthcare Community & State	$9.52
Rate for Payer: Wellpoint Medicaid Managed Care	$10.47

CEMENT RESTRICTOR FEMORAL SZ 3

Facility

$597.00

Hospital Charge Code	270330690
Hospital Revenue Code	278
Min. Negotiated Rate	$89.55
Max. Negotiated Rate	$144.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$131.34
Rate for Payer: Qualcare PPO/HMO/WC	$89.55

Know your out-of-pocket cost for care.

All Charges