Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

CEMENT RESTRICTOR FEMORAL SZ 4

Facility

$630.00

Hospital Charge Code	270330695
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$152.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$138.60
Rate for Payer: Qualcare PPO/HMO/WC	$94.50

CEMENT RESTRICTOR FEMORAL SZ 4

Facility

$630.00

Hospital Charge Code	270330695
Hospital Revenue Code	278
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Commercial	$239.40
Rate for Payer: Aetna Medicare Advantage	$189.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.65
Rate for Payer: Cigna Commercial	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$138.60
Rate for Payer: Qualcare PPO/HMO/WC	$94.50
Rate for Payer: UnitedHealthcare Community & State	$15.18
Rate for Payer: Wellpoint Medicaid Managed Care	$16.70

CEMENT RESTRICTOR-INSERTER

Facility

$1,055.00

Hospital Charge Code	270656484
Hospital Revenue Code	271
Min. Negotiated Rate	$158.25
Max. Negotiated Rate	$158.25
Rate for Payer: Qualcare PPO/HMO/WC	$158.25

CEMENT RESTRICTOR-INSERTER

Facility

$1,055.00

Hospital Charge Code	270656484
Hospital Revenue Code	271
Min. Negotiated Rate	$25.43
Max. Negotiated Rate	$527.50
Rate for Payer: Aetna Commercial	$400.90
Rate for Payer: Aetna Medicare Advantage	$316.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$269.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$269.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$269.02
Rate for Payer: Cigna Commercial	$527.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$316.50
Rate for Payer: Oxford Commercial	$211.00
Rate for Payer: Qualcare PPO/HMO/WC	$158.25
Rate for Payer: UnitedHealthcare Commercial	$211.00
Rate for Payer: UnitedHealthcare Community & State	$25.43
Rate for Payer: Wellpoint Medicaid Managed Care	$27.96

CEMENT RESTRICTOR SIZE 1

Facility

$547.00

Hospital Charge Code	270332160
Hospital Revenue Code	278
Min. Negotiated Rate	$13.18
Max. Negotiated Rate	$273.50
Rate for Payer: Aetna Commercial	$207.86
Rate for Payer: Aetna Medicare Advantage	$164.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.49
Rate for Payer: Cigna Commercial	$273.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$120.34
Rate for Payer: Qualcare PPO/HMO/WC	$82.05
Rate for Payer: UnitedHealthcare Community & State	$13.18
Rate for Payer: Wellpoint Medicaid Managed Care	$14.50

CEMENT RESTRICTOR SIZE 1

Facility

$547.00

Hospital Charge Code	270332160
Hospital Revenue Code	278
Min. Negotiated Rate	$82.05
Max. Negotiated Rate	$132.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$120.34
Rate for Payer: Qualcare PPO/HMO/WC	$82.05

CEMENT RESTRICTOR SZ3 13.25MM

Facility

$1,405.00

Service Code	HCPCS C1776
Hospital Charge Code	270699295
Hospital Revenue Code	278
Min. Negotiated Rate	$210.75
Max. Negotiated Rate	$340.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$281.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$340.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$309.10
Rate for Payer: Qualcare PPO/HMO/WC	$210.75

CEMENT RESTRICTOR SZ3 13.25MM

Facility

$1,405.00

Service Code	HCPCS C1776
Hospital Charge Code	270699295
Hospital Revenue Code	278
Min. Negotiated Rate	$33.86
Max. Negotiated Rate	$702.50
Rate for Payer: Aetna Commercial	$533.90
Rate for Payer: Aetna Medicare Advantage	$421.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$358.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$358.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$281.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$358.27
Rate for Payer: Cigna Commercial	$702.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$340.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$309.10
Rate for Payer: Qualcare PPO/HMO/WC	$210.75
Rate for Payer: UnitedHealthcare Community & State	$33.86
Rate for Payer: Wellpoint Medicaid Managed Care	$37.23

CEMENT RESTRICTOR SZ.5

Facility

$460.00

Hospital Charge Code	270331120
Hospital Revenue Code	278
Min. Negotiated Rate	$69.00
Max. Negotiated Rate	$111.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$101.20
Rate for Payer: Qualcare PPO/HMO/WC	$69.00

CEMENT RESTRICTOR SZ.5

Facility

$460.00

Hospital Charge Code	270331120
Hospital Revenue Code	278
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$230.00
Rate for Payer: Aetna Commercial	$174.80
Rate for Payer: Aetna Medicare Advantage	$138.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.30
Rate for Payer: Cigna Commercial	$230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$101.20
Rate for Payer: Qualcare PPO/HMO/WC	$69.00
Rate for Payer: UnitedHealthcare Community & State	$11.09
Rate for Payer: Wellpoint Medicaid Managed Care	$12.19

CEMENT SKIN ******

Facility

$21.00

Hospital Charge Code	8002685
Hospital Revenue Code	279
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

CEMENT SKIN ******

Facility

$21.00

Hospital Charge Code	8002685
Hospital Revenue Code	279
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

CEMENT SPACER MOULD 17mm 64mm

Facility

$13,485.00

Hospital Charge Code	270643860
Hospital Revenue Code	272
Min. Negotiated Rate	$324.99
Max. Negotiated Rate	$6,742.50
Rate for Payer: Aetna Commercial	$5,124.30
Rate for Payer: Aetna Medicare Advantage	$4,045.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,438.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,438.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,438.68
Rate for Payer: Cigna Commercial	$6,742.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,045.50
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,022.75
Rate for Payer: UnitedHealthcare Commercial	$2,697.00
Rate for Payer: UnitedHealthcare Community & State	$324.99
Rate for Payer: Wellpoint Medicaid Managed Care	$357.35

CEMENT SPACER MOULD 17mm 64mm

Facility

$13,485.00

Hospital Charge Code	270643860
Hospital Revenue Code	272
Min. Negotiated Rate	$2,022.75
Max. Negotiated Rate	$2,022.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,022.75

CEMENT VACUUM 3 DOSE COMPACT

Facility

$650.00

Hospital Charge Code	270687013
Hospital Revenue Code	272
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) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Commercial	$130.00
Rate for Payer: UnitedHealthcare Community & State	$15.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.23

CEMENT VACUUM 3 DOSE COMPACT

Facility

$650.00

Hospital Charge Code	270687013
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

CEMENT VERTEPLEX

Facility

$4,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270692069
Hospital Revenue Code	278
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$998.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$618.75

CEMENT VERTEPLEX

Facility

$4,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270692069
Hospital Revenue Code	278
Min. Negotiated Rate	$99.41
Max. Negotiated Rate	$2,062.50
Rate for Payer: Aetna Commercial	$1,567.50
Rate for Payer: Aetna Medicare Advantage	$1,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.88
Rate for Payer: Cigna Commercial	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$618.75
Rate for Payer: UnitedHealthcare Community & State	$99.41
Rate for Payer: Wellpoint Medicaid Managed Care	$109.31

CEMENT W/GENTAMICIN HI VISCOS

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270676722
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

CEMENT W/GENTAMICIN HI VISCOS

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270676722
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

CEMENT W/MIXER COMBO KIT

Facility

$773.85

Service Code	HCPCS C1713
Hospital Charge Code	270633747
Hospital Revenue Code	278
Min. Negotiated Rate	$116.08
Max. Negotiated Rate	$187.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$154.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$170.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.08

CEMENT W/MIXER COMBO KIT

Facility

$773.85

Service Code	HCPCS C1713
Hospital Charge Code	270633747
Hospital Revenue Code	278
Min. Negotiated Rate	$18.65
Max. Negotiated Rate	$386.93
Rate for Payer: Aetna Commercial	$294.06
Rate for Payer: Aetna Medicare Advantage	$232.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$154.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.33
Rate for Payer: Cigna Commercial	$386.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$170.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.08
Rate for Payer: UnitedHealthcare Community & State	$18.65
Rate for Payer: Wellpoint Medicaid Managed Care	$20.51

CEMENT ZIM BONE DOUGH 1102012*

Facility

$225.90

Hospital Charge Code	270600348
Hospital Revenue Code	279
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$112.95
Rate for Payer: Aetna Commercial	$85.84
Rate for Payer: Aetna Medicare Advantage	$67.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.60
Rate for Payer: Cigna Commercial	$112.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.77
Rate for Payer: Oxford Commercial	$45.18
Rate for Payer: Qualcare PPO/HMO/WC	$33.88
Rate for Payer: UnitedHealthcare Commercial	$45.18
Rate for Payer: UnitedHealthcare Community & State	$5.44
Rate for Payer: Wellpoint Medicaid Managed Care	$5.99

CEMENT ZIM BONE DOUGH 1102012*

Facility

$225.90

Hospital Charge Code	270600348
Hospital Revenue Code	279
Min. Negotiated Rate	$33.88
Max. Negotiated Rate	$33.88
Rate for Payer: Qualcare PPO/HMO/WC	$33.88

Know your out-of-pocket cost for care.

All Charges