Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COMPONENT FEMORAL SZ 7 RM/LL

Facility

$12,100.00

Hospital Charge Code	270668677
Hospital Revenue Code	278
Min. Negotiated Rate	$291.61
Max. Negotiated Rate	$6,050.00
Rate for Payer: Aetna Commercial	$4,598.00
Rate for Payer: Aetna Medicare Advantage	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,085.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,085.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,085.50
Rate for Payer: Cigna Commercial	$6,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,928.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,662.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,815.00
Rate for Payer: UnitedHealthcare Community & State	$291.61
Rate for Payer: Wellpoint Medicaid Managed Care	$320.65

COMPONENT FEMORAL SZ 8 LM/RL

Facility

$12,100.00

Hospital Charge Code	270668670
Hospital Revenue Code	278
Min. Negotiated Rate	$1,815.00
Max. Negotiated Rate	$2,928.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,928.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,662.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,815.00

COMPONENT FEMORAL SZ 8 LM/RL

Facility

$12,100.00

Hospital Charge Code	270668670
Hospital Revenue Code	278
Min. Negotiated Rate	$291.61
Max. Negotiated Rate	$6,050.00
Rate for Payer: Aetna Commercial	$4,598.00
Rate for Payer: Aetna Medicare Advantage	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,085.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,085.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,085.50
Rate for Payer: Cigna Commercial	$6,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,928.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,662.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,815.00
Rate for Payer: UnitedHealthcare Community & State	$291.61
Rate for Payer: Wellpoint Medicaid Managed Care	$320.65

COMPONENT FEMORAL SZ 8 RM/LL

Facility

$12,100.00

Hospital Charge Code	270668678
Hospital Revenue Code	278
Min. Negotiated Rate	$1,815.00
Max. Negotiated Rate	$2,928.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,928.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,662.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,815.00

COMPONENT FEMORAL SZ 8 RM/LL

Facility

$12,100.00

Hospital Charge Code	270668678
Hospital Revenue Code	278
Min. Negotiated Rate	$291.61
Max. Negotiated Rate	$6,050.00
Rate for Payer: Aetna Commercial	$4,598.00
Rate for Payer: Aetna Medicare Advantage	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,085.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,085.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,085.50
Rate for Payer: Cigna Commercial	$6,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,928.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,662.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,815.00
Rate for Payer: UnitedHealthcare Community & State	$291.61
Rate for Payer: Wellpoint Medicaid Managed Care	$320.65

COMPONENT FEM W/O HEAD 10MM

Facility

$15,645.00

Hospital Charge Code	270677207
Hospital Revenue Code	278
Min. Negotiated Rate	$2,346.75
Max. Negotiated Rate	$3,786.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,129.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,786.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,441.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,346.75

COMPONENT FEM W/O HEAD 10MM

Facility

$15,645.00

Hospital Charge Code	270677207
Hospital Revenue Code	278
Min. Negotiated Rate	$377.04
Max. Negotiated Rate	$7,822.50
Rate for Payer: Aetna Commercial	$5,945.10
Rate for Payer: Aetna Medicare Advantage	$4,693.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,989.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,989.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,129.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,989.47
Rate for Payer: Cigna Commercial	$7,822.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,786.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,441.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,346.75
Rate for Payer: UnitedHealthcare Community & State	$377.04
Rate for Payer: Wellpoint Medicaid Managed Care	$414.59

COMPONENT MODULAR HEAD 28MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270608171
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

COMPONENT MODULAR HEAD 28MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270608171
Hospital Revenue Code	278
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

COMPONENT TIBIA SZ 3 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677840
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

COMPONENT TIBIA SZ 3 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677840
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

COMPONENT TIBIA SZ 4 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677818
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

COMPONENT TIBIA SZ 4 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677818
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

COMPONENT TIBIA SZ 5 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677947
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

COMPONENT TIBIA SZ 5 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677947
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

COMPONENT TIBIA SZ 5 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678417
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

COMPONENT TIBIA SZ 5 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678417
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

COMPONENT TIBIA SZ 7 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677859
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

COMPONENT TIBIA SZ 7 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677859
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

COMPONENT TIBIA SZ 7 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677868
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

COMPONENT TIBIA SZ 7 RIGHT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677868
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

COMPOSIX MESH 4X6

Facility

$688.00

Hospital Charge Code	270335677
Hospital Revenue Code	278
Min. Negotiated Rate	$16.58
Max. Negotiated Rate	$344.00
Rate for Payer: Aetna Commercial	$261.44
Rate for Payer: Aetna Medicare Advantage	$206.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.44
Rate for Payer: Cigna Commercial	$344.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.36
Rate for Payer: Qualcare PPO/HMO/WC	$103.20
Rate for Payer: UnitedHealthcare Community & State	$16.58
Rate for Payer: Wellpoint Medicaid Managed Care	$18.23

COMPOSIX MESH 4X6

Facility

$688.00

Hospital Charge Code	270335677
Hospital Revenue Code	278
Min. Negotiated Rate	$103.20
Max. Negotiated Rate	$166.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.36
Rate for Payer: Qualcare PPO/HMO/WC	$103.20

COMPOUNDED IM INJ

Facility

$62.10

Hospital Charge Code	60628597
Hospital Revenue Code	250
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

COMPOUNDED IM INJ

Facility

$77.65

Hospital Charge Code	60628560
Hospital Revenue Code	250
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$38.83
Rate for Payer: Aetna Commercial	$29.51
Rate for Payer: Aetna Medicare Advantage	$23.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.80
Rate for Payer: Cigna Commercial	$38.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.30
Rate for Payer: Oxford Commercial	$15.53
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$15.53
Rate for Payer: UnitedHealthcare Community & State	$1.87
Rate for Payer: Wellpoint Medicaid Managed Care	$2.06

Know your out-of-pocket cost for care.

All Charges