Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CONNECTING SCREW

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270686084
Hospital Revenue Code	278
Min. Negotiated Rate	$12.53
Max. Negotiated Rate	$260.00
Rate for Payer: Aetna Commercial	$197.60
Rate for Payer: Aetna Medicare Advantage	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.60
Rate for Payer: Cigna Commercial	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.40
Rate for Payer: Qualcare PPO/HMO/WC	$78.00
Rate for Payer: UnitedHealthcare Community & State	$12.53
Rate for Payer: Wellpoint Medicaid Managed Care	$13.78

CONNECTION ROD LONG

Facility

$51.75

Service Code	HCPCS C1713
Hospital Charge Code	270678087
Hospital Revenue Code	278
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$25.88
Rate for Payer: Aetna Commercial	$19.66
Rate for Payer: Aetna Medicare Advantage	$15.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.20
Rate for Payer: Cigna Commercial	$25.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.38
Rate for Payer: Qualcare PPO/HMO/WC	$7.76
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.37

CONNECTION ROD LONG

Facility

$51.75

Service Code	HCPCS C1713
Hospital Charge Code	270678087
Hospital Revenue Code	278
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$12.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.38
Rate for Payer: Qualcare PPO/HMO/WC	$7.76

CONNECTIVE TISSUE DISORDERS

Facility

$7,669.19

Service Code	APR-DRG 3461
Min. Negotiated Rate	$7,518.81
Max. Negotiated Rate	$7,669.19
Rate for Payer: UnitedHealthcare Community & State	$7,518.81
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,669.19
Rate for Payer: Wellpoint Medicaid Managed Care	$7,518.81

CONNECTIVE TISSUE DISORDERS

Facility

$10,319.63

Service Code	APR-DRG 3462
Min. Negotiated Rate	$10,117.28
Max. Negotiated Rate	$10,319.63
Rate for Payer: UnitedHealthcare Community & State	$10,117.28
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,319.63
Rate for Payer: Wellpoint Medicaid Managed Care	$10,117.28

CONNECTIVE TISSUE DISORDERS

Facility

$15,629.50

Service Code	APR-DRG 3463
Min. Negotiated Rate	$15,323.04
Max. Negotiated Rate	$15,629.50
Rate for Payer: UnitedHealthcare Community & State	$15,323.04
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,629.50
Rate for Payer: Wellpoint Medicaid Managed Care	$15,323.04

CONNECTIVE TISSUE DISORDERS

Facility

$32,331.42

Service Code	APR-DRG 3464
Min. Negotiated Rate	$31,697.47
Max. Negotiated Rate	$32,331.42
Rate for Payer: UnitedHealthcare Community & State	$31,697.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$32,331.42
Rate for Payer: Wellpoint Medicaid Managed Care	$31,697.47

CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$39,413.87

Service Code	MSDRG 546
Min. Negotiated Rate	$12,001.02
Max. Negotiated Rate	$39,413.87
Rate for Payer: Aetna Commercial	$27,339.15
Rate for Payer: Aetna Medicare Advantage	$39,413.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,913.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,913.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,632.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,913.20
Rate for Payer: Cigna Commercial	$21,584.73
Rate for Payer: Cigna Medicare Advantage	$12,632.65
Rate for Payer: Clover Medicare Advantage	$12,001.02
Rate for Payer: EmblemHealth Commercial	$37,897.95
Rate for Payer: Humana Medicare Advantage	$13,011.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,632.65
Rate for Payer: Oxford Commercial	$15,513.23
Rate for Payer: UnitedHealthcare Commercial	$27,202.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,632.65
Rate for Payer: Wellcare Medicare Advantage	$12,632.65

CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$82,346.69

Service Code	MSDRG 545
Min. Negotiated Rate	$25,073.51
Max. Negotiated Rate	$82,346.69
Rate for Payer: Aetna Commercial	$56,838.88
Rate for Payer: Aetna Medicare Advantage	$82,346.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57,919.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57,919.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26,393.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57,919.89
Rate for Payer: Cigna Commercial	$46,442.53
Rate for Payer: Cigna Medicare Advantage	$26,393.17
Rate for Payer: Clover Medicare Advantage	$25,073.51
Rate for Payer: EmblemHealth Commercial	$79,179.51
Rate for Payer: Humana Medicare Advantage	$27,184.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26,393.17
Rate for Payer: Oxford Commercial	$33,378.86
Rate for Payer: UnitedHealthcare Commercial	$58,530.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$26,393.17
Rate for Payer: Wellcare Medicare Advantage	$26,393.17

CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$29,161.45

Service Code	MSDRG 547
Min. Negotiated Rate	$8,879.29
Max. Negotiated Rate	$29,161.45
Rate for Payer: Aetna Commercial	$20,294.57
Rate for Payer: Aetna Medicare Advantage	$29,161.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,074.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,074.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,346.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,074.02
Rate for Payer: Cigna Commercial	$15,648.65
Rate for Payer: Cigna Medicare Advantage	$9,346.62
Rate for Payer: Clover Medicare Advantage	$8,879.29
Rate for Payer: EmblemHealth Commercial	$28,039.86
Rate for Payer: Humana Medicare Advantage	$9,627.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,346.62
Rate for Payer: Oxford Commercial	$11,246.89
Rate for Payer: UnitedHealthcare Commercial	$19,721.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,346.62
Rate for Payer: Wellcare Medicare Advantage	$9,346.62

CONNECTOR 25 MM LATERNAL

Facility

$4,285.00

Service Code	HCPCS C1713
Hospital Charge Code	270685953
Hospital Revenue Code	278
Min. Negotiated Rate	$642.75
Max. Negotiated Rate	$1,036.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.70
Rate for Payer: Qualcare PPO/HMO/WC	$642.75

CONNECTOR 25 MM LATERNAL

Facility

$4,285.00

Service Code	HCPCS C1713
Hospital Charge Code	270685953
Hospital Revenue Code	278
Min. Negotiated Rate	$103.27
Max. Negotiated Rate	$2,142.50
Rate for Payer: Aetna Commercial	$1,628.30
Rate for Payer: Aetna Medicare Advantage	$1,285.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.67
Rate for Payer: Cigna Commercial	$2,142.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.70
Rate for Payer: Qualcare PPO/HMO/WC	$642.75
Rate for Payer: UnitedHealthcare Community & State	$103.27
Rate for Payer: Wellpoint Medicaid Managed Care	$113.55

CONNECTOR # 3

Facility

$8,010.00

Service Code	HCPCS C1713
Hospital Charge Code	270684914
Hospital Revenue Code	278
Min. Negotiated Rate	$193.04
Max. Negotiated Rate	$4,005.00
Rate for Payer: Aetna Commercial	$3,043.80
Rate for Payer: Aetna Medicare Advantage	$2,403.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,042.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,042.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,602.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,042.55
Rate for Payer: Cigna Commercial	$4,005.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,938.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,762.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,201.50
Rate for Payer: UnitedHealthcare Community & State	$193.04
Rate for Payer: Wellpoint Medicaid Managed Care	$212.26

CONNECTOR # 3

Facility

$8,010.00

Service Code	HCPCS C1713
Hospital Charge Code	270684914
Hospital Revenue Code	278
Min. Negotiated Rate	$1,201.50
Max. Negotiated Rate	$1,938.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,602.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,938.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,762.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,201.50

CONNECTOR 3-WAY****

Facility

$9.00

Hospital Charge Code	7000599
Hospital Revenue Code	279
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

CONNECTOR 3-WAY****

Facility

$9.00

Hospital Charge Code	7000599
Hospital Revenue Code	279
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

CONNECTOR 4A CROSSLINK

Facility

$7,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270659160
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

CONNECTOR 4A CROSSLINK

Facility

$7,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270659160
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

CONNECTOR 50MM LATERNAL

Facility

$4,285.00

Service Code	HCPCS C1713
Hospital Charge Code	270685954
Hospital Revenue Code	278
Min. Negotiated Rate	$642.75
Max. Negotiated Rate	$1,036.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.70
Rate for Payer: Qualcare PPO/HMO/WC	$642.75

CONNECTOR 50MM LATERNAL

Facility

$4,285.00

Service Code	HCPCS C1713
Hospital Charge Code	270685954
Hospital Revenue Code	278
Min. Negotiated Rate	$103.27
Max. Negotiated Rate	$2,142.50
Rate for Payer: Aetna Commercial	$1,628.30
Rate for Payer: Aetna Medicare Advantage	$1,285.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.67
Rate for Payer: Cigna Commercial	$2,142.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.70
Rate for Payer: Qualcare PPO/HMO/WC	$642.75
Rate for Payer: UnitedHealthcare Community & State	$103.27
Rate for Payer: Wellpoint Medicaid Managed Care	$113.55

CONNECTOR A1

Facility

$7,000.00

Hospital Charge Code	270669375
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

CONNECTOR A1

Facility

$7,000.00

Hospital Charge Code	270669375
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

CONNECTOR A4 CROSSLINK

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270675637
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

CONNECTOR A4 CROSSLINK

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270675637
Hospital Revenue Code	278
Min. Negotiated Rate	$153.64
Max. Negotiated Rate	$3,187.50
Rate for Payer: Aetna Commercial	$2,422.50
Rate for Payer: Aetna Medicare Advantage	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,625.62
Rate for Payer: Cigna Commercial	$3,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25
Rate for Payer: UnitedHealthcare Community & State	$153.64
Rate for Payer: Wellpoint Medicaid Managed Care	$168.94

CONNECTOR A7 55mm

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270679902
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

Know your out-of-pocket cost for care.

All Charges