Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CUP REVERS 36MM +2L

Facility

$8,925.00

Hospital Charge Code	270672293
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,963.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 36MM +2R

Facility

$8,925.00

Hospital Charge Code	270672294
Hospital Revenue Code	278
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$3,391.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,963.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75
Rate for Payer: UnitedHealthcare Community & State	$215.09
Rate for Payer: Wellpoint Medicaid Managed Care	$236.51

CUP REVERS 36MM +2R

Facility

$8,925.00

Hospital Charge Code	270672294
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,963.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 39MM

Facility

$8,925.00

Hospital Charge Code	270672295
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,963.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 39MM

Facility

$8,925.00

Hospital Charge Code	270672295
Hospital Revenue Code	278
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$3,391.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,963.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75
Rate for Payer: UnitedHealthcare Community & State	$215.09
Rate for Payer: Wellpoint Medicaid Managed Care	$236.51

CUP REVERS 39MM +2L

Facility

$8,925.00

Hospital Charge Code	270672296
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,963.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 39MM +2L

Facility

$8,925.00

Hospital Charge Code	270672296
Hospital Revenue Code	278
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$3,391.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,963.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75
Rate for Payer: UnitedHealthcare Community & State	$215.09
Rate for Payer: Wellpoint Medicaid Managed Care	$236.51

CUP REVERS 39MM +2R

Facility

$8,925.00

Hospital Charge Code	270672397
Hospital Revenue Code	278
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$3,391.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,963.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75
Rate for Payer: UnitedHealthcare Community & State	$215.09
Rate for Payer: Wellpoint Medicaid Managed Care	$236.51

CUP REVERS 39MM +2R

Facility

$8,925.00

Hospital Charge Code	270672397
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,963.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 42MM

Facility

$8,925.00

Hospital Charge Code	270672398
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,963.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 42MM

Facility

$8,925.00

Hospital Charge Code	270672398
Hospital Revenue Code	278
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$3,391.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,963.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75
Rate for Payer: UnitedHealthcare Community & State	$215.09
Rate for Payer: Wellpoint Medicaid Managed Care	$236.51

CUP REVERS 42MM +2L

Facility

$8,925.00

Hospital Charge Code	270672399
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,963.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 42MM +2L

Facility

$8,925.00

Hospital Charge Code	270672399
Hospital Revenue Code	278
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$3,391.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,963.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75
Rate for Payer: UnitedHealthcare Community & State	$215.09
Rate for Payer: Wellpoint Medicaid Managed Care	$236.51

CUP REVERS 42MM +2R

Facility

$8,925.00

Hospital Charge Code	270672400
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,963.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75

CUP REVERS 42MM +2R

Facility

$8,925.00

Hospital Charge Code	270672400
Hospital Revenue Code	278
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$4,462.50
Rate for Payer: Aetna Commercial	$3,391.50
Rate for Payer: Aetna Medicare Advantage	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,275.88
Rate for Payer: Cigna Commercial	$4,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,159.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,963.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,338.75
Rate for Payer: UnitedHealthcare Community & State	$215.09
Rate for Payer: Wellpoint Medicaid Managed Care	$236.51

CUPRIMINE/250MG/CAP

Facility

$6.00

Hospital Charge Code	60632759
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

CUPRIMINE/250MG/CAP

Facility

$6.00

Hospital Charge Code	60632759
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

CUP SNR PISTONS .5 4.5 14-2046

Facility

$629.65

Hospital Charge Code	270620116
Hospital Revenue Code	278
Min. Negotiated Rate	$15.17
Max. Negotiated Rate	$314.82
Rate for Payer: Aetna Commercial	$239.27
Rate for Payer: Aetna Medicare Advantage	$188.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.56
Rate for Payer: Cigna Commercial	$314.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$138.52
Rate for Payer: Qualcare PPO/HMO/WC	$94.45
Rate for Payer: UnitedHealthcare Community & State	$15.17
Rate for Payer: Wellpoint Medicaid Managed Care	$16.69

CUP SNR PISTONS .5 4.5 14-2046

Facility

$629.65

Hospital Charge Code	270620116
Hospital Revenue Code	278
Min. Negotiated Rate	$94.45
Max. Negotiated Rate	$152.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$138.52
Rate for Payer: Qualcare PPO/HMO/WC	$94.45

CUP SPECIMEN STERILE 4oz

Facility

$0.92

Hospital Charge Code	270649398
Hospital Revenue Code	272
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.46
Rate for Payer: Aetna Commercial	$0.35
Rate for Payer: Aetna Medicare Advantage	$0.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.23
Rate for Payer: Cigna Commercial	$0.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.28
Rate for Payer: Oxford Commercial	$0.18
Rate for Payer: Qualcare PPO/HMO/WC	$0.14
Rate for Payer: UnitedHealthcare Commercial	$0.18
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.02

CUP SPECIMEN STERILE 4oz

Facility

$0.92

Hospital Charge Code	270649398
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.14
Rate for Payer: Qualcare PPO/HMO/WC	$0.14

CUP SUBTALAR FUSION SM

Facility

$7,950.00

Service Code	HCPCS C1713
Hospital Charge Code	270698255
Hospital Revenue Code	278
Min. Negotiated Rate	$191.59
Max. Negotiated Rate	$3,975.00
Rate for Payer: Aetna Commercial	$3,021.00
Rate for Payer: Aetna Medicare Advantage	$2,385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,027.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,027.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,027.25
Rate for Payer: Cigna Commercial	$3,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,923.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,749.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,192.50
Rate for Payer: UnitedHealthcare Community & State	$191.59
Rate for Payer: Wellpoint Medicaid Managed Care	$210.68

CUP SUBTALAR FUSION SM

Facility

$7,950.00

Service Code	HCPCS C1713
Hospital Charge Code	270698255
Hospital Revenue Code	278
Min. Negotiated Rate	$1,192.50
Max. Negotiated Rate	$1,923.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,923.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,749.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,192.50

CUP TM MD 56 MULTIHD 620205620

Facility

$11,352.50

Hospital Charge Code	270633528
Hospital Revenue Code	278
Min. Negotiated Rate	$1,702.88
Max. Negotiated Rate	$2,747.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,270.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,747.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,497.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,702.88

CUP TM MD 56 MULTIHD 620205620

Facility

$11,352.50

Hospital Charge Code	270633528
Hospital Revenue Code	278
Min. Negotiated Rate	$273.60
Max. Negotiated Rate	$5,676.25
Rate for Payer: Aetna Commercial	$4,313.95
Rate for Payer: Aetna Medicare Advantage	$3,405.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,894.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,894.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,894.89
Rate for Payer: Cigna Commercial	$5,676.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,747.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,497.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,702.88
Rate for Payer: UnitedHealthcare Community & State	$273.60
Rate for Payer: Wellpoint Medicaid Managed Care	$300.84

Know your out-of-pocket cost for care.

All Charges