Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DISTAL RADIAL PLATE 3 HOLE

Facility

$8,224.30

Service Code	HCPCS C1713
Hospital Charge Code	270704349
Hospital Revenue Code	278
Min. Negotiated Rate	$1,233.64
Max. Negotiated Rate	$1,990.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,644.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,809.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.64

DISTAL SPACER

Facility

$900.00

Hospital Charge Code	270656494
Hospital Revenue Code	271
Min. Negotiated Rate	$21.69
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$270.00
Rate for Payer: Oxford Commercial	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Commercial	$180.00
Rate for Payer: UnitedHealthcare Community & State	$21.69
Rate for Payer: Wellpoint Medicaid Managed Care	$23.85

DISTAL SPACER

Facility

$900.00

Hospital Charge Code	270656494
Hospital Revenue Code	271
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

DISTAL TIPS AMS DURA II

Facility

$2,125.00

Hospital Charge Code	270654485
Hospital Revenue Code	272
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$318.75
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

DISTAL TIPS AMS DURA II

Facility

$2,125.00

Hospital Charge Code	270654485
Hospital Revenue Code	272
Min. Negotiated Rate	$51.21
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$807.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$637.50
Rate for Payer: Oxford Commercial	$425.00
Rate for Payer: Qualcare PPO/HMO/WC	$318.75
Rate for Payer: UnitedHealthcare Commercial	$425.00
Rate for Payer: UnitedHealthcare Community & State	$51.21
Rate for Payer: Wellpoint Medicaid Managed Care	$56.31

DISTAL TRIATHLON PEG

Facility

$1,057.10

Service Code	HCPCS C1776
Hospital Charge Code	270691402
Hospital Revenue Code	278
Min. Negotiated Rate	$25.48
Max. Negotiated Rate	$528.55
Rate for Payer: Aetna Commercial	$401.70
Rate for Payer: Aetna Medicare Advantage	$317.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$269.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$269.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$211.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$269.56
Rate for Payer: Cigna Commercial	$528.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$232.56
Rate for Payer: Qualcare PPO/HMO/WC	$158.56
Rate for Payer: UnitedHealthcare Community & State	$25.48
Rate for Payer: Wellpoint Medicaid Managed Care	$28.01

DISTAL TRIATHLON PEG

Facility

$1,057.10

Service Code	HCPCS C1776
Hospital Charge Code	270691402
Hospital Revenue Code	278
Min. Negotiated Rate	$158.56
Max. Negotiated Rate	$255.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$211.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$232.56
Rate for Payer: Qualcare PPO/HMO/WC	$158.56

DISTANCE TENDON GRAFT

Facility

$30,595.00

Service Code	HCPCS 20924
Hospital Charge Code	16000796
Hospital Revenue Code	360
Min. Negotiated Rate	$4,589.25
Max. Negotiated Rate	$4,589.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25

DISTANCE TENDON GRAFT

Facility

$30,595.00

Service Code	HCPCS 20924
Hospital Charge Code	16000796
Hospital Revenue Code	360
Min. Negotiated Rate	$737.34
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,178.50
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$737.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$810.77

DIST HUM LAT LT 11H 103MM

Facility

$12,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270704927
Hospital Revenue Code	278
Min. Negotiated Rate	$1,935.00
Max. Negotiated Rate	$3,121.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,121.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,838.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,935.00

DIST HUM LAT LT 11H 103MM

Facility

$12,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270704927
Hospital Revenue Code	278
Min. Negotiated Rate	$310.89
Max. Negotiated Rate	$6,450.00
Rate for Payer: Aetna Commercial	$4,902.00
Rate for Payer: Aetna Medicare Advantage	$3,870.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,289.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,289.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,289.50
Rate for Payer: Cigna Commercial	$6,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,121.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,838.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,935.00
Rate for Payer: UnitedHealthcare Community & State	$310.89
Rate for Payer: Wellpoint Medicaid Managed Care	$341.85

DIST HUM MED LT 13H 127MM

Facility

$12,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270704928
Hospital Revenue Code	278
Min. Negotiated Rate	$1,935.00
Max. Negotiated Rate	$3,121.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,121.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,838.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,935.00

DIST HUM MED LT 13H 127MM

Facility

$12,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270704928
Hospital Revenue Code	278
Min. Negotiated Rate	$310.89
Max. Negotiated Rate	$6,450.00
Rate for Payer: Aetna Commercial	$4,902.00
Rate for Payer: Aetna Medicare Advantage	$3,870.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,289.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,289.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,289.50
Rate for Payer: Cigna Commercial	$6,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,121.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,838.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,935.00
Rate for Payer: UnitedHealthcare Community & State	$310.89
Rate for Payer: Wellpoint Medicaid Managed Care	$341.85

DISTILLED WATER

Facility

$10.45

Hospital Charge Code	60628608
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.13
Rate for Payer: Oxford Commercial	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$2.09
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

DISTILLED WATER

Facility

$10.45

Hospital Charge Code	60628608
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

DISTRACTION PIN 14MM DISP

Facility

$113.50

Hospital Charge Code	270699346
Hospital Revenue Code	272
Min. Negotiated Rate	$17.02
Max. Negotiated Rate	$17.02
Rate for Payer: Qualcare PPO/HMO/WC	$17.02

DISTRACTION PIN 14MM DISP

Facility

$113.50

Hospital Charge Code	270699346
Hospital Revenue Code	272
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$56.75
Rate for Payer: Aetna Commercial	$43.13
Rate for Payer: Aetna Medicare Advantage	$34.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.94
Rate for Payer: Cigna Commercial	$56.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.05
Rate for Payer: Oxford Commercial	$22.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.02
Rate for Payer: UnitedHealthcare Commercial	$22.70
Rate for Payer: UnitedHealthcare Community & State	$2.74
Rate for Payer: Wellpoint Medicaid Managed Care	$3.01

DISTRACTION PINS

Facility

$347.00

Hospital Charge Code	270335905
Hospital Revenue Code	278
Min. Negotiated Rate	$52.05
Max. Negotiated Rate	$83.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$76.34
Rate for Payer: Qualcare PPO/HMO/WC	$52.05

DISTRACTION PINS

Facility

$347.00

Hospital Charge Code	270335905
Hospital Revenue Code	278
Min. Negotiated Rate	$8.36
Max. Negotiated Rate	$173.50
Rate for Payer: Aetna Commercial	$131.86
Rate for Payer: Aetna Medicare Advantage	$104.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.48
Rate for Payer: Cigna Commercial	$173.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$76.34
Rate for Payer: Qualcare PPO/HMO/WC	$52.05
Rate for Payer: UnitedHealthcare Community & State	$8.36
Rate for Payer: Wellpoint Medicaid Managed Care	$9.20

DISTRACTOR ANKLE UC GUHL

Facility

$1,975.00

Hospital Charge Code	270694961
Hospital Revenue Code	272
Min. Negotiated Rate	$296.25
Max. Negotiated Rate	$296.25
Rate for Payer: Qualcare PPO/HMO/WC	$296.25

DISTRACTOR ANKLE UC GUHL

Facility

$1,975.00

Hospital Charge Code	270694961
Hospital Revenue Code	272
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$987.50
Rate for Payer: Aetna Commercial	$750.50
Rate for Payer: Aetna Medicare Advantage	$592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.62
Rate for Payer: Cigna Commercial	$987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.50
Rate for Payer: Oxford Commercial	$395.00
Rate for Payer: Qualcare PPO/HMO/WC	$296.25
Rate for Payer: UnitedHealthcare Commercial	$395.00
Rate for Payer: UnitedHealthcare Community & State	$47.60
Rate for Payer: Wellpoint Medicaid Managed Care	$52.34

DISTRACTOR HINTERMANN

Facility

$5,505.00

Hospital Charge Code	270684913
Hospital Revenue Code	272
Min. Negotiated Rate	$132.67
Max. Negotiated Rate	$2,752.50
Rate for Payer: Aetna Commercial	$2,091.90
Rate for Payer: Aetna Medicare Advantage	$1,651.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,403.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,403.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,403.78
Rate for Payer: Cigna Commercial	$2,752.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,651.50
Rate for Payer: Oxford Commercial	$1,101.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.75
Rate for Payer: UnitedHealthcare Commercial	$1,101.00
Rate for Payer: UnitedHealthcare Community & State	$132.67
Rate for Payer: Wellpoint Medicaid Managed Care	$145.88

DISTRACTOR HINTERMANN

Facility

$5,505.00

Hospital Charge Code	270684913
Hospital Revenue Code	272
Min. Negotiated Rate	$825.75
Max. Negotiated Rate	$825.75
Rate for Payer: Qualcare PPO/HMO/WC	$825.75

DISTRACTOR HIP SUPINE

Facility

$5,500.00

Hospital Charge Code	270684947
Hospital Revenue Code	272
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) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,650.00
Rate for Payer: Oxford Commercial	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Commercial	$1,100.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

DISTRACTOR HIP SUPINE

Facility

$5,500.00

Hospital Charge Code	270684947
Hospital Revenue Code	272
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

Know your out-of-pocket cost for care.

All Charges