Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

18 X 30CM STRAIGHT GRAFT

Facility

$3,015.00

Service Code	HCPCS C1768
Hospital Charge Code	270683832
Hospital Revenue Code	278
Min. Negotiated Rate	$72.66
Max. Negotiated Rate	$1,507.50
Rate for Payer: Aetna Commercial	$1,145.70
Rate for Payer: Aetna Medicare Advantage	$904.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$603.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.83
Rate for Payer: Cigna Commercial	$1,507.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$729.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$663.30
Rate for Payer: Qualcare PPO/HMO/WC	$452.25
Rate for Payer: UnitedHealthcare Community & State	$72.66
Rate for Payer: Wellpoint Medicaid Managed Care	$79.90

18X50MM 15D 14HEIGHT IMP

Facility

$32,500.00

Hospital Charge Code	270704021
Hospital Revenue Code	272
Min. Negotiated Rate	$4,875.00
Max. Negotiated Rate	$4,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00

18X50MM 15D 14HEIGHT IMP

Facility

$32,500.00

Hospital Charge Code	270704021
Hospital Revenue Code	272
Min. Negotiated Rate	$783.25
Max. Negotiated Rate	$16,250.00
Rate for Payer: Aetna Commercial	$12,350.00
Rate for Payer: Aetna Medicare Advantage	$9,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,287.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,287.50
Rate for Payer: Cigna Commercial	$16,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,750.00
Rate for Payer: Oxford Commercial	$6,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,875.00
Rate for Payer: UnitedHealthcare Commercial	$6,500.00
Rate for Payer: UnitedHealthcare Community & State	$783.25
Rate for Payer: Wellpoint Medicaid Managed Care	$861.25

1948/58 ISOFLEX OPTIMLEADS

Facility

$3,000.00

Hospital Charge Code	270656342
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

1948/58 ISOFLEX OPTIMLEADS

Facility

$3,000.00

Hospital Charge Code	270656342
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

1CC DMM GEL

Facility

$1,100.00

Hospital Charge Code	270656308
Hospital Revenue Code	271
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$550.00
Rate for Payer: Aetna Commercial	$418.00
Rate for Payer: Aetna Medicare Advantage	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.50
Rate for Payer: Cigna Commercial	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$330.00
Rate for Payer: Oxford Commercial	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00
Rate for Payer: UnitedHealthcare Commercial	$220.00
Rate for Payer: UnitedHealthcare Community & State	$26.51
Rate for Payer: Wellpoint Medicaid Managed Care	$29.15

1CC DMM GEL

Facility

$1,100.00

Hospital Charge Code	270656308
Hospital Revenue Code	271
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00

1-KNIFE 2 15DEG 5MM

Facility

$16.25

Hospital Charge Code	270655298
Hospital Revenue Code	270
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.12
Rate for Payer: Aetna Commercial	$6.17
Rate for Payer: Aetna Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.14
Rate for Payer: Cigna Commercial	$8.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.88
Rate for Payer: Oxford Commercial	$3.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.44
Rate for Payer: UnitedHealthcare Commercial	$3.25
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

1-KNIFE 2 15DEG 5MM

Facility

$16.25

Hospital Charge Code	270655298
Hospital Revenue Code	270
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$2.44
Rate for Payer: Qualcare PPO/HMO/WC	$2.44

1 OS-8 SUTURE

Facility

$125.65

Hospital Charge Code	270703734
Hospital Revenue Code	279
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$62.83
Rate for Payer: Aetna Commercial	$47.75
Rate for Payer: Aetna Medicare Advantage	$37.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.04
Rate for Payer: Cigna Commercial	$62.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.70
Rate for Payer: Oxford Commercial	$25.13
Rate for Payer: Qualcare PPO/HMO/WC	$18.85
Rate for Payer: UnitedHealthcare Commercial	$25.13
Rate for Payer: UnitedHealthcare Community & State	$3.03
Rate for Payer: Wellpoint Medicaid Managed Care	$3.33

1 OS-8 SUTURE

Facility

$125.65

Hospital Charge Code	270703734
Hospital Revenue Code	279
Min. Negotiated Rate	$18.85
Max. Negotiated Rate	$18.85
Rate for Payer: Qualcare PPO/HMO/WC	$18.85

1 PEG PATELLA 35MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677345
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

1 PEG PATELLA 35MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677345
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

1' PROFUNDUS TENDON REPAIR

Facility

$26,471.80

Service Code	HCPCS 26370
Hospital Charge Code	16000411
Hospital Revenue Code	360
Min. Negotiated Rate	$637.97
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
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	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,941.54
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,970.77
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$637.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$701.50

1' PROFUNDUS TENDON REPAIR

Facility

$26,471.80

Service Code	HCPCS 26370
Hospital Charge Code	16000411
Hospital Revenue Code	360
Min. Negotiated Rate	$3,970.77
Max. Negotiated Rate	$3,970.77
Rate for Payer: Qualcare PPO/HMO/WC	$3,970.77

1' REPR/SUTR LEG EXTSOR TENDON

Facility

$30,663.00

Service Code	HCPCS 27664
Hospital Charge Code	16000895
Hospital Revenue Code	360
Min. Negotiated Rate	$738.98
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	$1,016.00
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	$9,198.90
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,599.45
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$738.98
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	$812.57

1' REPR/SUTR LEG EXTSOR TENDON

Facility

$30,663.00

Service Code	HCPCS 27664
Hospital Charge Code	16000895
Hospital Revenue Code	360
Min. Negotiated Rate	$4,599.45
Max. Negotiated Rate	$4,599.45
Rate for Payer: Qualcare PPO/HMO/WC	$4,599.45

1' REPR/SUTR LEG FLEXOR TENDON

Facility

$19,467.90

Service Code	HCPCS 27658
Hospital Charge Code	16000713
Hospital Revenue Code	360
Min. Negotiated Rate	$469.18
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,840.37
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$469.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$515.90

1' REPR/SUTR LEG FLEXOR TENDON

Facility

$19,467.90

Service Code	HCPCS 27658
Hospital Charge Code	16000713
Hospital Revenue Code	360
Min. Negotiated Rate	$2,920.18
Max. Negotiated Rate	$2,920.18
Rate for Payer: Qualcare PPO/HMO/WC	$2,920.18

1 STAGE SET W/BIA300 4MM IMPL

Facility

$13,825.00

Hospital Charge Code	270657053
Hospital Revenue Code	278
Min. Negotiated Rate	$333.18
Max. Negotiated Rate	$6,912.50
Rate for Payer: Aetna Commercial	$5,253.50
Rate for Payer: Aetna Medicare Advantage	$4,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,525.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,525.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,525.38
Rate for Payer: Cigna Commercial	$6,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,345.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,041.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,073.75
Rate for Payer: UnitedHealthcare Community & State	$333.18
Rate for Payer: Wellpoint Medicaid Managed Care	$366.36

1 STAGE SET W/BIA300 4MM IMPL

Facility

$13,825.00

Hospital Charge Code	270657053
Hospital Revenue Code	278
Min. Negotiated Rate	$2,073.75
Max. Negotiated Rate	$3,345.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,345.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,041.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,073.75

1ST AMPL PT NUCL ACID MULT

Facility

$47.00

Service Code	HCPCS 83900
Hospital Charge Code	3035165
Hospital Revenue Code	301
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$17.86
Rate for Payer: Aetna Medicare Advantage	$14.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.98
Rate for Payer: Cigna Commercial	$23.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.10
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

1ST AMPL PT NUCL ACID MULT

Facility

$47.00

Service Code	HCPCS 83900
Hospital Charge Code	3035165
Hospital Revenue Code	301
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$7.05
Rate for Payer: Qualcare PPO/HMO/WC	$7.05

1STDAYHOSP CARE HIGH SEV

Facility

$350.00

Service Code	HCPCS 99223
Hospital Charge Code	83246205
Hospital Revenue Code	919
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

1STDAYHOSP CARE HIGH SEV

Facility

$350.00

Service Code	HCPCS 99223
Hospital Charge Code	83246205
Hospital Revenue Code	919
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

Know your out-of-pocket cost for care.

All Charges