Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FERMORAL HEAD CEREMIC BIOLOX D

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688631
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

FERMORAL HEAD CEREMIC BIOLOX D

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688631
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

FERMORAL HEAD COCR -3.5x36MM

Facility

$3,311.05

Hospital Charge Code	270675769
Hospital Revenue Code	278
Min. Negotiated Rate	$496.66
Max. Negotiated Rate	$801.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$662.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$801.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$728.43
Rate for Payer: Qualcare PPO/HMO/WC	$496.66

FERMORAL HEAD COCR -3.5x36MM

Facility

$3,311.05

Hospital Charge Code	270675769
Hospital Revenue Code	278
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$1,655.53
Rate for Payer: Aetna Commercial	$1,258.20
Rate for Payer: Aetna Medicare Advantage	$993.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$844.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$844.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$662.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$844.32
Rate for Payer: Cigna Commercial	$1,655.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$801.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$728.43
Rate for Payer: Qualcare PPO/HMO/WC	$496.66
Rate for Payer: UnitedHealthcare Community & State	$79.80
Rate for Payer: Wellpoint Medicaid Managed Care	$87.74

FERMORAL NAIL 12 MM TI CANN

Facility

$16,295.00

Service Code	HCPCS C1713
Hospital Charge Code	270687125
Hospital Revenue Code	278
Min. Negotiated Rate	$392.71
Max. Negotiated Rate	$8,147.50
Rate for Payer: Aetna Commercial	$6,192.10
Rate for Payer: Aetna Medicare Advantage	$4,888.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,155.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,155.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,259.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,155.23
Rate for Payer: Cigna Commercial	$8,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,943.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,584.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,444.25
Rate for Payer: UnitedHealthcare Community & State	$392.71
Rate for Payer: Wellpoint Medicaid Managed Care	$431.82

FERMORAL NAIL 12 MM TI CANN

Facility

$16,295.00

Service Code	HCPCS C1713
Hospital Charge Code	270687125
Hospital Revenue Code	278
Min. Negotiated Rate	$2,444.25
Max. Negotiated Rate	$3,943.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,259.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,943.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,584.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,444.25

FERMORAL TAP STEM EXT OFF-SZ 2

Facility

$7,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270669093
Hospital Revenue Code	278
Min. Negotiated Rate	$172.80
Max. Negotiated Rate	$3,585.00
Rate for Payer: Aetna Commercial	$2,724.60
Rate for Payer: Aetna Medicare Advantage	$2,151.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,828.35
Rate for Payer: Cigna Commercial	$3,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50
Rate for Payer: UnitedHealthcare Community & State	$172.80
Rate for Payer: Wellpoint Medicaid Managed Care	$190.00

FERMORAL TAP STEM EXT OFF-SZ 2

Facility

$7,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270669093
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.50
Max. Negotiated Rate	$1,735.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50

FERMORAL TAP STEM EXT OFF-SZ 4

Facility

$7,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270669095
Hospital Revenue Code	278
Min. Negotiated Rate	$172.80
Max. Negotiated Rate	$3,585.00
Rate for Payer: Aetna Commercial	$2,724.60
Rate for Payer: Aetna Medicare Advantage	$2,151.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,828.35
Rate for Payer: Cigna Commercial	$3,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50
Rate for Payer: UnitedHealthcare Community & State	$172.80
Rate for Payer: Wellpoint Medicaid Managed Care	$190.00

FERMORAL TAP STEM EXT OFF-SZ 4

Facility

$7,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270669095
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.50
Max. Negotiated Rate	$1,735.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50

FERMORAL TAP STEM EXT OFF-SZ 5

Facility

$7,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270669096
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.50
Max. Negotiated Rate	$1,735.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50

FERMORAL TAP STEM EXT OFF-SZ 5

Facility

$7,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270669096
Hospital Revenue Code	278
Min. Negotiated Rate	$172.80
Max. Negotiated Rate	$3,585.00
Rate for Payer: Aetna Commercial	$2,724.60
Rate for Payer: Aetna Medicare Advantage	$2,151.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,828.35
Rate for Payer: Cigna Commercial	$3,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50
Rate for Payer: UnitedHealthcare Community & State	$172.80
Rate for Payer: Wellpoint Medicaid Managed Care	$190.00

FERRIC CHLORIDE SOLN

Facility

$61.00

Hospital Charge Code	60634790
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$23.18
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.30
Rate for Payer: Oxford Commercial	$12.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$12.20
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

FERRIC CHLORIDE SOLN

Facility

$61.00

Hospital Charge Code	60634790
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

FERRIC CITRATE 210 MG TAB

Facility

$27.65

Hospital Charge Code	606390071
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$13.82
Rate for Payer: Aetna Commercial	$10.51
Rate for Payer: Aetna Medicare Advantage	$8.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.05
Rate for Payer: Cigna Commercial	$13.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.29
Rate for Payer: Oxford Commercial	$5.53
Rate for Payer: Qualcare PPO/HMO/WC	$4.15
Rate for Payer: UnitedHealthcare Commercial	$5.53
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.73

FERRIC CITRATE 210 MG TAB

Facility

$27.65

Hospital Charge Code	606390071
Hospital Revenue Code	250
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$4.15
Rate for Payer: Qualcare PPO/HMO/WC	$4.15

FERRIC GLUCONATE NA INJ 62.5MG

Facility

$208.85

Hospital Charge Code	60629230
Hospital Revenue Code	250
Min. Negotiated Rate	$31.33
Max. Negotiated Rate	$31.33
Rate for Payer: Qualcare PPO/HMO/WC	$31.33

FERRIC GLUCONATE NA INJ 62.5MG

Facility

$208.85

Hospital Charge Code	60629230
Hospital Revenue Code	250
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$104.42
Rate for Payer: Aetna Commercial	$79.36
Rate for Payer: Aetna Medicare Advantage	$62.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.26
Rate for Payer: Cigna Commercial	$104.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.66
Rate for Payer: Oxford Commercial	$41.77
Rate for Payer: Qualcare PPO/HMO/WC	$31.33
Rate for Payer: UnitedHealthcare Commercial	$41.77
Rate for Payer: UnitedHealthcare Community & State	$5.03
Rate for Payer: Wellpoint Medicaid Managed Care	$5.53

FERRIC SUBSULFATE 30 ML

Facility

$16.75

Service Code	NDC 10481011202
Hospital Charge Code	6023411
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$8.38
Rate for Payer: Aetna Commercial	$6.37
Rate for Payer: Aetna Medicare Advantage	$5.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.27
Rate for Payer: Cigna Commercial	$8.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.03
Rate for Payer: Oxford Commercial	$3.35
Rate for Payer: Qualcare PPO/HMO/WC	$2.51
Rate for Payer: UnitedHealthcare Commercial	$3.35
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

FERRIC SUBSULFATE 30 ML

Facility

$16.75

Service Code	NDC 10481011202
Hospital Charge Code	6023411
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$2.51
Rate for Payer: Qualcare PPO/HMO/WC	$2.51

FERRIC SUBSULFATE 8G SOL

Facility

$230.00

Hospital Charge Code	60635590
Hospital Revenue Code	250
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$115.00
Rate for Payer: Aetna Commercial	$87.40
Rate for Payer: Aetna Medicare Advantage	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.65
Rate for Payer: Cigna Commercial	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.00
Rate for Payer: Oxford Commercial	$46.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.50
Rate for Payer: UnitedHealthcare Commercial	$46.00
Rate for Payer: UnitedHealthcare Community & State	$5.54
Rate for Payer: Wellpoint Medicaid Managed Care	$6.09

FERRIC SUBSULFATE 8G SOL

Facility

$230.00

Hospital Charge Code	60635590
Hospital Revenue Code	250
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$34.50
Rate for Payer: Qualcare PPO/HMO/WC	$34.50

FERRIC SUBSULFATE 8ML

Facility

$95.95

Hospital Charge Code	606390573
Hospital Revenue Code	250
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$14.39
Rate for Payer: Qualcare PPO/HMO/WC	$14.39

FERRIC SUBSULFATE 8ML

Facility

$95.95

Hospital Charge Code	606390573
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$47.98
Rate for Payer: Aetna Commercial	$36.46
Rate for Payer: Aetna Medicare Advantage	$28.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.47
Rate for Payer: Cigna Commercial	$47.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.79
Rate for Payer: Oxford Commercial	$19.19
Rate for Payer: Qualcare PPO/HMO/WC	$14.39
Rate for Payer: UnitedHealthcare Commercial	$19.19
Rate for Payer: UnitedHealthcare Community & State	$2.31
Rate for Payer: Wellpoint Medicaid Managed Care	$2.54

FERRIC SUBSULFATE SOL

Facility

$125.63

Service Code	NDC 10481011202
Hospital Charge Code	60628446
Hospital Revenue Code	250
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$18.84
Rate for Payer: Qualcare PPO/HMO/WC	$18.84

Know your out-of-pocket cost for care.

All Charges