Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FIXATOR STANDARD COMPLET 01000

Facility

$14,646.95

Hospital Charge Code	270634728
Hospital Revenue Code	272
Min. Negotiated Rate	$2,197.04
Max. Negotiated Rate	$2,197.04
Rate for Payer: Qualcare PPO/HMO/WC	$2,197.04

FIXATR SYN DIS RAD 200 390052S

Facility

$9,796.00

Hospital Charge Code	270612724
Hospital Revenue Code	272
Min. Negotiated Rate	$236.08
Max. Negotiated Rate	$4,898.00
Rate for Payer: Aetna Commercial	$3,722.48
Rate for Payer: Aetna Medicare Advantage	$2,938.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,497.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,497.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,497.98
Rate for Payer: Cigna Commercial	$4,898.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,938.80
Rate for Payer: Oxford Commercial	$1,959.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,469.40
Rate for Payer: UnitedHealthcare Commercial	$1,959.20
Rate for Payer: UnitedHealthcare Community & State	$236.08
Rate for Payer: Wellpoint Medicaid Managed Care	$259.59

FIXATR SYN DIS RAD 200 390052S

Facility

$9,796.00

Hospital Charge Code	270612724
Hospital Revenue Code	272
Min. Negotiated Rate	$1,469.40
Max. Negotiated Rate	$1,469.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,469.40

FIXATR SYN DIS RAD 200 395841S

Facility

$8,556.00

Hospital Charge Code	270626969
Hospital Revenue Code	272
Min. Negotiated Rate	$206.20
Max. Negotiated Rate	$4,278.00
Rate for Payer: Aetna Commercial	$3,251.28
Rate for Payer: Aetna Medicare Advantage	$2,566.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,181.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,181.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,181.78
Rate for Payer: Cigna Commercial	$4,278.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,566.80
Rate for Payer: Oxford Commercial	$1,711.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,283.40
Rate for Payer: UnitedHealthcare Commercial	$1,711.20
Rate for Payer: UnitedHealthcare Community & State	$206.20
Rate for Payer: Wellpoint Medicaid Managed Care	$226.73

FIXATR SYN DIS RAD 200 395841S

Facility

$8,556.00

Hospital Charge Code	270626969
Hospital Revenue Code	272
Min. Negotiated Rate	$1,283.40
Max. Negotiated Rate	$1,283.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,283.40

FIXATR SYN DIS RAD 220 395822

Facility

$8,267.25

Hospital Charge Code	270625227
Hospital Revenue Code	272
Min. Negotiated Rate	$199.24
Max. Negotiated Rate	$4,133.62
Rate for Payer: Aetna Commercial	$3,141.55
Rate for Payer: Aetna Medicare Advantage	$2,480.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,108.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,108.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,108.15
Rate for Payer: Cigna Commercial	$4,133.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.18
Rate for Payer: Oxford Commercial	$1,653.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,240.09
Rate for Payer: UnitedHealthcare Commercial	$1,653.45
Rate for Payer: UnitedHealthcare Community & State	$199.24
Rate for Payer: Wellpoint Medicaid Managed Care	$219.08

FIXATR SYN DIS RAD 220 395822

Facility

$8,267.25

Hospital Charge Code	270625227
Hospital Revenue Code	272
Min. Negotiated Rate	$1,240.09
Max. Negotiated Rate	$1,240.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,240.09

FIXED 4.0MM SELF TAPPING 12MM

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693407
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

FIXED 4.0MM SELF TAPPING 12MM

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693407
Hospital Revenue Code	278
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

FIXED SCREW 4X16MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705474
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

FIXED SCREW 4X16MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705474
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

FIXOS SCREW 4X36MM.

Facility

$1,760.00

Service Code	HCPCS C1713
Hospital Charge Code	270703680
Hospital Revenue Code	278
Min. Negotiated Rate	$42.42
Max. Negotiated Rate	$880.00
Rate for Payer: Aetna Commercial	$668.80
Rate for Payer: Aetna Medicare Advantage	$528.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$352.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.80
Rate for Payer: Cigna Commercial	$880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$425.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$387.20
Rate for Payer: Qualcare PPO/HMO/WC	$264.00
Rate for Payer: UnitedHealthcare Community & State	$42.42
Rate for Payer: Wellpoint Medicaid Managed Care	$46.64

FIXOS SCREW 4X36MM.

Facility

$1,760.00

Service Code	HCPCS C1713
Hospital Charge Code	270703680
Hospital Revenue Code	278
Min. Negotiated Rate	$264.00
Max. Negotiated Rate	$425.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$352.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$425.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$387.20
Rate for Payer: Qualcare PPO/HMO/WC	$264.00

FIX PIN

Facility

$543.80

Service Code	HCPCS C1713
Hospital Charge Code	270689205
Hospital Revenue Code	278
Min. Negotiated Rate	$81.57
Max. Negotiated Rate	$131.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$119.64
Rate for Payer: Qualcare PPO/HMO/WC	$81.57

FIX PIN

Facility

$543.80

Service Code	HCPCS C1713
Hospital Charge Code	270689205
Hospital Revenue Code	278
Min. Negotiated Rate	$13.11
Max. Negotiated Rate	$271.90
Rate for Payer: Aetna Commercial	$206.64
Rate for Payer: Aetna Medicare Advantage	$163.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.67
Rate for Payer: Cigna Commercial	$271.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$119.64
Rate for Payer: Qualcare PPO/HMO/WC	$81.57
Rate for Payer: UnitedHealthcare Community & State	$13.11
Rate for Payer: Wellpoint Medicaid Managed Care	$14.41

FLAGYL/250MG/TAB

Facility

$12.00

Hospital Charge Code	60632993
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

FLAGYL/250MG/TAB

Facility

$12.00

Hospital Charge Code	60632992
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

FLAGYL/250MG/TAB

Facility

$12.00

Hospital Charge Code	60632992
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

FLAGYL/250MG/TAB

Facility

$12.00

Hospital Charge Code	60632993
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

FLAGYL PREMIX IV/500MG

Facility

$51.00

Hospital Charge Code	60634494
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

FLAGYL PREMIX IV/500MG

Facility

$51.00

Hospital Charge Code	60634494
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$19.38
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.30
Rate for Payer: Oxford Commercial	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$10.20
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

FLANGE BREAST 2 BREAST CUST

Facility

$28.33

Hospital Charge Code	270665662
Hospital Revenue Code	278
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6.23
Rate for Payer: Qualcare PPO/HMO/WC	$4.25

FLANGE BREAST 2 BREAST CUST

Facility

$28.33

Hospital Charge Code	270665662
Hospital Revenue Code	278
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$14.16
Rate for Payer: Aetna Commercial	$10.77
Rate for Payer: Aetna Medicare Advantage	$8.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.22
Rate for Payer: Cigna Commercial	$14.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6.23
Rate for Payer: Qualcare PPO/HMO/WC	$4.25
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.75

FLAREHAWK 11MM SHIM, 29MM

Facility

$10,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270703876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

FLAREHAWK 11MM SHIM, 29MM

Facility

$10,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270703876
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

Know your out-of-pocket cost for care.

All Charges