Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FUZEON 90 MG

Facility

$130.00

Hospital Charge Code	60635667
Hospital Revenue Code	250
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$19.50
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

FUZEON 90 MG

Facility

$130.00

Hospital Charge Code	60635667
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.00
Rate for Payer: Oxford Commercial	$26.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.50
Rate for Payer: UnitedHealthcare Commercial	$26.00
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$3.44

FUZEON 90MG INJ

Facility

$340.00

Hospital Charge Code	60635564
Hospital Revenue Code	636
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$82.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.28
Rate for Payer: Qualcare PPO/HMO/WC	$51.00

FUZEON 90MG INJ

Facility

$340.00

Hospital Charge Code	60635564
Hospital Revenue Code	636
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$170.00
Rate for Payer: Aetna Commercial	$129.20
Rate for Payer: Aetna Medicare Advantage	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.70
Rate for Payer: Cigna Commercial	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.28
Rate for Payer: Qualcare PPO/HMO/WC	$51.00
Rate for Payer: UnitedHealthcare Community & State	$8.19
Rate for Payer: Wellpoint Medicaid Managed Care	$9.01

FUZEON INJ 90MG

Facility

$196.00

Hospital Charge Code	60635666
Hospital Revenue Code	636
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$98.00
Rate for Payer: Aetna Commercial	$74.48
Rate for Payer: Aetna Medicare Advantage	$58.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.98
Rate for Payer: Cigna Commercial	$98.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.43
Rate for Payer: Qualcare PPO/HMO/WC	$29.40
Rate for Payer: UnitedHealthcare Community & State	$4.72
Rate for Payer: Wellpoint Medicaid Managed Care	$5.19

FUZEON INJ 90MG

Facility

$196.00

Hospital Charge Code	60635666
Hospital Revenue Code	636
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$47.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.43
Rate for Payer: Qualcare PPO/HMO/WC	$29.40

FX BRIDGE TUBEROSITY REPAIR

Facility

$4,000.00

Hospital Charge Code	270703189
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

FX BRIDGE TUBEROSITY REPAIR

Facility

$4,000.00

Hospital Charge Code	270703189
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

G25 GUS DISNFECTION FILTER

Facility

$4,440.00

Hospital Charge Code	270656302
Hospital Revenue Code	278
Min. Negotiated Rate	$107.00
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$1,687.20
Rate for Payer: Aetna Medicare Advantage	$1,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,132.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,132.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$888.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,132.20
Rate for Payer: Cigna Commercial	$2,220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,074.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$976.80
Rate for Payer: Qualcare PPO/HMO/WC	$666.00
Rate for Payer: UnitedHealthcare Community & State	$107.00
Rate for Payer: Wellpoint Medicaid Managed Care	$117.66

G25 GUS DISNFECTION FILTER

Facility

$4,440.00

Hospital Charge Code	270656302
Hospital Revenue Code	278
Min. Negotiated Rate	$666.00
Max. Negotiated Rate	$1,074.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$888.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,074.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$976.80
Rate for Payer: Qualcare PPO/HMO/WC	$666.00

G2 FILTER SYSTEM

Facility

$6,975.00

Service Code	HCPCS C1880
Hospital Charge Code	270635864
Hospital Revenue Code	278
Min. Negotiated Rate	$168.10
Max. Negotiated Rate	$3,487.50
Rate for Payer: Aetna Commercial	$2,650.50
Rate for Payer: Aetna Medicare Advantage	$2,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,778.62
Rate for Payer: Cigna Commercial	$3,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,534.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25
Rate for Payer: UnitedHealthcare Community & State	$168.10
Rate for Payer: Wellpoint Medicaid Managed Care	$184.84

G2 FILTER SYSTEM

Facility

$6,975.00

Service Code	HCPCS C1880
Hospital Charge Code	270635864
Hospital Revenue Code	278
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$1,687.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,534.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

G2 FILTER SYSTEM

Facility

$6,975.00

Hospital Charge Code	270635864C
Hospital Revenue Code	272
Min. Negotiated Rate	$168.10
Max. Negotiated Rate	$3,487.50
Rate for Payer: Aetna Commercial	$2,650.50
Rate for Payer: Aetna Medicare Advantage	$2,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,778.62
Rate for Payer: Cigna Commercial	$3,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,092.50
Rate for Payer: Oxford Commercial	$1,395.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25
Rate for Payer: UnitedHealthcare Commercial	$1,395.00
Rate for Payer: UnitedHealthcare Community & State	$168.10
Rate for Payer: Wellpoint Medicaid Managed Care	$184.84

G2 FILTER SYSTEM

Facility

$6,975.00

Hospital Charge Code	270635864C
Hospital Revenue Code	272
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$1,046.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

G-6-PD,RBC

Facility

$390.00

Service Code	HCPCS 82955
Hospital Charge Code	39900087
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

G-6-PD,RBC

Facility

$390.00

Service Code	HCPCS 82955
Hospital Charge Code	39900087
Hospital Revenue Code	301
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$26.38
Rate for Payer: Aetna Medicare Advantage	$31.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.01
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$9.70
Rate for Payer: Clover Medicare Advantage	$9.21
Rate for Payer: EmblemHealth Commercial	$29.10
Rate for Payer: Humana Medicare Advantage	$9.99
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$7.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.70
Rate for Payer: Wellcare Medicare Advantage	$9.70
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

G7 ACETABULAR LINER HIGH WALL

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270685251
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

G7 ACETABULAR LINER HIGH WALL

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270685251
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

G7 DUAL MOBILITY LINER 44MM F

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680810
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

G7 DUAL MOBILITY LINER 44MM F

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680810
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

G7 DUAL MOBILITY LINER 46MM G

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686368
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

G7 DUAL MOBILITY LINER 46MM G

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686368
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

G7 FINNED 3 HOLE SHELL 48C

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688750
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

G7 FINNED 3 HOLE SHELL 48C

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270688750
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

G7 FINNED 3 HOLE SHELL 50D Q

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684058
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

Know your out-of-pocket cost for care.

All Charges