Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HIP BI W/WO PELVIS =/> 5 VIEWS

Facility

$5,100.00

Service Code	HCPCS 73523
Hospital Charge Code	2011562
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

HIP BI W/WO PELVIS =/> 5 VIEWS

Facility

$1,131.07

Service Code	HCPCS 73523
Hospital Charge Code	2011598
Hospital Revenue Code	320
Min. Negotiated Rate	$169.66
Max. Negotiated Rate	$169.66
Rate for Payer: Qualcare PPO/HMO/WC	$169.66

HIP BI W/WO PELVIS =/> 5 VIEWS

Facility

$1,131.07

Service Code	HCPCS 73523
Hospital Charge Code	2011598
Hospital Revenue Code	320
Min. Negotiated Rate	$27.26
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.32
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$169.66
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$27.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$29.97

HIP BI W/WO PELVIS =/> 5 VIEWS

Facility

$5,100.00

Service Code	HCPCS 73523
Hospital Charge Code	2011562
Hospital Revenue Code	320
Min. Negotiated Rate	$60.89
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

HIP BI W/WO PELVIS =/> 5 VIEWS

Facility

$1,131.07

Service Code	HCPCS 73523
Hospital Charge Code	94061482
Hospital Revenue Code	320
Min. Negotiated Rate	$27.26
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$448.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$448.32
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.32
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$169.66
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$27.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$29.97

HIP BI W/WO PELVIS =/> 5 VIEWS

Facility

$1,131.07

Service Code	HCPCS 73523
Hospital Charge Code	94270262
Hospital Revenue Code	320
Min. Negotiated Rate	$169.66
Max. Negotiated Rate	$169.66
Rate for Payer: Qualcare PPO/HMO/WC	$169.66

HIP BI W/WO PELVIS =/> 5 VIEWS

Facility

$1,131.07

Service Code	HCPCS 73523
Hospital Charge Code	75190637
Hospital Revenue Code	320
Min. Negotiated Rate	$169.66
Max. Negotiated Rate	$169.66
Rate for Payer: Qualcare PPO/HMO/WC	$169.66

HIP COMPLETE-LT

Facility

$250.00

Hospital Charge Code	94061357
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

HIP COMPLETE-LT

Facility

$250.00

Hospital Charge Code	94061357
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

HIP COMPLETE-RT

Facility

$250.00

Hospital Charge Code	94061359
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

HIP COMPLETE-RT

Facility

$250.00

Hospital Charge Code	94061359
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

HIP FIBER TAK SUTURE ANCH DL

Facility

$2,008.50

Service Code	HCPCS C1713
Hospital Charge Code	270704866
Hospital Revenue Code	278
Min. Negotiated Rate	$301.27
Max. Negotiated Rate	$486.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$401.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$441.87
Rate for Payer: Qualcare PPO/HMO/WC	$301.27

HIP FIBER TAK SUTURE ANCH DL

Facility

$2,008.50

Service Code	HCPCS C1713
Hospital Charge Code	270704866
Hospital Revenue Code	278
Min. Negotiated Rate	$48.40
Max. Negotiated Rate	$1,004.25
Rate for Payer: Aetna Commercial	$763.23
Rate for Payer: Aetna Medicare Advantage	$602.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$512.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$512.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$401.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$512.17
Rate for Payer: Cigna Commercial	$1,004.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$441.87
Rate for Payer: Qualcare PPO/HMO/WC	$301.27
Rate for Payer: UnitedHealthcare Community & State	$48.40
Rate for Payer: Wellpoint Medicaid Managed Care	$53.23

HIP FRACTURE NAIL LAG SCREW

Facility

$2,640.00

Service Code	HCPCS C1713
Hospital Charge Code	270683106
Hospital Revenue Code	278
Min. Negotiated Rate	$396.00
Max. Negotiated Rate	$638.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$528.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$638.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$396.00

HIP FRACTURE NAIL LAG SCREW

Facility

$2,640.00

Service Code	HCPCS C1713
Hospital Charge Code	270683106
Hospital Revenue Code	278
Min. Negotiated Rate	$63.62
Max. Negotiated Rate	$1,320.00
Rate for Payer: Aetna Commercial	$1,003.20
Rate for Payer: Aetna Medicare Advantage	$792.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$673.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$673.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$528.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$673.20
Rate for Payer: Cigna Commercial	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$638.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$396.00
Rate for Payer: UnitedHealthcare Community & State	$63.62
Rate for Payer: Wellpoint Medicaid Managed Care	$69.96

HIP FRACTURE NAIL LEFT 11X380M

Facility

$29,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705821
Hospital Revenue Code	278
Min. Negotiated Rate	$698.90
Max. Negotiated Rate	$14,500.00
Rate for Payer: Aetna Commercial	$11,020.00
Rate for Payer: Aetna Medicare Advantage	$8,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,395.00
Rate for Payer: Cigna Commercial	$14,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,018.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,380.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,350.00
Rate for Payer: UnitedHealthcare Community & State	$698.90
Rate for Payer: Wellpoint Medicaid Managed Care	$768.50

HIP FRACTURE NAIL LEFT 11X380M

Facility

$29,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705821
Hospital Revenue Code	278
Min. Negotiated Rate	$4,350.00
Max. Negotiated Rate	$7,018.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,018.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,380.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,350.00

HIP FRACTURE NAIL RIGHT 11X360

Facility

$29,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705819
Hospital Revenue Code	278
Min. Negotiated Rate	$698.90
Max. Negotiated Rate	$14,500.00
Rate for Payer: Aetna Commercial	$11,020.00
Rate for Payer: Aetna Medicare Advantage	$8,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,395.00
Rate for Payer: Cigna Commercial	$14,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,018.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,380.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,350.00
Rate for Payer: UnitedHealthcare Community & State	$698.90
Rate for Payer: Wellpoint Medicaid Managed Care	$768.50

HIP FRACTURE NAIL RIGHT 11X360

Facility

$29,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705819
Hospital Revenue Code	278
Min. Negotiated Rate	$4,350.00
Max. Negotiated Rate	$7,018.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,018.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,380.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,350.00

HIP INSTRUMENTATION SYSTEM

Facility

$2,500.00

Hospital Charge Code	270670489
Hospital Revenue Code	272
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) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$500.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

HIP INSTRUMENTATION SYSTEM

Facility

$2,500.00

Hospital Charge Code	270670489
Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

HIP INSTRUMENT USAGE FEE

Facility

$6,450.00

Hospital Charge Code	270698191
Hospital Revenue Code	279
Min. Negotiated Rate	$155.44
Max. Negotiated Rate	$3,225.00
Rate for Payer: Aetna Commercial	$2,451.00
Rate for Payer: Aetna Medicare Advantage	$1,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,644.75
Rate for Payer: Cigna Commercial	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,935.00
Rate for Payer: Oxford Commercial	$1,290.00
Rate for Payer: Qualcare PPO/HMO/WC	$967.50
Rate for Payer: UnitedHealthcare Commercial	$1,290.00
Rate for Payer: UnitedHealthcare Community & State	$155.44
Rate for Payer: Wellpoint Medicaid Managed Care	$170.93

HIP INSTRUMENT USAGE FEE

Facility

$6,450.00

Hospital Charge Code	270698191
Hospital Revenue Code	279
Min. Negotiated Rate	$967.50
Max. Negotiated Rate	$967.50
Rate for Payer: Qualcare PPO/HMO/WC	$967.50

HIP I VIEW W/WO PELVIS 1V LT

Facility

$5,100.00

Service Code	HCPCS 73501LT
Hospital Charge Code	94061485
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

HIP I VIEW W/WO PELVIS 1V LT

Facility

$358.23

Service Code	HCPCS 73501LT
Hospital Charge Code	94270265
Hospital Revenue Code	320
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$136.13
Rate for Payer: Aetna Medicare Advantage	$107.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.35
Rate for Payer: Cigna Commercial	$179.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.47
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.73
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$8.63
Rate for Payer: Wellpoint Medicaid Managed Care	$9.49

Know your out-of-pocket cost for care.

All Charges