Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IFOSFAMIDE INJ 1GM

Facility

$277.15

Hospital Charge Code	6000350
Hospital Revenue Code	636
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$138.57
Rate for Payer: Aetna Commercial	$105.32
Rate for Payer: Aetna Medicare Advantage	$83.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.67
Rate for Payer: Cigna Commercial	$138.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.07
Rate for Payer: Qualcare PPO/HMO/WC	$41.57
Rate for Payer: UnitedHealthcare Community & State	$6.68
Rate for Payer: Wellpoint Medicaid Managed Care	$7.34

IFOSFAMIDE INJ 1GM

Facility

$277.15

Hospital Charge Code	6000350
Hospital Revenue Code	636
Min. Negotiated Rate	$41.57
Max. Negotiated Rate	$67.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.07
Rate for Payer: Qualcare PPO/HMO/WC	$41.57

IFUSE-3D IMPLANT 7.0MM X 50MM

Facility

$17,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270692837
Hospital Revenue Code	278
Min. Negotiated Rate	$2,614.50
Max. Negotiated Rate	$4,218.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,218.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,834.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,614.50

IFUSE-3D IMPLANT 7.0MM X 50MM

Facility

$17,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270692837
Hospital Revenue Code	278
Min. Negotiated Rate	$420.06
Max. Negotiated Rate	$8,715.00
Rate for Payer: Aetna Commercial	$6,623.40
Rate for Payer: Aetna Medicare Advantage	$5,229.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,444.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,444.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,444.65
Rate for Payer: Cigna Commercial	$8,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,218.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,834.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,614.50
Rate for Payer: UnitedHealthcare Community & State	$420.06
Rate for Payer: Wellpoint Medicaid Managed Care	$461.89

IFUSE-3D IMPLANT 7.0MM X 65MM

Facility

$17,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270692836
Hospital Revenue Code	278
Min. Negotiated Rate	$2,614.50
Max. Negotiated Rate	$4,218.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,218.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,834.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,614.50

IFUSE-3D IMPLANT 7.0MM X 65MM

Facility

$17,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270692836
Hospital Revenue Code	278
Min. Negotiated Rate	$420.06
Max. Negotiated Rate	$8,715.00
Rate for Payer: Aetna Commercial	$6,623.40
Rate for Payer: Aetna Medicare Advantage	$5,229.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,444.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,444.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,444.65
Rate for Payer: Cigna Commercial	$8,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,218.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,834.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,614.50
Rate for Payer: UnitedHealthcare Community & State	$420.06
Rate for Payer: Wellpoint Medicaid Managed Care	$461.89

IFUSE IMPLANT SYST 7.0X30MM

Facility

$17,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270694944
Hospital Revenue Code	278
Min. Negotiated Rate	$2,614.50
Max. Negotiated Rate	$4,218.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,218.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,834.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,614.50

IFUSE IMPLANT SYST 7.0X30MM

Facility

$17,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270694944
Hospital Revenue Code	278
Min. Negotiated Rate	$420.06
Max. Negotiated Rate	$8,715.00
Rate for Payer: Aetna Commercial	$6,623.40
Rate for Payer: Aetna Medicare Advantage	$5,229.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,444.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,444.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,444.65
Rate for Payer: Cigna Commercial	$8,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,218.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,834.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,614.50
Rate for Payer: UnitedHealthcare Community & State	$420.06
Rate for Payer: Wellpoint Medicaid Managed Care	$461.89

IFUSE SYST SI JT 3D 7.0X35MM

Facility

$17,430.00

Service Code	HCPCS C1776
Hospital Charge Code	270693647
Hospital Revenue Code	278
Min. Negotiated Rate	$2,614.50
Max. Negotiated Rate	$4,218.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,218.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,834.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,614.50

IFUSE SYST SI JT 3D 7.0X35MM

Facility

$17,430.00

Service Code	HCPCS C1776
Hospital Charge Code	270693647
Hospital Revenue Code	278
Min. Negotiated Rate	$420.06
Max. Negotiated Rate	$8,715.00
Rate for Payer: Aetna Commercial	$6,623.40
Rate for Payer: Aetna Medicare Advantage	$5,229.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,444.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,444.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,444.65
Rate for Payer: Cigna Commercial	$8,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,218.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,834.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,614.50
Rate for Payer: UnitedHealthcare Community & State	$420.06
Rate for Payer: Wellpoint Medicaid Managed Care	$461.89

IFUSE TORQ 10X35MM IMPLANT

Facility

$16,125.00

Hospital Charge Code	270703479
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

IFUSE TORQ 10X35MM IMPLANT

Facility

$16,125.00

Hospital Charge Code	270703479
Hospital Revenue Code	278
Min. Negotiated Rate	$388.61
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$388.61
Rate for Payer: Wellpoint Medicaid Managed Care	$427.31

iFUSE-TORQ 10X40MM

Facility

$16,125.00

Hospital Charge Code	270702582
Hospital Revenue Code	278
Min. Negotiated Rate	$388.61
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$388.61
Rate for Payer: Wellpoint Medicaid Managed Care	$427.31

iFUSE-TORQ 10X40MM

Facility

$16,125.00

Hospital Charge Code	270702582
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

iFUSE-TORQ 10X45MM

Facility

$16,125.00

Hospital Charge Code	270702467
Hospital Revenue Code	278
Min. Negotiated Rate	$388.61
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$388.61
Rate for Payer: Wellpoint Medicaid Managed Care	$427.31

iFUSE-TORQ 10X45MM

Facility

$16,125.00

Hospital Charge Code	270702467
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

iFUSE-TORQ 10X55MM

Facility

$16,125.00

Hospital Charge Code	270702466
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

iFUSE-TORQ 10X55MM

Facility

$16,125.00

Hospital Charge Code	270702466
Hospital Revenue Code	278
Min. Negotiated Rate	$388.61
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$388.61
Rate for Payer: Wellpoint Medicaid Managed Care	$427.31

IFUSE TORQ 11.5X40MM

Facility

$16,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270702635
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

IFUSE TORQ 11.5X40MM

Facility

$16,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270702635
Hospital Revenue Code	278
Min. Negotiated Rate	$388.61
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$388.61
Rate for Payer: Wellpoint Medicaid Managed Care	$427.31

IFUSE TORQ 11.5X45MM IMPLANT

Facility

$16,125.00

Hospital Charge Code	270703478
Hospital Revenue Code	278
Min. Negotiated Rate	$388.61
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$388.61
Rate for Payer: Wellpoint Medicaid Managed Care	$427.31

IFUSE TORQ 11.5X45MM IMPLANT

Facility

$16,125.00

Hospital Charge Code	270703478
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

IFUSE TORQ 11.5X55MM

Facility

$16,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270704542
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

IFUSE TORQ 11.5X55MM

Facility

$16,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270704542
Hospital Revenue Code	278
Min. Negotiated Rate	$388.61
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$388.61
Rate for Payer: Wellpoint Medicaid Managed Care	$427.31

IFUSE-TORQ IMPLANT 10MMX50MM

Facility

$16,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270702634
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

Know your out-of-pocket cost for care.

All Charges