Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IMPLANT PRODISC-C VIVO MED 5MM

Facility

$42,500.00

Service Code	HCPCS L8699
Hospital Charge Code	270698936
Hospital Revenue Code	278
Min. Negotiated Rate	$1,024.25
Max. Negotiated Rate	$21,250.00
Rate for Payer: Aetna Commercial	$16,150.00
Rate for Payer: Aetna Medicare Advantage	$12,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,837.50
Rate for Payer: Cigna Commercial	$21,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,285.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,350.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,375.00
Rate for Payer: UnitedHealthcare Community & State	$1,024.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1,126.25

IMPLANT REMOVAL

Facility

$2,081.00

Service Code	HCPCS 11976
Hospital Charge Code	87502595
Hospital Revenue Code	761
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$3,036.77
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,036.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,036.77
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.30
Rate for Payer: Oxford Commercial	$416.20
Rate for Payer: Qualcare PPO/HMO/WC	$312.15
Rate for Payer: UnitedHealthcare Commercial	$416.20
Rate for Payer: UnitedHealthcare Community & State	$50.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$55.15

IMPLANT REMOVAL

Facility

$2,081.00

Service Code	HCPCS 11976
Hospital Charge Code	87502595
Hospital Revenue Code	761
Min. Negotiated Rate	$312.15
Max. Negotiated Rate	$312.15
Rate for Payer: Qualcare PPO/HMO/WC	$312.15

IMPLANT REMVL W REINSERTION

Facility

$2,081.00

Hospital Charge Code	83652067
Hospital Revenue Code	360
Min. Negotiated Rate	$312.15
Max. Negotiated Rate	$312.15
Rate for Payer: Qualcare PPO/HMO/WC	$312.15

IMPLANT REMVL W REINSERTION

Facility

$2,081.00

Hospital Charge Code	83652067
Hospital Revenue Code	360
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$790.78
Rate for Payer: Aetna Medicare Advantage	$624.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$530.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$530.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$530.65
Rate for Payer: Cigna Commercial	$1,040.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.30
Rate for Payer: Qualcare PPO/HMO/WC	$312.15
Rate for Payer: UnitedHealthcare Community & State	$50.15
Rate for Payer: Wellpoint Medicaid Managed Care	$55.15

IMPLANT REPAIR DEVICE MENISCAL

Facility

$3,037.50

Service Code	HCPCS C1776
Hospital Charge Code	270663297
Hospital Revenue Code	278
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$1,518.75
Rate for Payer: Aetna Commercial	$1,154.25
Rate for Payer: Aetna Medicare Advantage	$911.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$774.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$774.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$607.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$774.56
Rate for Payer: Cigna Commercial	$1,518.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$735.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$668.25
Rate for Payer: Qualcare PPO/HMO/WC	$455.62
Rate for Payer: UnitedHealthcare Community & State	$73.20
Rate for Payer: Wellpoint Medicaid Managed Care	$80.49

IMPLANT REPAIR DEVICE MENISCAL

Facility

$3,037.50

Service Code	HCPCS C1776
Hospital Charge Code	270663297
Hospital Revenue Code	278
Min. Negotiated Rate	$455.62
Max. Negotiated Rate	$735.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$735.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$668.25
Rate for Payer: Qualcare PPO/HMO/WC	$455.62

IMPLANT ROI-C LORDOSE 12 X 15.

Facility

$11,666.65

Service Code	HCPCS C1713
Hospital Charge Code	270684352
Hospital Revenue Code	278
Min. Negotiated Rate	$1,750.00
Max. Negotiated Rate	$2,823.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,333.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,823.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,566.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,750.00

IMPLANT ROI-C LORDOSE 12 X 15.

Facility

$11,666.65

Service Code	HCPCS C1713
Hospital Charge Code	270684352
Hospital Revenue Code	278
Min. Negotiated Rate	$281.17
Max. Negotiated Rate	$5,833.32
Rate for Payer: Aetna Commercial	$4,433.33
Rate for Payer: Aetna Medicare Advantage	$3,499.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,333.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,975.00
Rate for Payer: Cigna Commercial	$5,833.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,823.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,566.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,750.00
Rate for Payer: UnitedHealthcare Community & State	$281.17
Rate for Payer: Wellpoint Medicaid Managed Care	$309.17

IMPLANT SCLERA QUARTER

Facility

$1,500.00

Hospital Charge Code	270683332
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

IMPLANT SCLERA QUARTER

Facility

$1,500.00

Hospital Charge Code	270683332
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

IMPLANT SGL TOE FLEX 426-0050

Facility

$4,482.45

Hospital Charge Code	270619528
Hospital Revenue Code	278
Min. Negotiated Rate	$108.03
Max. Negotiated Rate	$2,241.22
Rate for Payer: Aetna Commercial	$1,703.33
Rate for Payer: Aetna Medicare Advantage	$1,344.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,143.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,143.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$896.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,143.02
Rate for Payer: Cigna Commercial	$2,241.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,084.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$986.14
Rate for Payer: Qualcare PPO/HMO/WC	$672.37
Rate for Payer: UnitedHealthcare Community & State	$108.03
Rate for Payer: Wellpoint Medicaid Managed Care	$118.78

IMPLANT SGL TOE FLEX 426-0050

Facility

$4,482.45

Hospital Charge Code	270619528
Hospital Revenue Code	278
Min. Negotiated Rate	$672.37
Max. Negotiated Rate	$1,084.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$896.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,084.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$986.14
Rate for Payer: Qualcare PPO/HMO/WC	$672.37

IMPLANT SGL TOE LONG 80-100-01

Facility

$1,915.25

Hospital Charge Code	270615425
Hospital Revenue Code	278
Min. Negotiated Rate	$46.16
Max. Negotiated Rate	$957.62
Rate for Payer: Aetna Commercial	$727.79
Rate for Payer: Aetna Medicare Advantage	$574.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$488.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$488.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$383.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$488.39
Rate for Payer: Cigna Commercial	$957.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$421.36
Rate for Payer: Qualcare PPO/HMO/WC	$287.29
Rate for Payer: UnitedHealthcare Community & State	$46.16
Rate for Payer: Wellpoint Medicaid Managed Care	$50.75

IMPLANT SGL TOE LONG 80-100-01

Facility

$1,915.25

Hospital Charge Code	270615425
Hospital Revenue Code	278
Min. Negotiated Rate	$287.29
Max. Negotiated Rate	$463.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$383.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$421.36
Rate for Payer: Qualcare PPO/HMO/WC	$287.29

IMPLANT SGL TOE MED 70-100-02

Facility

$1,915.25

Hospital Charge Code	270615424
Hospital Revenue Code	278
Min. Negotiated Rate	$46.16
Max. Negotiated Rate	$957.62
Rate for Payer: Aetna Commercial	$727.79
Rate for Payer: Aetna Medicare Advantage	$574.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$488.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$488.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$383.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$488.39
Rate for Payer: Cigna Commercial	$957.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$421.36
Rate for Payer: Qualcare PPO/HMO/WC	$287.29
Rate for Payer: UnitedHealthcare Community & State	$46.16
Rate for Payer: Wellpoint Medicaid Managed Care	$50.75

IMPLANT SGL TOE MED 70-100-02

Facility

$1,915.25

Hospital Charge Code	270615424
Hospital Revenue Code	278
Min. Negotiated Rate	$287.29
Max. Negotiated Rate	$463.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$383.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$421.36
Rate for Payer: Qualcare PPO/HMO/WC	$287.29

IMPLANT SGL TOE SMAL 70-100-01

Facility

$1,915.25

Hospital Charge Code	270615423
Hospital Revenue Code	278
Min. Negotiated Rate	$46.16
Max. Negotiated Rate	$957.62
Rate for Payer: Aetna Commercial	$727.79
Rate for Payer: Aetna Medicare Advantage	$574.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$488.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$488.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$383.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$488.39
Rate for Payer: Cigna Commercial	$957.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$421.36
Rate for Payer: Qualcare PPO/HMO/WC	$287.29
Rate for Payer: UnitedHealthcare Community & State	$46.16
Rate for Payer: Wellpoint Medicaid Managed Care	$50.75

IMPLANT SGL TOE SMAL 70-100-01

Facility

$1,915.25

Hospital Charge Code	270615423
Hospital Revenue Code	278
Min. Negotiated Rate	$287.29
Max. Negotiated Rate	$463.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$383.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$421.36
Rate for Payer: Qualcare PPO/HMO/WC	$287.29

IMPLANT SHAW FLEXBLE 90-100-01

Facility

$818.45

Hospital Charge Code	270631286
Hospital Revenue Code	278
Min. Negotiated Rate	$122.77
Max. Negotiated Rate	$198.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$180.06
Rate for Payer: Qualcare PPO/HMO/WC	$122.77

IMPLANT SHAW FLEXBLE 90-100-01

Facility

$818.45

Hospital Charge Code	270631286
Hospital Revenue Code	278
Min. Negotiated Rate	$19.72
Max. Negotiated Rate	$409.23
Rate for Payer: Aetna Commercial	$311.01
Rate for Payer: Aetna Medicare Advantage	$245.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.70
Rate for Payer: Cigna Commercial	$409.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$180.06
Rate for Payer: Qualcare PPO/HMO/WC	$122.77
Rate for Payer: UnitedHealthcare Community & State	$19.72
Rate for Payer: Wellpoint Medicaid Managed Care	$21.69

IMPLANT SHAW REGULAR 90-100-02

Facility

$818.45

Hospital Charge Code	270631287
Hospital Revenue Code	278
Min. Negotiated Rate	$122.77
Max. Negotiated Rate	$198.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$180.06
Rate for Payer: Qualcare PPO/HMO/WC	$122.77

IMPLANT SHAW REGULAR 90-100-02

Facility

$818.45

Hospital Charge Code	270631287
Hospital Revenue Code	278
Min. Negotiated Rate	$19.72
Max. Negotiated Rate	$409.23
Rate for Payer: Aetna Commercial	$311.01
Rate for Payer: Aetna Medicare Advantage	$245.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.70
Rate for Payer: Cigna Commercial	$409.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$180.06
Rate for Payer: Qualcare PPO/HMO/WC	$122.77
Rate for Payer: UnitedHealthcare Community & State	$19.72
Rate for Payer: Wellpoint Medicaid Managed Care	$21.69

IMPLANT SHAW STIFF 9010003

Facility

$818.45

Hospital Charge Code	270631288
Hospital Revenue Code	278
Min. Negotiated Rate	$122.77
Max. Negotiated Rate	$198.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$180.06
Rate for Payer: Qualcare PPO/HMO/WC	$122.77

IMPLANT SHAW STIFF 9010003

Facility

$818.45

Hospital Charge Code	270631288
Hospital Revenue Code	278
Min. Negotiated Rate	$19.72
Max. Negotiated Rate	$409.23
Rate for Payer: Aetna Commercial	$311.01
Rate for Payer: Aetna Medicare Advantage	$245.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.70
Rate for Payer: Cigna Commercial	$409.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$180.06
Rate for Payer: Qualcare PPO/HMO/WC	$122.77
Rate for Payer: UnitedHealthcare Community & State	$19.72
Rate for Payer: Wellpoint Medicaid Managed Care	$21.69

Know your out-of-pocket cost for care.

All Charges