Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IMPLANT SHORTEN MET SLOT 2.7

Facility

$2,985.00

Service Code	HCPCS C1713
Hospital Charge Code	270701869
Hospital Revenue Code	278
Min. Negotiated Rate	$447.75
Max. Negotiated Rate	$722.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$597.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$722.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$656.70
Rate for Payer: Qualcare PPO/HMO/WC	$447.75

IMPLANT SHORTEN MET SLOT 2.7

Facility

$2,985.00

Service Code	HCPCS C1713
Hospital Charge Code	270701869
Hospital Revenue Code	278
Min. Negotiated Rate	$71.94
Max. Negotiated Rate	$1,492.50
Rate for Payer: Aetna Commercial	$1,134.30
Rate for Payer: Aetna Medicare Advantage	$895.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$761.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$761.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$597.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$761.17
Rate for Payer: Cigna Commercial	$1,492.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$722.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$656.70
Rate for Payer: Qualcare PPO/HMO/WC	$447.75
Rate for Payer: UnitedHealthcare Community & State	$71.94
Rate for Payer: Wellpoint Medicaid Managed Care	$79.10

IMPLANT SINUS TARSI SZ 6

Facility

$7,900.05

Hospital Charge Code	270647216
Hospital Revenue Code	278
Min. Negotiated Rate	$190.39
Max. Negotiated Rate	$3,950.03
Rate for Payer: Aetna Commercial	$3,002.02
Rate for Payer: Aetna Medicare Advantage	$2,370.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,014.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,014.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,580.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,014.51
Rate for Payer: Cigna Commercial	$3,950.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,911.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,738.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,185.01
Rate for Payer: UnitedHealthcare Community & State	$190.39
Rate for Payer: Wellpoint Medicaid Managed Care	$209.35

IMPLANT SINUS TARSI SZ 6

Facility

$7,900.05

Hospital Charge Code	270647216
Hospital Revenue Code	278
Min. Negotiated Rate	$1,185.01
Max. Negotiated Rate	$1,911.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,580.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,911.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,738.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,185.01

IMPLANT SMALL 10 DEG ANGLED

Facility

$5,390.00

Hospital Charge Code	270675709
Hospital Revenue Code	278
Min. Negotiated Rate	$129.90
Max. Negotiated Rate	$2,695.00
Rate for Payer: Aetna Commercial	$2,048.20
Rate for Payer: Aetna Medicare Advantage	$1,617.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,374.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,374.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,078.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,374.45
Rate for Payer: Cigna Commercial	$2,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,304.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,185.80
Rate for Payer: Qualcare PPO/HMO/WC	$808.50
Rate for Payer: UnitedHealthcare Community & State	$129.90
Rate for Payer: Wellpoint Medicaid Managed Care	$142.84

IMPLANT SMALL 10 DEG ANGLED

Facility

$5,390.00

Hospital Charge Code	270675709
Hospital Revenue Code	278
Min. Negotiated Rate	$808.50
Max. Negotiated Rate	$1,304.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,078.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,304.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,185.80
Rate for Payer: Qualcare PPO/HMO/WC	$808.50

IMPLANT SMART TOE ST 0-16

Facility

$1,750.00

Hospital Charge Code	270639822
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

IMPLANT SMART TOE ST 0-16

Facility

$1,750.00

Hospital Charge Code	270639822
Hospital Revenue Code	278
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

IMPLANT SOFT TISSUE RESTORE

Facility

$11,259.25

Service Code	HCPCS C1763
Hospital Charge Code	270633427
Hospital Revenue Code	278
Min. Negotiated Rate	$1,688.89
Max. Negotiated Rate	$2,724.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,251.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,724.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,477.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,688.89

IMPLANT SOFT TISSUE RESTORE

Facility

$11,259.25

Service Code	HCPCS C1763
Hospital Charge Code	270633427
Hospital Revenue Code	278
Min. Negotiated Rate	$271.35
Max. Negotiated Rate	$5,629.62
Rate for Payer: Aetna Commercial	$4,278.52
Rate for Payer: Aetna Medicare Advantage	$3,377.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,871.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,871.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,251.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,871.11
Rate for Payer: Cigna Commercial	$5,629.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,724.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,477.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,688.89
Rate for Payer: UnitedHealthcare Community & State	$271.35
Rate for Payer: Wellpoint Medicaid Managed Care	$298.37

IMPLANT SYS HIP LABRAL RECON

Facility

$9,835.00

Service Code	HCPCS C1713
Hospital Charge Code	270691620
Hospital Revenue Code	278
Min. Negotiated Rate	$1,475.25
Max. Negotiated Rate	$2,380.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,967.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,380.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,163.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,475.25

IMPLANT SYS HIP LABRAL RECON

Facility

$9,835.00

Service Code	HCPCS C1713
Hospital Charge Code	270691620
Hospital Revenue Code	278
Min. Negotiated Rate	$237.02
Max. Negotiated Rate	$4,917.50
Rate for Payer: Aetna Commercial	$3,737.30
Rate for Payer: Aetna Medicare Advantage	$2,950.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,507.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,507.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,967.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,507.93
Rate for Payer: Cigna Commercial	$4,917.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,380.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,163.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,475.25
Rate for Payer: UnitedHealthcare Community & State	$237.02
Rate for Payer: Wellpoint Medicaid Managed Care	$260.63

IMPLANT SYS KIT PROX TENODESIS

Facility

$3,375.00

Service Code	HCPCS C1776
Hospital Charge Code	270673597
Hospital Revenue Code	278
Min. Negotiated Rate	$81.34
Max. Negotiated Rate	$1,687.50
Rate for Payer: Aetna Commercial	$1,282.50
Rate for Payer: Aetna Medicare Advantage	$1,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.62
Rate for Payer: Cigna Commercial	$1,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$742.50
Rate for Payer: Qualcare PPO/HMO/WC	$506.25
Rate for Payer: UnitedHealthcare Community & State	$81.34
Rate for Payer: Wellpoint Medicaid Managed Care	$89.44

IMPLANT SYS KIT PROX TENODESIS

Facility

$3,375.00

Service Code	HCPCS C1776
Hospital Charge Code	270673597
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$816.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$742.50
Rate for Payer: Qualcare PPO/HMO/WC	$506.25

IMPLANT SYS MPFL BIO-COMPOSITE

Facility

$7,435.00

Service Code	HCPCS C1713
Hospital Charge Code	270669427
Hospital Revenue Code	278
Min. Negotiated Rate	$1,115.25
Max. Negotiated Rate	$1,799.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,487.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,799.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,635.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,115.25

IMPLANT SYS MPFL BIO-COMPOSITE

Facility

$7,435.00

Service Code	HCPCS C1713
Hospital Charge Code	270669427
Hospital Revenue Code	278
Min. Negotiated Rate	$179.18
Max. Negotiated Rate	$3,717.50
Rate for Payer: Aetna Commercial	$2,825.30
Rate for Payer: Aetna Medicare Advantage	$2,230.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,895.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,895.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,487.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,895.92
Rate for Payer: Cigna Commercial	$3,717.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,799.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,635.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,115.25
Rate for Payer: UnitedHealthcare Community & State	$179.18
Rate for Payer: Wellpoint Medicaid Managed Care	$197.03

IMPLANT SYS MPFL W/TIGHTROPE

Facility

$8,435.00

Service Code	HCPCS C1713
Hospital Charge Code	270675206
Hospital Revenue Code	278
Min. Negotiated Rate	$1,265.25
Max. Negotiated Rate	$2,041.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,687.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,041.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,855.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.25

IMPLANT SYS MPFL W/TIGHTROPE

Facility

$8,435.00

Service Code	HCPCS C1713
Hospital Charge Code	270675206
Hospital Revenue Code	278
Min. Negotiated Rate	$203.28
Max. Negotiated Rate	$4,217.50
Rate for Payer: Aetna Commercial	$3,205.30
Rate for Payer: Aetna Medicare Advantage	$2,530.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,150.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,150.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,150.93
Rate for Payer: Cigna Commercial	$4,217.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,041.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,855.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.25
Rate for Payer: UnitedHealthcare Community & State	$203.28
Rate for Payer: Wellpoint Medicaid Managed Care	$223.53

IMPLANT SYS SPDBRG 4.75x19.1M

Facility

$7,025.00

Hospital Charge Code	270675507
Hospital Revenue Code	272
Min. Negotiated Rate	$1,053.75
Max. Negotiated Rate	$1,053.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,053.75

IMPLANT SYS SPDBRG 4.75x19.1M

Facility

$7,025.00

Hospital Charge Code	270675507
Hospital Revenue Code	272
Min. Negotiated Rate	$169.30
Max. Negotiated Rate	$3,512.50
Rate for Payer: Aetna Commercial	$2,669.50
Rate for Payer: Aetna Medicare Advantage	$2,107.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,791.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,791.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,791.38
Rate for Payer: Cigna Commercial	$3,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,107.50
Rate for Payer: Oxford Commercial	$1,405.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,053.75
Rate for Payer: UnitedHealthcare Commercial	$1,405.00
Rate for Payer: UnitedHealthcare Community & State	$169.30
Rate for Payer: Wellpoint Medicaid Managed Care	$186.16

IMPLANT SYS SPDBRG 4.75x19.1MM

Facility

$8,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270675255
Hospital Revenue Code	278
Min. Negotiated Rate	$1,305.00
Max. Negotiated Rate	$2,105.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,740.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,105.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,914.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,305.00

IMPLANT SYS SPDBRG 4.75x19.1MM

Facility

$8,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270675255
Hospital Revenue Code	278
Min. Negotiated Rate	$209.67
Max. Negotiated Rate	$4,350.00
Rate for Payer: Aetna Commercial	$3,306.00
Rate for Payer: Aetna Medicare Advantage	$2,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,218.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,218.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,740.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,218.50
Rate for Payer: Cigna Commercial	$4,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,105.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,914.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,305.00
Rate for Payer: UnitedHealthcare Community & State	$209.67
Rate for Payer: Wellpoint Medicaid Managed Care	$230.55

IMPLANT SYSTEM ACHILLES SPDBRG

Facility

$4,850.00

Hospital Charge Code	270675708
Hospital Revenue Code	272
Min. Negotiated Rate	$116.89
Max. Negotiated Rate	$2,425.00
Rate for Payer: Aetna Commercial	$1,843.00
Rate for Payer: Aetna Medicare Advantage	$1,455.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,236.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,236.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,236.75
Rate for Payer: Cigna Commercial	$2,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,455.00
Rate for Payer: Oxford Commercial	$970.00
Rate for Payer: Qualcare PPO/HMO/WC	$727.50
Rate for Payer: UnitedHealthcare Commercial	$970.00
Rate for Payer: UnitedHealthcare Community & State	$116.89
Rate for Payer: Wellpoint Medicaid Managed Care	$128.53

IMPLANT SYSTEM ACHILLES SPDBRG

Facility

$4,850.00

Hospital Charge Code	270675708
Hospital Revenue Code	272
Min. Negotiated Rate	$727.50
Max. Negotiated Rate	$727.50
Rate for Payer: Qualcare PPO/HMO/WC	$727.50

IMPLANT SYSTEM FIBERTAG IIFOR

Facility

$6,743.75

Service Code	HCPCS C1713
Hospital Charge Code	270704450
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.56
Max. Negotiated Rate	$1,631.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,483.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.56

Know your out-of-pocket cost for care.

All Charges