Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IMPLANT SYSTEM FIBERTAG IIFOR

Facility

$6,743.75

Service Code	HCPCS C1713
Hospital Charge Code	270704450
Hospital Revenue Code	278
Min. Negotiated Rate	$162.52
Max. Negotiated Rate	$3,371.88
Rate for Payer: Aetna Commercial	$2,562.62
Rate for Payer: Aetna Medicare Advantage	$2,023.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,719.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,719.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,719.66
Rate for Payer: Cigna Commercial	$3,371.88
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
Rate for Payer: UnitedHealthcare Community & State	$162.52
Rate for Payer: Wellpoint Medicaid Managed Care	$178.71

IMPLANT SYSTEM LAT ANKLE RECON

Facility

$8,750.00

Hospital Charge Code	270684370
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

IMPLANT SYSTEM LAT ANKLE RECON

Facility

$8,750.00

Hospital Charge Code	270684370
Hospital Revenue Code	278
Min. Negotiated Rate	$210.88
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$3,325.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50
Rate for Payer: UnitedHealthcare Community & State	$210.88
Rate for Payer: Wellpoint Medicaid Managed Care	$231.88

IMPLANT SYSTEM PARS SUTURE

Facility

$3,750.00

Hospital Charge Code	270682350
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

IMPLANT SYSTEM PARS SUTURE

Facility

$3,750.00

Hospital Charge Code	270682350
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

IMPLANT SYSTEM SUTURELOC

Facility

$10,300.00

Hospital Charge Code	270702109
Hospital Revenue Code	278
Min. Negotiated Rate	$248.23
Max. Negotiated Rate	$5,150.00
Rate for Payer: Aetna Commercial	$3,914.00
Rate for Payer: Aetna Medicare Advantage	$3,090.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,626.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,626.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,626.50
Rate for Payer: Cigna Commercial	$5,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,492.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,266.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,545.00
Rate for Payer: UnitedHealthcare Community & State	$248.23
Rate for Payer: Wellpoint Medicaid Managed Care	$272.95

IMPLANT SYSTEM SUTURELOC

Facility

$10,300.00

Hospital Charge Code	270702109
Hospital Revenue Code	278
Min. Negotiated Rate	$1,545.00
Max. Negotiated Rate	$2,492.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,492.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,266.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,545.00

IMPLANT SYSTM PARS SUTURE TAPE

Facility

$7,475.00

Hospital Charge Code	270683624
Hospital Revenue Code	272
Min. Negotiated Rate	$180.15
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,840.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.50
Rate for Payer: Oxford Commercial	$1,495.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25
Rate for Payer: UnitedHealthcare Commercial	$1,495.00
Rate for Payer: UnitedHealthcare Community & State	$180.15
Rate for Payer: Wellpoint Medicaid Managed Care	$198.09

IMPLANT SYSTM PARS SUTURE TAPE

Facility

$7,475.00

Hospital Charge Code	270683624
Hospital Revenue Code	272
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$1,121.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

IMPLANT TALIEN TALAR COMPONENT

Facility

$18,750.00

Hospital Charge Code	270656743
Hospital Revenue Code	278
Min. Negotiated Rate	$451.88
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$7,125.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50
Rate for Payer: UnitedHealthcare Community & State	$451.88
Rate for Payer: Wellpoint Medicaid Managed Care	$496.88

IMPLANT TALIEN TALAR COMPONENT

Facility

$18,750.00

Hospital Charge Code	270656743
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

IMPLANT TIBIAL COMPONENT T.=1

Facility

$24,750.00

Hospital Charge Code	270656744
Hospital Revenue Code	278
Min. Negotiated Rate	$3,712.50
Max. Negotiated Rate	$5,989.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,989.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,445.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,712.50

IMPLANT TIBIAL COMPONENT T.=1

Facility

$24,750.00

Hospital Charge Code	270656744
Hospital Revenue Code	278
Min. Negotiated Rate	$596.48
Max. Negotiated Rate	$12,375.00
Rate for Payer: Aetna Commercial	$9,405.00
Rate for Payer: Aetna Medicare Advantage	$7,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,311.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,311.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,311.25
Rate for Payer: Cigna Commercial	$12,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,989.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,445.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,712.50
Rate for Payer: UnitedHealthcare Community & State	$596.48
Rate for Payer: Wellpoint Medicaid Managed Care	$655.88

IMPLANT TIGHTROPE ABS

Facility

$920.00

Service Code	HCPCS C1713
Hospital Charge Code	270663930
Hospital Revenue Code	278
Min. Negotiated Rate	$138.00
Max. Negotiated Rate	$222.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$184.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$202.40
Rate for Payer: Qualcare PPO/HMO/WC	$138.00

IMPLANT TIGHTROPE ABS

Facility

$920.00

Service Code	HCPCS C1713
Hospital Charge Code	270663930
Hospital Revenue Code	278
Min. Negotiated Rate	$22.17
Max. Negotiated Rate	$460.00
Rate for Payer: Aetna Commercial	$349.60
Rate for Payer: Aetna Medicare Advantage	$276.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$184.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.60
Rate for Payer: Cigna Commercial	$460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$202.40
Rate for Payer: Qualcare PPO/HMO/WC	$138.00
Rate for Payer: UnitedHealthcare Community & State	$22.17
Rate for Payer: Wellpoint Medicaid Managed Care	$24.38

IMPLANT TOE ANGLED 2 487A002

Facility

$10,875.00

Hospital Charge Code	270638424
Hospital Revenue Code	278
Min. Negotiated Rate	$262.09
Max. Negotiated Rate	$5,437.50
Rate for Payer: Aetna Commercial	$4,132.50
Rate for Payer: Aetna Medicare Advantage	$3,262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,773.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,773.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,773.12
Rate for Payer: Cigna Commercial	$5,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,631.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,392.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,631.25
Rate for Payer: UnitedHealthcare Community & State	$262.09
Rate for Payer: Wellpoint Medicaid Managed Care	$288.19

IMPLANT TOE ANGLED 2 487A002

Facility

$10,875.00

Hospital Charge Code	270638424
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.25
Max. Negotiated Rate	$2,631.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,631.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,392.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,631.25

IMPLANT TOE LARGE NPC 10062

Facility

$3,844.00

Hospital Charge Code	270632589
Hospital Revenue Code	278
Min. Negotiated Rate	$92.64
Max. Negotiated Rate	$1,922.00
Rate for Payer: Aetna Commercial	$1,460.72
Rate for Payer: Aetna Medicare Advantage	$1,153.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$980.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$980.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$768.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$980.22
Rate for Payer: Cigna Commercial	$1,922.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$930.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$845.68
Rate for Payer: Qualcare PPO/HMO/WC	$576.60
Rate for Payer: UnitedHealthcare Community & State	$92.64
Rate for Payer: Wellpoint Medicaid Managed Care	$101.87

IMPLANT TOE LARGE NPC 10062

Facility

$3,844.00

Hospital Charge Code	270632589
Hospital Revenue Code	278
Min. Negotiated Rate	$576.60
Max. Negotiated Rate	$930.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$768.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$930.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$845.68
Rate for Payer: Qualcare PPO/HMO/WC	$576.60

IMPLANT TOE LARGE PC 10414

Facility

$4,588.00

Hospital Charge Code	270632585
Hospital Revenue Code	278
Min. Negotiated Rate	$110.57
Max. Negotiated Rate	$2,294.00
Rate for Payer: Aetna Commercial	$1,743.44
Rate for Payer: Aetna Medicare Advantage	$1,376.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,169.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,169.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$917.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,169.94
Rate for Payer: Cigna Commercial	$2,294.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,110.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,009.36
Rate for Payer: Qualcare PPO/HMO/WC	$688.20
Rate for Payer: UnitedHealthcare Community & State	$110.57
Rate for Payer: Wellpoint Medicaid Managed Care	$121.58

IMPLANT TOE LARGE PC 10414

Facility

$4,588.00

Hospital Charge Code	270632585
Hospital Revenue Code	278
Min. Negotiated Rate	$688.20
Max. Negotiated Rate	$1,110.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$917.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,110.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,009.36
Rate for Payer: Qualcare PPO/HMO/WC	$688.20

IMPLANT TOE MD/LG NPC 14958

Facility

$3,844.00

Hospital Charge Code	270632787
Hospital Revenue Code	278
Min. Negotiated Rate	$576.60
Max. Negotiated Rate	$930.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$768.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$930.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$845.68
Rate for Payer: Qualcare PPO/HMO/WC	$576.60

IMPLANT TOE MD/LG NPC 14958

Facility

$3,844.00

Hospital Charge Code	270632787
Hospital Revenue Code	278
Min. Negotiated Rate	$92.64
Max. Negotiated Rate	$1,922.00
Rate for Payer: Aetna Commercial	$1,460.72
Rate for Payer: Aetna Medicare Advantage	$1,153.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$980.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$980.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$768.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$980.22
Rate for Payer: Cigna Commercial	$1,922.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$930.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$845.68
Rate for Payer: Qualcare PPO/HMO/WC	$576.60
Rate for Payer: UnitedHealthcare Community & State	$92.64
Rate for Payer: Wellpoint Medicaid Managed Care	$101.87

IMPLANT TOE MEDIUM NPC 10061

Facility

$4,000.00

Hospital Charge Code	270632587
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

IMPLANT TOE MEDIUM NPC 10061

Facility

$4,000.00

Hospital Charge Code	270632587
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

Know your out-of-pocket cost for care.

All Charges