Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ANKLE JT TARSI IMP HYPROC SZ5

Facility

$7,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270663697
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

ANKLE JT TARSI IMP HYPROC SZ5

Facility

$7,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270663697
Hospital Revenue Code	278
Min. Negotiated Rate	$174.72
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$174.72
Rate for Payer: Wellpoint Medicaid Managed Care	$192.12

ANKLE KIT STERILE HOFMAN 2

Facility

$30,705.00

Hospital Charge Code	270663498
Hospital Revenue Code	278
Min. Negotiated Rate	$4,605.75
Max. Negotiated Rate	$7,430.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,141.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,430.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,755.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,605.75

ANKLE KIT STERILE HOFMAN 2

Facility

$30,705.00

Hospital Charge Code	270663498
Hospital Revenue Code	278
Min. Negotiated Rate	$739.99
Max. Negotiated Rate	$15,352.50
Rate for Payer: Aetna Commercial	$11,667.90
Rate for Payer: Aetna Medicare Advantage	$9,211.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,829.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,829.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,141.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,829.77
Rate for Payer: Cigna Commercial	$15,352.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,430.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,755.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,605.75
Rate for Payer: UnitedHealthcare Community & State	$739.99
Rate for Payer: Wellpoint Medicaid Managed Care	$813.68

ANKLE TIB INSERT PROLONG SZ 4

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695544
Hospital Revenue Code	278
Min. Negotiated Rate	$277.15
Max. Negotiated Rate	$5,750.00
Rate for Payer: Aetna Commercial	$4,370.00
Rate for Payer: Aetna Medicare Advantage	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,932.50
Rate for Payer: Cigna Commercial	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,530.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00
Rate for Payer: UnitedHealthcare Community & State	$277.15
Rate for Payer: Wellpoint Medicaid Managed Care	$304.75

ANKLE TIB INSERT PROLONG SZ 4

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695544
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$2,783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,530.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

ANKLE TOTAL TALUS TM RT SZ 4

Facility

$29,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270695543
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

ANKLE TOTAL TALUS TM RT SZ 4

Facility

$29,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270695543
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

ANKLE,TPLE ARTHRODESIS/SUBTALR

Facility

$77,285.80

Service Code	HCPCS 27815
Hospital Charge Code	160000246
Hospital Revenue Code	360
Min. Negotiated Rate	$11,592.87
Max. Negotiated Rate	$11,592.87
Rate for Payer: Qualcare PPO/HMO/WC	$11,592.87

ANKLE,TPLE ARTHRODESIS/SUBTALR

Facility

$77,285.80

Service Code	HCPCS 27815
Hospital Charge Code	160000246
Hospital Revenue Code	360
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$38,642.90
Rate for Payer: Aetna Commercial	$29,368.60
Rate for Payer: Aetna Medicare Advantage	$23,185.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,707.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,707.88
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	$19,707.88
Rate for Payer: Cigna Commercial	$38,642.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23,185.74
Rate for Payer: Qualcare PPO/HMO/WC	$11,592.87
Rate for Payer: UnitedHealthcare Community & State	$1,862.59
Rate for Payer: Wellpoint Medicaid Managed Care	$2,048.07

ANN BLUNT TIP SCREW 4X40MM

Facility

$1,323.00

Service Code	HCPCS C1713
Hospital Charge Code	270704515
Hospital Revenue Code	278
Min. Negotiated Rate	$31.88
Max. Negotiated Rate	$661.50
Rate for Payer: Aetna Commercial	$502.74
Rate for Payer: Aetna Medicare Advantage	$396.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.37
Rate for Payer: Cigna Commercial	$661.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.06
Rate for Payer: Qualcare PPO/HMO/WC	$198.45
Rate for Payer: UnitedHealthcare Community & State	$31.88
Rate for Payer: Wellpoint Medicaid Managed Care	$35.06

ANN BLUNT TIP SCREW 4X40MM

Facility

$1,323.00

Service Code	HCPCS C1713
Hospital Charge Code	270704515
Hospital Revenue Code	278
Min. Negotiated Rate	$198.45
Max. Negotiated Rate	$320.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.06
Rate for Payer: Qualcare PPO/HMO/WC	$198.45

ANN BLUNT TIP SCREW 4X42MM

Facility

$1,323.00

Service Code	HCPCS C1713
Hospital Charge Code	270704516
Hospital Revenue Code	278
Min. Negotiated Rate	$31.88
Max. Negotiated Rate	$661.50
Rate for Payer: Aetna Commercial	$502.74
Rate for Payer: Aetna Medicare Advantage	$396.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.37
Rate for Payer: Cigna Commercial	$661.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.06
Rate for Payer: Qualcare PPO/HMO/WC	$198.45
Rate for Payer: UnitedHealthcare Community & State	$31.88
Rate for Payer: Wellpoint Medicaid Managed Care	$35.06

ANN BLUNT TIP SCREW 4X42MM

Facility

$1,323.00

Service Code	HCPCS C1713
Hospital Charge Code	270704516
Hospital Revenue Code	278
Min. Negotiated Rate	$198.45
Max. Negotiated Rate	$320.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.06
Rate for Payer: Qualcare PPO/HMO/WC	$198.45

ANN CORT BONE SCREW 4 X 24MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270688148
Hospital Revenue Code	278
Min. Negotiated Rate	$23.02
Max. Negotiated Rate	$477.50
Rate for Payer: Aetna Commercial	$362.90
Rate for Payer: Aetna Medicare Advantage	$286.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.53
Rate for Payer: Cigna Commercial	$477.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$210.10
Rate for Payer: Qualcare PPO/HMO/WC	$143.25
Rate for Payer: UnitedHealthcare Community & State	$23.02
Rate for Payer: Wellpoint Medicaid Managed Care	$25.31

ANN CORT BONE SCREW 4 X 24MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270688148
Hospital Revenue Code	278
Min. Negotiated Rate	$143.25
Max. Negotiated Rate	$231.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$210.10
Rate for Payer: Qualcare PPO/HMO/WC	$143.25

ANN CORT BONE SCREW 4 X 26MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270688152
Hospital Revenue Code	278
Min. Negotiated Rate	$23.02
Max. Negotiated Rate	$477.50
Rate for Payer: Aetna Commercial	$362.90
Rate for Payer: Aetna Medicare Advantage	$286.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.53
Rate for Payer: Cigna Commercial	$477.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$210.10
Rate for Payer: Qualcare PPO/HMO/WC	$143.25
Rate for Payer: UnitedHealthcare Community & State	$23.02
Rate for Payer: Wellpoint Medicaid Managed Care	$25.31

ANN CORT BONE SCREW 4 X 26MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270688152
Hospital Revenue Code	278
Min. Negotiated Rate	$143.25
Max. Negotiated Rate	$231.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$210.10
Rate for Payer: Qualcare PPO/HMO/WC	$143.25

ANN CORT BONE SCREW 4 X 36MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270688144
Hospital Revenue Code	278
Min. Negotiated Rate	$23.02
Max. Negotiated Rate	$477.50
Rate for Payer: Aetna Commercial	$362.90
Rate for Payer: Aetna Medicare Advantage	$286.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.53
Rate for Payer: Cigna Commercial	$477.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$210.10
Rate for Payer: Qualcare PPO/HMO/WC	$143.25
Rate for Payer: UnitedHealthcare Community & State	$23.02
Rate for Payer: Wellpoint Medicaid Managed Care	$25.31

ANN CORT BONE SCREW 4 X 36MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270688144
Hospital Revenue Code	278
Min. Negotiated Rate	$143.25
Max. Negotiated Rate	$231.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$210.10
Rate for Payer: Qualcare PPO/HMO/WC	$143.25

ANN CORT BONE SCREW 4 X 38MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270688145
Hospital Revenue Code	278
Min. Negotiated Rate	$23.02
Max. Negotiated Rate	$477.50
Rate for Payer: Aetna Commercial	$362.90
Rate for Payer: Aetna Medicare Advantage	$286.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.53
Rate for Payer: Cigna Commercial	$477.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$210.10
Rate for Payer: Qualcare PPO/HMO/WC	$143.25
Rate for Payer: UnitedHealthcare Community & State	$23.02
Rate for Payer: Wellpoint Medicaid Managed Care	$25.31

ANN CORT BONE SCREW 4 X 38MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270688145
Hospital Revenue Code	278
Min. Negotiated Rate	$143.25
Max. Negotiated Rate	$231.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$210.10
Rate for Payer: Qualcare PPO/HMO/WC	$143.25

ANNUAL HEALTH - PENINSULA EMP

Facility

$50.00

Hospital Charge Code	9600501
Hospital Revenue Code	510
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

ANNUAL HEALTH - PENINSULA EMP

Facility

$50.00

Hospital Charge Code	9600501
Hospital Revenue Code	510
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

ANNUAL VISIT WHC*****

Facility

$49.50

Service Code	HCPCS 99395WF
Hospital Charge Code	9600012
Hospital Revenue Code	519
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$7.42
Rate for Payer: Qualcare PPO/HMO/WC	$7.42

Know your out-of-pocket cost for care.

All Charges