Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INSERT 12x71/75 183742

Facility

$3,750.00

Hospital Charge Code	270638692
Hospital Revenue Code	272
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) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$750.00
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

INSERT 12x71/75 183742

Facility

$3,750.00

Hospital Charge Code	270638692
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

INSERT 14 X 63

Facility

$4,720.00

Hospital Charge Code	270637515
Hospital Revenue Code	272
Min. Negotiated Rate	$708.00
Max. Negotiated Rate	$708.00
Rate for Payer: Qualcare PPO/HMO/WC	$708.00

INSERT 14 X 63

Facility

$4,720.00

Hospital Charge Code	270637515
Hospital Revenue Code	272
Min. Negotiated Rate	$113.75
Max. Negotiated Rate	$2,360.00
Rate for Payer: Aetna Commercial	$1,793.60
Rate for Payer: Aetna Medicare Advantage	$1,416.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,203.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,203.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,203.60
Rate for Payer: Cigna Commercial	$2,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,416.00
Rate for Payer: Oxford Commercial	$944.00
Rate for Payer: Qualcare PPO/HMO/WC	$708.00
Rate for Payer: UnitedHealthcare Commercial	$944.00
Rate for Payer: UnitedHealthcare Community & State	$113.75
Rate for Payer: Wellpoint Medicaid Managed Care	$125.08

INSERT 1 ELECT PM-DEFIB REPEAT

Facility

$27,329.78

Service Code	HCPCS 3321678
Hospital Charge Code	5100820
Hospital Revenue Code	480
Min. Negotiated Rate	$658.65
Max. Negotiated Rate	$13,664.89
Rate for Payer: Aetna Commercial	$10,385.32
Rate for Payer: Aetna Medicare Advantage	$8,198.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,969.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,969.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,969.09
Rate for Payer: Cigna Commercial	$13,664.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,198.93
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,099.47
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$658.65
Rate for Payer: Wellpoint Medicaid Managed Care	$724.24

INSERT 1 ELECT PM-DEFIB REPEAT

Facility

$27,329.78

Service Code	HCPCS 3321678
Hospital Charge Code	5100820
Hospital Revenue Code	480
Min. Negotiated Rate	$4,099.47
Max. Negotiated Rate	$4,099.47
Rate for Payer: Qualcare PPO/HMO/WC	$4,099.47

INSERT 1 ELECTRODE PM-DEFIB

Facility

$27,329.78

Service Code	HCPCS 33216
Hospital Charge Code	5100819
Hospital Revenue Code	480
Min. Negotiated Rate	$476.26
Max. Negotiated Rate	$35,488.33
Rate for Payer: Aetna Commercial	$26,741.35
Rate for Payer: Aetna Medicare Advantage	$31,853.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35,488.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35,488.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,831.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$476.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35,488.33
Rate for Payer: Cigna Commercial	$19,706.96
Rate for Payer: Cigna Medicare Advantage	$9,831.38
Rate for Payer: Clover Medicare Advantage	$9,339.81
Rate for Payer: EmblemHealth Commercial	$29,494.14
Rate for Payer: Humana Medicare Advantage	$10,126.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,831.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,198.93
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,099.47
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$658.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,831.38
Rate for Payer: Wellcare Medicare Advantage	$9,831.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$981.11
Rate for Payer: Wellpoint Medicaid Managed Care	$724.24

INSERT 1 ELECTRODE PM-DEFIB

Facility

$27,329.78

Service Code	HCPCS 33216
Hospital Charge Code	5100819
Hospital Revenue Code	480
Min. Negotiated Rate	$4,099.47
Max. Negotiated Rate	$4,099.47
Rate for Payer: Qualcare PPO/HMO/WC	$4,099.47

INSERT AND REMOVE BONE PIN

Facility

$15,297.50

Service Code	HCPCS 20650
Hospital Charge Code	5701010
Hospital Revenue Code	450
Min. Negotiated Rate	$2,294.62
Max. Negotiated Rate	$2,294.62
Rate for Payer: Qualcare PPO/HMO/WC	$2,294.62

INSERT AND REMOVE BONE PIN

Facility

$15,297.50

Service Code	HCPCS 20650
Hospital Charge Code	5701010
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$14,031.70
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,031.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$158.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,031.70
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,589.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,294.62
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$405.38

INSERT BEARING THIATHLON SZ2

Facility

$5,182.10

Service Code	HCPCS C1776
Hospital Charge Code	270682133
Hospital Revenue Code	278
Min. Negotiated Rate	$777.32
Max. Negotiated Rate	$1,254.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,254.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,140.06
Rate for Payer: Qualcare PPO/HMO/WC	$777.32

INSERT BEARING THIATHLON SZ2

Facility

$5,182.10

Service Code	HCPCS C1776
Hospital Charge Code	270682133
Hospital Revenue Code	278
Min. Negotiated Rate	$124.89
Max. Negotiated Rate	$2,591.05
Rate for Payer: Aetna Commercial	$1,969.20
Rate for Payer: Aetna Medicare Advantage	$1,554.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,321.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,321.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,321.44
Rate for Payer: Cigna Commercial	$2,591.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,254.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,140.06
Rate for Payer: Qualcare PPO/HMO/WC	$777.32
Rate for Payer: UnitedHealthcare Community & State	$124.89
Rate for Payer: Wellpoint Medicaid Managed Care	$137.33

INSERT BEARING TIBIAL 6X11MM

Facility

$4,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270692133
Hospital Revenue Code	278
Min. Negotiated Rate	$730.50
Max. Negotiated Rate	$1,178.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$974.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,178.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,071.40
Rate for Payer: Qualcare PPO/HMO/WC	$730.50

INSERT BEARING TIBIAL 6X11MM

Facility

$4,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270692133
Hospital Revenue Code	278
Min. Negotiated Rate	$117.37
Max. Negotiated Rate	$2,435.00
Rate for Payer: Aetna Commercial	$1,850.60
Rate for Payer: Aetna Medicare Advantage	$1,461.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,241.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,241.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$974.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,241.85
Rate for Payer: Cigna Commercial	$2,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,178.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,071.40
Rate for Payer: Qualcare PPO/HMO/WC	$730.50
Rate for Payer: UnitedHealthcare Community & State	$117.37
Rate for Payer: Wellpoint Medicaid Managed Care	$129.06

INSERT BEARING TIBIAL PS X3

Facility

$5,211.40

Service Code	HCPCS C1776
Hospital Charge Code	270691404
Hospital Revenue Code	278
Min. Negotiated Rate	$781.71
Max. Negotiated Rate	$1,261.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,042.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,261.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,146.51
Rate for Payer: Qualcare PPO/HMO/WC	$781.71

INSERT BEARING TIBIAL PS X3

Facility

$5,211.40

Service Code	HCPCS C1776
Hospital Charge Code	270691404
Hospital Revenue Code	278
Min. Negotiated Rate	$125.59
Max. Negotiated Rate	$2,605.70
Rate for Payer: Aetna Commercial	$1,980.33
Rate for Payer: Aetna Medicare Advantage	$1,563.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,328.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,328.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,042.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,328.91
Rate for Payer: Cigna Commercial	$2,605.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,261.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,146.51
Rate for Payer: Qualcare PPO/HMO/WC	$781.71
Rate for Payer: UnitedHealthcare Community & State	$125.59
Rate for Payer: Wellpoint Medicaid Managed Care	$138.10

INSERT BEARING TIBIAL SZ 6 13

Facility

$5,759.20

Service Code	HCPCS C1776
Hospital Charge Code	270691408
Hospital Revenue Code	278
Min. Negotiated Rate	$863.88
Max. Negotiated Rate	$1,393.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,151.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,393.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,267.02
Rate for Payer: Qualcare PPO/HMO/WC	$863.88

INSERT BEARING TIBIAL SZ 6 13

Facility

$5,759.20

Service Code	HCPCS C1776
Hospital Charge Code	270691408
Hospital Revenue Code	278
Min. Negotiated Rate	$138.80
Max. Negotiated Rate	$2,879.60
Rate for Payer: Aetna Commercial	$2,188.50
Rate for Payer: Aetna Medicare Advantage	$1,727.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,468.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,468.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,151.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,468.60
Rate for Payer: Cigna Commercial	$2,879.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,393.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,267.02
Rate for Payer: Qualcare PPO/HMO/WC	$863.88
Rate for Payer: UnitedHealthcare Community & State	$138.80
Rate for Payer: Wellpoint Medicaid Managed Care	$152.62

INSERT BEARING X3 TIBIAL

Facility

$4,985.25

Service Code	HCPCS C1776
Hospital Charge Code	270691261
Hospital Revenue Code	278
Min. Negotiated Rate	$120.14
Max. Negotiated Rate	$2,492.62
Rate for Payer: Aetna Commercial	$1,894.39
Rate for Payer: Aetna Medicare Advantage	$1,495.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.24
Rate for Payer: Cigna Commercial	$2,492.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,096.76
Rate for Payer: Qualcare PPO/HMO/WC	$747.79
Rate for Payer: UnitedHealthcare Community & State	$120.14
Rate for Payer: Wellpoint Medicaid Managed Care	$132.11

INSERT BEARING X3 TIBIAL

Facility

$4,985.25

Service Code	HCPCS C1776
Hospital Charge Code	270691261
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$1,206.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,096.76
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

INSERT BERING TIBIA SZ 3

Facility

$4,985.25

Service Code	HCPCS C1776
Hospital Charge Code	270691268
Hospital Revenue Code	278
Min. Negotiated Rate	$120.14
Max. Negotiated Rate	$2,492.62
Rate for Payer: Aetna Commercial	$1,894.39
Rate for Payer: Aetna Medicare Advantage	$1,495.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.24
Rate for Payer: Cigna Commercial	$2,492.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,096.76
Rate for Payer: Qualcare PPO/HMO/WC	$747.79
Rate for Payer: UnitedHealthcare Community & State	$120.14
Rate for Payer: Wellpoint Medicaid Managed Care	$132.11

INSERT BERING TIBIA SZ 3

Facility

$4,985.25

Service Code	HCPCS C1776
Hospital Charge Code	270691268
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$1,206.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,096.76
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

INSERT BMT 10 71/75 146150

Facility

$3,972.00

Hospital Charge Code	270606912
Hospital Revenue Code	278
Min. Negotiated Rate	$595.80
Max. Negotiated Rate	$961.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$794.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$873.84
Rate for Payer: Qualcare PPO/HMO/WC	$595.80

INSERT BMT 10 71/75 146150

Facility

$3,972.00

Hospital Charge Code	270606912
Hospital Revenue Code	278
Min. Negotiated Rate	$95.73
Max. Negotiated Rate	$1,986.00
Rate for Payer: Aetna Commercial	$1,509.36
Rate for Payer: Aetna Medicare Advantage	$1,191.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,012.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,012.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$794.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,012.86
Rate for Payer: Cigna Commercial	$1,986.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$873.84
Rate for Payer: Qualcare PPO/HMO/WC	$595.80
Rate for Payer: UnitedHealthcare Community & State	$95.73
Rate for Payer: Wellpoint Medicaid Managed Care	$105.26

INSERT BMT 18 71/75 146158

Facility

$3,972.00

Hospital Charge Code	270609000
Hospital Revenue Code	278
Min. Negotiated Rate	$95.73
Max. Negotiated Rate	$1,986.00
Rate for Payer: Aetna Commercial	$1,509.36
Rate for Payer: Aetna Medicare Advantage	$1,191.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,012.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,012.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$794.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,012.86
Rate for Payer: Cigna Commercial	$1,986.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$873.84
Rate for Payer: Qualcare PPO/HMO/WC	$595.80
Rate for Payer: UnitedHealthcare Community & State	$95.73
Rate for Payer: Wellpoint Medicaid Managed Care	$105.26

Know your out-of-pocket cost for care.

All Charges