Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INSERT TIBIAL ULTRACON #6 15MM

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676845
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

INSERT TIBIAL ULTRACON #6 15MM

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676845
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

INSERT TIBIAL ULTRACON #6 9MM

Facility

$3,000.00

Hospital Charge Code	270676727
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

INSERT TIBIAL ULTRACON #6 9MM

Facility

$3,000.00

Hospital Charge Code	270676727
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

INSERT TIBIAL ULTRACONGR #3 9M

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676625
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

INSERT TIBIAL ULTRACONGR #3 9M

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676625
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

INSERT TIBIA PIVOT 14MM SZ2 RT

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697282
Hospital Revenue Code	278
Min. Negotiated Rate	$204.85
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Community & State	$204.85
Rate for Payer: Wellpoint Medicaid Managed Care	$225.25

INSERT TIBIA PIVOT 14MM SZ2 RT

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697282
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

INSERT TIBIA TRIATH SZ4CS16MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270697364
Hospital Revenue Code	278
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

INSERT TIBIA TRIATH SZ4CS16MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270697364
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

INSERT TIBILA FLEX R20MM S4

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687438
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

INSERT TIBILA FLEX R20MM S4

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687438
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

INSERT TIB INFINIT POLY 7MM

Facility

$19,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693699
Hospital Revenue Code	278
Min. Negotiated Rate	$469.95
Max. Negotiated Rate	$9,750.00
Rate for Payer: Aetna Commercial	$7,410.00
Rate for Payer: Aetna Medicare Advantage	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,972.50
Rate for Payer: Cigna Commercial	$9,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,290.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00
Rate for Payer: UnitedHealthcare Community & State	$469.95
Rate for Payer: Wellpoint Medicaid Managed Care	$516.75

INSERT TIB INFINIT POLY 7MM

Facility

$19,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693699
Hospital Revenue Code	278
Min. Negotiated Rate	$2,925.00
Max. Negotiated Rate	$4,719.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,290.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00

INSERT TIB SZ5 LONG INFINITY

Facility

$55,670.00

Service Code	HCPCS C1776
Hospital Charge Code	270693698
Hospital Revenue Code	278
Min. Negotiated Rate	$1,341.65
Max. Negotiated Rate	$27,835.00
Rate for Payer: Aetna Commercial	$21,154.60
Rate for Payer: Aetna Medicare Advantage	$16,701.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,195.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,195.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,134.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,195.85
Rate for Payer: Cigna Commercial	$27,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,472.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,247.40
Rate for Payer: Qualcare PPO/HMO/WC	$8,350.50
Rate for Payer: UnitedHealthcare Community & State	$1,341.65
Rate for Payer: Wellpoint Medicaid Managed Care	$1,475.26

INSERT TIB SZ5 LONG INFINITY

Facility

$55,670.00

Service Code	HCPCS C1776
Hospital Charge Code	270693698
Hospital Revenue Code	278
Min. Negotiated Rate	$8,350.50
Max. Negotiated Rate	$13,472.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,134.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,472.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,247.40
Rate for Payer: Qualcare PPO/HMO/WC	$8,350.50

INSERT TISSUE EXPANDER(S)

Facility

$17,020.16

Service Code	HCPCS 11960
Hospital Charge Code	16000782
Hospital Revenue Code	360
Min. Negotiated Rate	$2,553.02
Max. Negotiated Rate	$2,553.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,553.02

INSERT TISSUE EXPANDER(S)

Facility

$17,020.16

Service Code	HCPCS 11960
Hospital Charge Code	16000782
Hospital Revenue Code	360
Min. Negotiated Rate	$410.19
Max. Negotiated Rate	$15,196.98
Rate for Payer: Aetna Commercial	$11,451.31
Rate for Payer: Aetna Medicare Advantage	$13,640.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,196.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,196.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,210.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,196.98
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: Cigna Medicare Advantage	$4,210.04
Rate for Payer: Clover Medicare Advantage	$3,999.54
Rate for Payer: EmblemHealth Commercial	$12,630.12
Rate for Payer: Humana Medicare Advantage	$4,336.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,210.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,106.05
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,553.02
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$410.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,210.04
Rate for Payer: Wellcare Medicare Advantage	$4,210.04
Rate for Payer: Wellpoint Medicaid Managed Care	$451.03

INSERT TOTAL STABILIZER SZ 7

Facility

$23,925.00

Service Code	HCPCS C1776
Hospital Charge Code	270691991
Hospital Revenue Code	278
Min. Negotiated Rate	$3,588.75
Max. Negotiated Rate	$5,789.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,789.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,263.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,588.75

INSERT TOTAL STABILIZER SZ 7

Facility

$23,925.00

Service Code	HCPCS C1776
Hospital Charge Code	270691991
Hospital Revenue Code	278
Min. Negotiated Rate	$576.59
Max. Negotiated Rate	$11,962.50
Rate for Payer: Aetna Commercial	$9,091.50
Rate for Payer: Aetna Medicare Advantage	$7,177.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,100.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,100.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,100.88
Rate for Payer: Cigna Commercial	$11,962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,789.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,263.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,588.75
Rate for Payer: UnitedHealthcare Community & State	$576.59
Rate for Payer: Wellpoint Medicaid Managed Care	$634.01

INSERT TRIDENT X3 PE 36MM

Facility

$4,155.70

Service Code	HCPCS C1776
Hospital Charge Code	270694558
Hospital Revenue Code	278
Min. Negotiated Rate	$100.15
Max. Negotiated Rate	$2,077.85
Rate for Payer: Aetna Commercial	$1,579.17
Rate for Payer: Aetna Medicare Advantage	$1,246.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,059.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,059.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$831.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,059.70
Rate for Payer: Cigna Commercial	$2,077.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,005.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$914.25
Rate for Payer: Qualcare PPO/HMO/WC	$623.36
Rate for Payer: UnitedHealthcare Community & State	$100.15
Rate for Payer: Wellpoint Medicaid Managed Care	$110.13

INSERT TRIDENT X3 PE 36MM

Facility

$4,155.70

Service Code	HCPCS C1776
Hospital Charge Code	270694558
Hospital Revenue Code	278
Min. Negotiated Rate	$623.36
Max. Negotiated Rate	$1,005.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$831.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,005.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$914.25
Rate for Payer: Qualcare PPO/HMO/WC	$623.36

INSERT TRI-TSA PLUS POLY 19MM

Facility

$13,581.75

Service Code	HCPCS C1776
Hospital Charge Code	270677997
Hospital Revenue Code	278
Min. Negotiated Rate	$327.32
Max. Negotiated Rate	$6,790.88
Rate for Payer: Aetna Commercial	$5,161.06
Rate for Payer: Aetna Medicare Advantage	$4,074.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,463.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,463.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,716.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,463.35
Rate for Payer: Cigna Commercial	$6,790.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,286.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,987.99
Rate for Payer: Qualcare PPO/HMO/WC	$2,037.26
Rate for Payer: UnitedHealthcare Community & State	$327.32
Rate for Payer: Wellpoint Medicaid Managed Care	$359.92

INSERT TRI-TSA PLUS POLY 19MM

Facility

$13,581.75

Service Code	HCPCS C1776
Hospital Charge Code	270677997
Hospital Revenue Code	278
Min. Negotiated Rate	$2,037.26
Max. Negotiated Rate	$3,286.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,716.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,286.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,987.99
Rate for Payer: Qualcare PPO/HMO/WC	$2,037.26

INSERT TUN CV CATH W/O PORT

Facility

$17,869.95

Service Code	HCPCS 36565
Hospital Charge Code	7411456
Hospital Revenue Code	361
Min. Negotiated Rate	$2,680.49
Max. Negotiated Rate	$2,680.49
Rate for Payer: Qualcare PPO/HMO/WC	$2,680.49

Know your out-of-pocket cost for care.

All Charges