Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LAPIPLASTY 2.7MM 16/18MM

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270699092
Hospital Revenue Code	278
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$840.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$764.50
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

LAPIPLASTY 2.7MM 16/18MM

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270699092
Hospital Revenue Code	278
Min. Negotiated Rate	$83.75
Max. Negotiated Rate	$1,737.50
Rate for Payer: Aetna Commercial	$1,320.50
Rate for Payer: Aetna Medicare Advantage	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$886.12
Rate for Payer: Cigna Commercial	$1,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$764.50
Rate for Payer: Qualcare PPO/HMO/WC	$521.25
Rate for Payer: UnitedHealthcare Community & State	$83.75
Rate for Payer: Wellpoint Medicaid Managed Care	$92.09

LAPIPLASTY BIPLANAR SYSTEM 1

Facility

$19,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270693836
Hospital Revenue Code	278
Min. Negotiated Rate	$469.35
Max. Negotiated Rate	$9,737.50
Rate for Payer: Aetna Commercial	$7,400.50
Rate for Payer: Aetna Medicare Advantage	$5,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,966.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,966.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,966.12
Rate for Payer: Cigna Commercial	$9,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,712.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,284.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,921.25
Rate for Payer: UnitedHealthcare Community & State	$469.35
Rate for Payer: Wellpoint Medicaid Managed Care	$516.09

LAPIPLASTY BIPLANAR SYSTEM 1

Facility

$19,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270693836
Hospital Revenue Code	278
Min. Negotiated Rate	$2,921.25
Max. Negotiated Rate	$4,712.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,712.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,284.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,921.25

LAPIPLASTY KIT SK341-SD211-SD2

Facility

$19,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270697469
Hospital Revenue Code	278
Min. Negotiated Rate	$457.90
Max. Negotiated Rate	$9,500.00
Rate for Payer: Aetna Commercial	$7,220.00
Rate for Payer: Aetna Medicare Advantage	$5,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,845.00
Rate for Payer: Cigna Commercial	$9,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,598.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,180.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,850.00
Rate for Payer: UnitedHealthcare Community & State	$457.90
Rate for Payer: Wellpoint Medicaid Managed Care	$503.50

LAPIPLASTY KIT SK341-SD211-SD2

Facility

$19,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270697469
Hospital Revenue Code	278
Min. Negotiated Rate	$2,850.00
Max. Negotiated Rate	$4,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,598.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,180.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,850.00

LAPIPLASTY MINI SYSTEM SK30

Facility

$27,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270694873
Hospital Revenue Code	278
Min. Negotiated Rate	$4,121.25
Max. Negotiated Rate	$6,648.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,648.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,044.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,121.25

LAPIPLASTY MINI SYSTEM SK30

Facility

$27,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270694873
Hospital Revenue Code	278
Min. Negotiated Rate	$662.15
Max. Negotiated Rate	$13,737.50
Rate for Payer: Aetna Commercial	$10,440.50
Rate for Payer: Aetna Medicare Advantage	$8,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,006.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,006.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,006.12
Rate for Payer: Cigna Commercial	$13,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,648.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,044.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,121.25
Rate for Payer: UnitedHealthcare Community & State	$662.15
Rate for Payer: Wellpoint Medicaid Managed Care	$728.09

LAPIPLASTY SAW BLADE 40MM X 11

Facility

$725.00

Hospital Charge Code	270690887
Hospital Revenue Code	272
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.50
Rate for Payer: Oxford Commercial	$145.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Commercial	$145.00
Rate for Payer: UnitedHealthcare Community & State	$17.47
Rate for Payer: Wellpoint Medicaid Managed Care	$19.21

LAPIPLASTY SAW BLADE 40MM X 11

Facility

$725.00

Hospital Charge Code	270690887
Hospital Revenue Code	272
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$108.75
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

LAPIPLASTY SELECT ANATOMIC

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270701275
Hospital Revenue Code	278
Min. Negotiated Rate	$331.38
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$5,225.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50
Rate for Payer: UnitedHealthcare Community & State	$331.38
Rate for Payer: Wellpoint Medicaid Managed Care	$364.38

LAPIPLASTY SELECT ANATOMIC

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270701275
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

LAPIPLASTY SPEEDPLATE

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270700315
Hospital Revenue Code	278
Min. Negotiated Rate	$2,530.50
Max. Negotiated Rate	$4,082.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,711.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50

LAPIPLASTY SPEEDPLATE

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270700315
Hospital Revenue Code	278
Min. Negotiated Rate	$406.57
Max. Negotiated Rate	$8,435.00
Rate for Payer: Aetna Commercial	$6,410.60
Rate for Payer: Aetna Medicare Advantage	$5,061.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,301.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,301.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,301.85
Rate for Payer: Cigna Commercial	$8,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,711.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50
Rate for Payer: UnitedHealthcare Community & State	$406.57
Rate for Payer: Wellpoint Medicaid Managed Care	$447.06

LAPIPLASTY SPEEDPLATE KIT 18X1

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270699935
Hospital Revenue Code	278
Min. Negotiated Rate	$406.57
Max. Negotiated Rate	$8,435.00
Rate for Payer: Aetna Commercial	$6,410.60
Rate for Payer: Aetna Medicare Advantage	$5,061.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,301.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,301.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,301.85
Rate for Payer: Cigna Commercial	$8,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,711.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50
Rate for Payer: UnitedHealthcare Community & State	$406.57
Rate for Payer: Wellpoint Medicaid Managed Care	$447.06

LAPIPLASTY SPEEDPLATE KIT 18X1

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270699935
Hospital Revenue Code	278
Min. Negotiated Rate	$2,530.50
Max. Negotiated Rate	$4,082.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,711.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50

LAPIPLASTY SPEEDPLATE QUAD

Facility

$18,120.00

Hospital Charge Code	270701879
Hospital Revenue Code	278
Min. Negotiated Rate	$436.69
Max. Negotiated Rate	$9,060.00
Rate for Payer: Aetna Commercial	$6,885.60
Rate for Payer: Aetna Medicare Advantage	$5,436.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,620.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,620.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,624.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,620.60
Rate for Payer: Cigna Commercial	$9,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,385.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,986.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.00
Rate for Payer: UnitedHealthcare Community & State	$436.69
Rate for Payer: Wellpoint Medicaid Managed Care	$480.18

LAPIPLASTY SPEEDPLATE QUAD

Facility

$18,120.00

Hospital Charge Code	270701879
Hospital Revenue Code	278
Min. Negotiated Rate	$2,718.00
Max. Negotiated Rate	$4,385.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,624.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,385.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,986.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.00

LAPIPLASTY SPEED PLATE SQUAD

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270699211
Hospital Revenue Code	278
Min. Negotiated Rate	$2,530.50
Max. Negotiated Rate	$4,082.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,711.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50

LAPIPLASTY SPEED PLATE SQUAD

Facility

$16,870.00

Service Code	HCPCS C1713
Hospital Charge Code	270699211
Hospital Revenue Code	278
Min. Negotiated Rate	$406.57
Max. Negotiated Rate	$8,435.00
Rate for Payer: Aetna Commercial	$6,410.60
Rate for Payer: Aetna Medicare Advantage	$5,061.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,301.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,301.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,301.85
Rate for Payer: Cigna Commercial	$8,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,082.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,711.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,530.50
Rate for Payer: UnitedHealthcare Community & State	$406.57
Rate for Payer: Wellpoint Medicaid Managed Care	$447.06

LAPIPLASTY SPEED PLT QUAD SK50

Facility

$18,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270700151
Hospital Revenue Code	278
Min. Negotiated Rate	$2,718.00
Max. Negotiated Rate	$4,385.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,624.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,385.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,986.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.00

LAPIPLASTY SPEED PLT QUAD SK50

Facility

$18,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270700151
Hospital Revenue Code	278
Min. Negotiated Rate	$436.69
Max. Negotiated Rate	$9,060.00
Rate for Payer: Aetna Commercial	$6,885.60
Rate for Payer: Aetna Medicare Advantage	$5,436.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,620.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,620.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,624.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,620.60
Rate for Payer: Cigna Commercial	$9,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,385.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,986.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.00
Rate for Payer: UnitedHealthcare Community & State	$436.69
Rate for Payer: Wellpoint Medicaid Managed Care	$480.18

LAPIPLASTY SYSTEM2 PLT 3.9MM

Facility

$27,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270690865
Hospital Revenue Code	278
Min. Negotiated Rate	$4,121.25
Max. Negotiated Rate	$6,648.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,648.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,044.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,121.25

LAPIPLASTY SYSTEM2 PLT 3.9MM

Facility

$27,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270690865
Hospital Revenue Code	278
Min. Negotiated Rate	$662.15
Max. Negotiated Rate	$13,737.50
Rate for Payer: Aetna Commercial	$10,440.50
Rate for Payer: Aetna Medicare Advantage	$8,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,006.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,006.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,006.12
Rate for Payer: Cigna Commercial	$13,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,648.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,044.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,121.25
Rate for Payer: UnitedHealthcare Community & State	$662.15
Rate for Payer: Wellpoint Medicaid Managed Care	$728.09

LAPIPLASTY SYSTEM 3R SK23

Facility

$37,470.00

Service Code	HCPCS C1713
Hospital Charge Code	270697749
Hospital Revenue Code	278
Min. Negotiated Rate	$903.03
Max. Negotiated Rate	$18,735.00
Rate for Payer: Aetna Commercial	$14,238.60
Rate for Payer: Aetna Medicare Advantage	$11,241.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,554.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,554.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,494.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,554.85
Rate for Payer: Cigna Commercial	$18,735.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,067.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,243.40
Rate for Payer: Qualcare PPO/HMO/WC	$5,620.50
Rate for Payer: UnitedHealthcare Community & State	$903.03
Rate for Payer: Wellpoint Medicaid Managed Care	$992.96

Know your out-of-pocket cost for care.

All Charges