Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LOCALIZATION NEEDLE HARDWIRE 2

Facility

$140.00

Service Code	HCPCS A4648
Hospital Charge Code	270665151
Hospital Revenue Code	278
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.80
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

LOCALIZATION NEEDLE HARDWIRE 2

Facility

$140.00

Service Code	HCPCS A4648
Hospital Charge Code	270665151
Hospital Revenue Code	278
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.80
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Community & State	$3.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.71

LOCAL KIT

Facility

$46.00

Hospital Charge Code	270338745
Hospital Revenue Code	272
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$23.00
Rate for Payer: Aetna Commercial	$17.48
Rate for Payer: Aetna Medicare Advantage	$13.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.73
Rate for Payer: Cigna Commercial	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.80
Rate for Payer: Oxford Commercial	$9.20
Rate for Payer: Qualcare PPO/HMO/WC	$6.90
Rate for Payer: UnitedHealthcare Commercial	$9.20
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

LOCAL KIT

Facility

$46.00

Hospital Charge Code	270338745
Hospital Revenue Code	272
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.90

LOCING PLATE

Facility

$3,615.00

Hospital Charge Code	270660696
Hospital Revenue Code	278
Min. Negotiated Rate	$542.25
Max. Negotiated Rate	$874.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$723.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$874.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$795.30
Rate for Payer: Qualcare PPO/HMO/WC	$542.25

LOCING PLATE

Facility

$3,615.00

Hospital Charge Code	270660696
Hospital Revenue Code	278
Min. Negotiated Rate	$87.12
Max. Negotiated Rate	$1,807.50
Rate for Payer: Aetna Commercial	$1,373.70
Rate for Payer: Aetna Medicare Advantage	$1,084.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$921.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$921.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$723.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$921.83
Rate for Payer: Cigna Commercial	$1,807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$874.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$795.30
Rate for Payer: Qualcare PPO/HMO/WC	$542.25
Rate for Payer: UnitedHealthcare Community & State	$87.12
Rate for Payer: Wellpoint Medicaid Managed Care	$95.80

LOCK ASSEMBLY OXYGEN PERCENT

Facility

$4.85

Hospital Charge Code	270636626
Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.84
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

LOCK ASSEMBLY OXYGEN PERCENT

Facility

$4.85

Hospital Charge Code	270636626
Hospital Revenue Code	270
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

LOCK CAPS

Facility

$1,735.00

Hospital Charge Code	270657311
Hospital Revenue Code	278
Min. Negotiated Rate	$260.25
Max. Negotiated Rate	$419.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$347.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$419.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$381.70
Rate for Payer: Qualcare PPO/HMO/WC	$260.25

LOCK CAPS

Facility

$1,735.00

Hospital Charge Code	270657311
Hospital Revenue Code	278
Min. Negotiated Rate	$41.81
Max. Negotiated Rate	$867.50
Rate for Payer: Aetna Commercial	$659.30
Rate for Payer: Aetna Medicare Advantage	$520.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$442.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$442.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$347.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$442.43
Rate for Payer: Cigna Commercial	$867.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$419.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$381.70
Rate for Payer: Qualcare PPO/HMO/WC	$260.25
Rate for Payer: UnitedHealthcare Community & State	$41.81
Rate for Payer: Wellpoint Medicaid Managed Care	$45.98

LOCK DIST FIBULA PLT SS RT 6H

Facility

$3,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270663095
Hospital Revenue Code	278
Min. Negotiated Rate	$543.75
Max. Negotiated Rate	$877.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$797.50
Rate for Payer: Qualcare PPO/HMO/WC	$543.75

LOCK DIST FIBULA PLT SS RT 6H

Facility

$3,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270663095
Hospital Revenue Code	278
Min. Negotiated Rate	$87.36
Max. Negotiated Rate	$1,812.50
Rate for Payer: Aetna Commercial	$1,377.50
Rate for Payer: Aetna Medicare Advantage	$1,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$924.38
Rate for Payer: Cigna Commercial	$1,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$797.50
Rate for Payer: Qualcare PPO/HMO/WC	$543.75
Rate for Payer: UnitedHealthcare Community & State	$87.36
Rate for Payer: Wellpoint Medicaid Managed Care	$96.06

LOCKG. SCRW FULLTHRD 6 X 35MM

Facility

$1,320.00

Hospital Charge Code	270656532
Hospital Revenue Code	278
Min. Negotiated Rate	$31.81
Max. Negotiated Rate	$660.00
Rate for Payer: Aetna Commercial	$501.60
Rate for Payer: Aetna Medicare Advantage	$396.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$336.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$336.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$336.60
Rate for Payer: Cigna Commercial	$660.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$319.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$198.00
Rate for Payer: UnitedHealthcare Community & State	$31.81
Rate for Payer: Wellpoint Medicaid Managed Care	$34.98

LOCKG. SCRW FULLTHRD 6 X 35MM

Facility

$1,320.00

Hospital Charge Code	270656532
Hospital Revenue Code	278
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$319.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$319.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$198.00

LOCK IMPLANT SYS TENOESIS CONV

Facility

$975.00

Hospital Charge Code	270676732
Hospital Revenue Code	272
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$146.25
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

LOCK IMPLANT SYS TENOESIS CONV

Facility

$975.00

Hospital Charge Code	270676732
Hospital Revenue Code	272
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$370.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Commercial	$195.00
Rate for Payer: UnitedHealthcare Community & State	$23.50
Rate for Payer: Wellpoint Medicaid Managed Care	$25.84

LOCKING CAPS

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270704008
Hospital Revenue Code	278
Min. Negotiated Rate	$12.53
Max. Negotiated Rate	$260.00
Rate for Payer: Aetna Commercial	$197.60
Rate for Payer: Aetna Medicare Advantage	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.60
Rate for Payer: Cigna Commercial	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.40
Rate for Payer: Qualcare PPO/HMO/WC	$78.00
Rate for Payer: UnitedHealthcare Community & State	$12.53
Rate for Payer: Wellpoint Medicaid Managed Care	$13.78

LOCKING CAPS

Facility

$475.00

Service Code	HCPCS C1713
Hospital Charge Code	270705830
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

LOCKING CAPS

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270699243
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

LOCKING CAPS

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270704008
Hospital Revenue Code	278
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$125.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.40
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

LOCKING CAPS

Facility

$400.00

Service Code	HCPCS C1713
Hospital Charge Code	270705531
Hospital Revenue Code	278
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$96.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$88.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

LOCKING CAPS

Facility

$400.00

Service Code	HCPCS C1713
Hospital Charge Code	270705531
Hospital Revenue Code	278
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$88.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: Wellpoint Medicaid Managed Care	$10.60

LOCKING CAPS

Facility

$475.00

Service Code	HCPCS C1713
Hospital Charge Code	270705830
Hospital Revenue Code	278
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

LOCKING CAPS

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270699243
Hospital Revenue Code	278
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

LOCKING CAPS SET SCREW

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270697898
Hospital Revenue Code	278
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

Know your out-of-pocket cost for care.

All Charges