Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ARTHRSCP WRIST,TRNSV CARP LIG

Facility

$32,775.00

Service Code	HCPCS 29848
Hospital Charge Code	16000332
Hospital Revenue Code	360
Min. Negotiated Rate	$4,916.25
Max. Negotiated Rate	$4,916.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,916.25

ARTHRSCP WRIST,TRNSV CARP LIG

Facility

$32,775.00

Service Code	HCPCS 29848
Hospital Charge Code	16000332
Hospital Revenue Code	360
Min. Negotiated Rate	$318.43
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,895.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
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	$6,895.75
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,832.50
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,916.25
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$789.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$324.80
Rate for Payer: Wellpoint Medicaid Managed Care	$318.43

ARTHRT ANKLE W SYNVCT, W TENSY

Facility

$30,651.00

Service Code	HCPCS 27626
Hospital Charge Code	16000625
Hospital Revenue Code	360
Min. Negotiated Rate	$4,597.65
Max. Negotiated Rate	$4,597.65
Rate for Payer: Qualcare PPO/HMO/WC	$4,597.65

ARTHRT ANKLE W SYNVCT, W TENSY

Facility

$30,651.00

Service Code	HCPCS 27626
Hospital Charge Code	16000625
Hospital Revenue Code	360
Min. Negotiated Rate	$738.69
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	$1,626.00
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	$9,195.30
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,597.65
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$738.69
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	$812.25

ARTIC GEL PAD LARGE 317-09

Facility

$1,150.00

Hospital Charge Code	270639525
Hospital Revenue Code	272
Min. Negotiated Rate	$27.71
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$437.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$345.00
Rate for Payer: Oxford Commercial	$230.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Commercial	$230.00
Rate for Payer: UnitedHealthcare Community & State	$27.71
Rate for Payer: Wellpoint Medicaid Managed Care	$30.48

ARTIC GEL PAD LARGE 317-09

Facility

$1,150.00

Hospital Charge Code	270639525
Hospital Revenue Code	272
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

ARTIC GEL PAD MEDIUM 317-07

Facility

$1,150.00

Hospital Charge Code	270639524
Hospital Revenue Code	272
Min. Negotiated Rate	$27.71
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$437.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$345.00
Rate for Payer: Oxford Commercial	$230.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Commercial	$230.00
Rate for Payer: UnitedHealthcare Community & State	$27.71
Rate for Payer: Wellpoint Medicaid Managed Care	$30.48

ARTIC GEL PAD MEDIUM 317-07

Facility

$1,150.00

Hospital Charge Code	270639524
Hospital Revenue Code	272
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

ARTICLR SURFACE 10 90597004010

Facility

$4,964.55

Hospital Charge Code	270638400
Hospital Revenue Code	270
Min. Negotiated Rate	$119.65
Max. Negotiated Rate	$2,482.28
Rate for Payer: Aetna Commercial	$1,886.53
Rate for Payer: Aetna Medicare Advantage	$1,489.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,265.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,265.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,265.96
Rate for Payer: Cigna Commercial	$2,482.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,489.37
Rate for Payer: Oxford Commercial	$992.91
Rate for Payer: Qualcare PPO/HMO/WC	$744.68
Rate for Payer: UnitedHealthcare Commercial	$992.91
Rate for Payer: UnitedHealthcare Community & State	$119.65
Rate for Payer: Wellpoint Medicaid Managed Care	$131.56

ARTICLR SURFACE 10 90597004010

Facility

$4,964.55

Hospital Charge Code	270638400
Hospital Revenue Code	270
Min. Negotiated Rate	$744.68
Max. Negotiated Rate	$744.68
Rate for Payer: Qualcare PPO/HMO/WC	$744.68

ARTIC SU 10 C-H/3-4 9059703010

Facility

$4,964.60

Hospital Charge Code	270638275
Hospital Revenue Code	270
Min. Negotiated Rate	$744.69
Max. Negotiated Rate	$744.69
Rate for Payer: Qualcare PPO/HMO/WC	$744.69

ARTIC SU 10 C-H/3-4 9059703010

Facility

$4,964.60

Hospital Charge Code	270638275
Hospital Revenue Code	270
Min. Negotiated Rate	$119.65
Max. Negotiated Rate	$2,482.30
Rate for Payer: Aetna Commercial	$1,886.55
Rate for Payer: Aetna Medicare Advantage	$1,489.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,265.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,265.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,265.97
Rate for Payer: Cigna Commercial	$2,482.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,489.38
Rate for Payer: Oxford Commercial	$992.92
Rate for Payer: Qualcare PPO/HMO/WC	$744.69
Rate for Payer: UnitedHealthcare Commercial	$992.92
Rate for Payer: UnitedHealthcare Community & State	$119.65
Rate for Payer: Wellpoint Medicaid Managed Care	$131.56

ARTIC SURFACE CCK 12MMH RIGHT

Facility

$19,975.55

Service Code	HCPCS C1713
Hospital Charge Code	270705528
Hospital Revenue Code	278
Min. Negotiated Rate	$2,996.33
Max. Negotiated Rate	$4,834.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,995.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,834.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,394.62
Rate for Payer: Qualcare PPO/HMO/WC	$2,996.33

ARTIC SURFACE CCK 12MMH RIGHT

Facility

$19,975.55

Service Code	HCPCS C1713
Hospital Charge Code	270705528
Hospital Revenue Code	278
Min. Negotiated Rate	$481.41
Max. Negotiated Rate	$9,987.77
Rate for Payer: Aetna Commercial	$7,590.71
Rate for Payer: Aetna Medicare Advantage	$5,992.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,093.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,093.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,995.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,093.77
Rate for Payer: Cigna Commercial	$9,987.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,834.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,394.62
Rate for Payer: Qualcare PPO/HMO/WC	$2,996.33
Rate for Payer: UnitedHealthcare Community & State	$481.41
Rate for Payer: Wellpoint Medicaid Managed Care	$529.35

ARTICULAR SURFACE 12MM RT 6-9

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270686535
Hospital Revenue Code	278
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) NJ Health	$750.00
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	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

ARTICULAR SURFACE 12MM RT 6-9

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270686535
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

ARTICULAR SURFACE FIXED

Facility

$5,860.00

Hospital Charge Code	270658851
Hospital Revenue Code	278
Min. Negotiated Rate	$879.00
Max. Negotiated Rate	$1,418.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.20
Rate for Payer: Qualcare PPO/HMO/WC	$879.00

ARTICULAR SURFACE FIXED

Facility

$5,862.10

Hospital Charge Code	270656972
Hospital Revenue Code	278
Min. Negotiated Rate	$141.28
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$141.28
Rate for Payer: Wellpoint Medicaid Managed Care	$155.35

ARTICULAR SURFACE FIXED

Facility

$5,860.00

Hospital Charge Code	270658861
Hospital Revenue Code	278
Min. Negotiated Rate	$141.23
Max. Negotiated Rate	$2,930.00
Rate for Payer: Aetna Commercial	$2,226.80
Rate for Payer: Aetna Medicare Advantage	$1,758.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.30
Rate for Payer: Cigna Commercial	$2,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.20
Rate for Payer: Qualcare PPO/HMO/WC	$879.00
Rate for Payer: UnitedHealthcare Community & State	$141.23
Rate for Payer: Wellpoint Medicaid Managed Care	$155.29

ARTICULAR SURFACE FIXED

Facility

$5,862.10

Hospital Charge Code	270656972
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

ARTICULAR SURFACE FIXED

Facility

$5,860.00

Hospital Charge Code	270658861
Hospital Revenue Code	278
Min. Negotiated Rate	$879.00
Max. Negotiated Rate	$1,418.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.20
Rate for Payer: Qualcare PPO/HMO/WC	$879.00

ARTICULAR SURFACE FIXED

Facility

$5,860.00

Hospital Charge Code	270658851
Hospital Revenue Code	278
Min. Negotiated Rate	$141.23
Max. Negotiated Rate	$2,930.00
Rate for Payer: Aetna Commercial	$2,226.80
Rate for Payer: Aetna Medicare Advantage	$1,758.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.30
Rate for Payer: Cigna Commercial	$2,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.20
Rate for Payer: Qualcare PPO/HMO/WC	$879.00
Rate for Payer: UnitedHealthcare Community & State	$141.23
Rate for Payer: Wellpoint Medicaid Managed Care	$155.29

ARTICULAR SURFACE POLYETHYLENE

Facility

$5,862.10

Hospital Charge Code	270657833
Hospital Revenue Code	278
Min. Negotiated Rate	$141.28
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$141.28
Rate for Payer: Wellpoint Medicaid Managed Care	$155.35

ARTICULAR SURFACE POLYETHYLENE

Facility

$5,862.10

Hospital Charge Code	270657833
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

ARTICULAR SUR SZ3,8MM 58422308

Facility

$2,868.15

Hospital Charge Code	270635700
Hospital Revenue Code	270
Min. Negotiated Rate	$430.22
Max. Negotiated Rate	$430.22
Rate for Payer: Qualcare PPO/HMO/WC	$430.22

Know your out-of-pocket cost for care.

All Charges