Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MTMS BY PHARM EST 15 MIN

Facility

$260.00

Service Code	HCPCS 99605
Hospital Charge Code	6063943374
Hospital Revenue Code	250
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

MTMS BY PHARM EST 15 MIN

Facility

$260.00

Service Code	HCPCS 99605
Hospital Charge Code	6063943374
Hospital Revenue Code	250
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna Medicare Advantage	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.30
Rate for Payer: Cigna Commercial	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.00
Rate for Payer: Oxford Commercial	$52.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Commercial	$52.00
Rate for Payer: UnitedHealthcare Community & State	$6.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.89

MT MULTIPL FOR CAVUS FOOT

Facility

$6,573.95

Service Code	HCPCS 28309
Hospital Charge Code	16000724
Hospital Revenue Code	360
Min. Negotiated Rate	$986.09
Max. Negotiated Rate	$986.09
Rate for Payer: Qualcare PPO/HMO/WC	$986.09

MT MULTIPL FOR CAVUS FOOT

Facility

$6,573.95

Service Code	HCPCS 28309
Hospital Charge Code	16000724
Hospital Revenue Code	360
Min. Negotiated Rate	$158.43
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,972.18
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$986.09
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$158.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$174.21

MTP CE ARTICULAR 15X2.5X3.5MM

Facility

$15,030.00

Service Code	HCPCS L8641
Hospital Charge Code	270693567
Hospital Revenue Code	278
Min. Negotiated Rate	$2,254.50
Max. Negotiated Rate	$3,637.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,006.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,637.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,306.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,254.50

MTP CE ARTICULAR 15X2.5X3.5MM

Facility

$15,030.00

Service Code	HCPCS L8641
Hospital Charge Code	270693567
Hospital Revenue Code	278
Min. Negotiated Rate	$362.22
Max. Negotiated Rate	$7,515.00
Rate for Payer: Aetna Commercial	$5,711.40
Rate for Payer: Aetna Medicare Advantage	$4,509.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,832.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,832.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,006.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,832.65
Rate for Payer: Cigna Commercial	$7,515.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,637.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,306.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,254.50
Rate for Payer: UnitedHealthcare Community & State	$362.22
Rate for Payer: Wellpoint Medicaid Managed Care	$398.30

MTP CE POST TAPER 7.0MMX13MM

Facility

$2,580.00

Service Code	HCPCS L8641
Hospital Charge Code	270693287
Hospital Revenue Code	278
Min. Negotiated Rate	$62.18
Max. Negotiated Rate	$1,290.00
Rate for Payer: Aetna Commercial	$980.40
Rate for Payer: Aetna Medicare Advantage	$774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$657.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$657.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$657.90
Rate for Payer: Cigna Commercial	$1,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$567.60
Rate for Payer: Qualcare PPO/HMO/WC	$387.00
Rate for Payer: UnitedHealthcare Community & State	$62.18
Rate for Payer: Wellpoint Medicaid Managed Care	$68.37

MTP CE POST TAPER 7.0MMX13MM

Facility

$2,580.00

Service Code	HCPCS L8641
Hospital Charge Code	270693287
Hospital Revenue Code	278
Min. Negotiated Rate	$387.00
Max. Negotiated Rate	$624.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$624.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$567.60
Rate for Payer: Qualcare PPO/HMO/WC	$387.00

MTP DISC 19X15MM

Facility

$13,825.00

Hospital Charge Code	270702446
Hospital Revenue Code	278
Min. Negotiated Rate	$333.18
Max. Negotiated Rate	$6,912.50
Rate for Payer: Aetna Commercial	$5,253.50
Rate for Payer: Aetna Medicare Advantage	$4,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,525.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,525.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,525.38
Rate for Payer: Cigna Commercial	$6,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,345.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,041.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,073.75
Rate for Payer: UnitedHealthcare Community & State	$333.18
Rate for Payer: Wellpoint Medicaid Managed Care	$366.36

MTP DISC 19X15MM

Facility

$13,825.00

Hospital Charge Code	270702446
Hospital Revenue Code	278
Min. Negotiated Rate	$2,073.75
Max. Negotiated Rate	$3,345.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,345.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,041.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,073.75

MTP JNT CAPSULOTOMY EA SGL JNT

Facility

$19,998.60

Service Code	HCPCS 28270
Hospital Charge Code	16000202
Hospital Revenue Code	360
Min. Negotiated Rate	$481.97
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	$1,355.00
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	$5,999.58
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$481.97
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	$529.96

MTP JNT CAPSULOTOMY EA SGL JNT

Facility

$19,998.60

Service Code	HCPCS 28270
Hospital Charge Code	16000202
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

MTP JT 12MM ART COMP 2.0X3.0MM

Facility

$13,070.00

Service Code	HCPCS L8641
Hospital Charge Code	270693288
Hospital Revenue Code	278
Min. Negotiated Rate	$1,960.50
Max. Negotiated Rate	$3,162.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,614.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,162.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,875.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,960.50

MTP JT 12MM ART COMP 2.0X3.0MM

Facility

$13,070.00

Service Code	HCPCS L8641
Hospital Charge Code	270693288
Hospital Revenue Code	278
Min. Negotiated Rate	$314.99
Max. Negotiated Rate	$6,535.00
Rate for Payer: Aetna Commercial	$4,966.60
Rate for Payer: Aetna Medicare Advantage	$3,921.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,332.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,332.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,614.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,332.85
Rate for Payer: Cigna Commercial	$6,535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,162.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,875.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,960.50
Rate for Payer: UnitedHealthcare Community & State	$314.99
Rate for Payer: Wellpoint Medicaid Managed Care	$346.36

MTP PLATE 0 DEG MED RT

Facility

$6,503.75

Hospital Charge Code	270702192
Hospital Revenue Code	278
Min. Negotiated Rate	$156.74
Max. Negotiated Rate	$3,251.88
Rate for Payer: Aetna Commercial	$2,471.43
Rate for Payer: Aetna Medicare Advantage	$1,951.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,658.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,658.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,658.46
Rate for Payer: Cigna Commercial	$3,251.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.83
Rate for Payer: Qualcare PPO/HMO/WC	$975.56
Rate for Payer: UnitedHealthcare Community & State	$156.74
Rate for Payer: Wellpoint Medicaid Managed Care	$172.35

MTP PLATE 0 DEG MED RT

Facility

$6,503.75

Hospital Charge Code	270702192
Hospital Revenue Code	278
Min. Negotiated Rate	$975.56
Max. Negotiated Rate	$1,573.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.83
Rate for Payer: Qualcare PPO/HMO/WC	$975.56

MTP PLATE 5 DEG REV MED LT

Facility

$8,315.00

Service Code	HCPCS C1713
Hospital Charge Code	270702740
Hospital Revenue Code	278
Min. Negotiated Rate	$1,247.25
Max. Negotiated Rate	$2,012.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,663.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,012.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,829.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,247.25

MTP PLATE 5 DEG REV MED LT

Facility

$8,315.00

Service Code	HCPCS C1713
Hospital Charge Code	270702740
Hospital Revenue Code	278
Min. Negotiated Rate	$200.39
Max. Negotiated Rate	$4,157.50
Rate for Payer: Aetna Commercial	$3,159.70
Rate for Payer: Aetna Medicare Advantage	$2,494.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,120.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,120.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,663.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,120.32
Rate for Payer: Cigna Commercial	$4,157.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,012.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,829.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,247.25
Rate for Payer: UnitedHealthcare Community & State	$200.39
Rate for Payer: Wellpoint Medicaid Managed Care	$220.35

MTP PLATE, 5, LG, LT

Facility

$6,503.75

Hospital Charge Code	270702427
Hospital Revenue Code	278
Min. Negotiated Rate	$975.56
Max. Negotiated Rate	$1,573.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.83
Rate for Payer: Qualcare PPO/HMO/WC	$975.56

MTP PLATE, 5, LG, LT

Facility

$6,503.75

Hospital Charge Code	270702427
Hospital Revenue Code	278
Min. Negotiated Rate	$156.74
Max. Negotiated Rate	$3,251.88
Rate for Payer: Aetna Commercial	$2,471.43
Rate for Payer: Aetna Medicare Advantage	$1,951.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,658.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,658.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,658.46
Rate for Payer: Cigna Commercial	$3,251.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.83
Rate for Payer: Qualcare PPO/HMO/WC	$975.56
Rate for Payer: UnitedHealthcare Community & State	$156.74
Rate for Payer: Wellpoint Medicaid Managed Care	$172.35

MTP SPIN GRD FML REAMER 19MM

Facility

$1,657.50

Hospital Charge Code	270702428
Hospital Revenue Code	272
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$828.75
Rate for Payer: Aetna Commercial	$629.85
Rate for Payer: Aetna Medicare Advantage	$497.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$422.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$422.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$422.66
Rate for Payer: Cigna Commercial	$828.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$497.25
Rate for Payer: Oxford Commercial	$331.50
Rate for Payer: Qualcare PPO/HMO/WC	$248.62
Rate for Payer: UnitedHealthcare Commercial	$331.50
Rate for Payer: UnitedHealthcare Community & State	$39.95
Rate for Payer: Wellpoint Medicaid Managed Care	$43.92

MTP SPIN GRD FML REAMER 19MM

Facility

$1,657.50

Hospital Charge Code	270702428
Hospital Revenue Code	272
Min. Negotiated Rate	$248.62
Max. Negotiated Rate	$248.62
Rate for Payer: Qualcare PPO/HMO/WC	$248.62

MTP SPIN GRD MALE REAMER 19MM

Facility

$1,657.50

Hospital Charge Code	270702195
Hospital Revenue Code	272
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$828.75
Rate for Payer: Aetna Commercial	$629.85
Rate for Payer: Aetna Medicare Advantage	$497.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$422.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$422.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$422.66
Rate for Payer: Cigna Commercial	$828.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$497.25
Rate for Payer: Oxford Commercial	$331.50
Rate for Payer: Qualcare PPO/HMO/WC	$248.62
Rate for Payer: UnitedHealthcare Commercial	$331.50
Rate for Payer: UnitedHealthcare Community & State	$39.95
Rate for Payer: Wellpoint Medicaid Managed Care	$43.92

MTP SPIN GRD MALE REAMER 19MM

Facility

$1,657.50

Hospital Charge Code	270702195
Hospital Revenue Code	272
Min. Negotiated Rate	$248.62
Max. Negotiated Rate	$248.62
Rate for Payer: Qualcare PPO/HMO/WC	$248.62

MT SHORTEN,1ST MT W ALLOGR LT

Facility

$19,998.60

Service Code	HCPCS 28307
Hospital Charge Code	16000907
Hospital Revenue Code	360
Min. Negotiated Rate	$481.97
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,999.58
Rate for Payer: Oxford Commercial	$4,871.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$8,157.00
Rate for Payer: UnitedHealthcare Community & State	$481.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$529.96

Know your out-of-pocket cost for care.

All Charges