Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

NCB LOCKING SCREW CAP

Facility

$637.50

Service Code	HCPCS C1713
Hospital Charge Code	270679963
Hospital Revenue Code	278
Min. Negotiated Rate	$95.62
Max. Negotiated Rate	$154.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$140.25
Rate for Payer: Qualcare PPO/HMO/WC	$95.62

NCB PP PROX FEM PLT R,L 245MM

Facility

$5,482.50

Service Code	HCPCS C1713
Hospital Charge Code	270679955
Hospital Revenue Code	278
Min. Negotiated Rate	$132.13
Max. Negotiated Rate	$2,741.25
Rate for Payer: Aetna Commercial	$2,083.35
Rate for Payer: Aetna Medicare Advantage	$1,644.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,398.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,398.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,096.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,398.04
Rate for Payer: Cigna Commercial	$2,741.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,206.15
Rate for Payer: Qualcare PPO/HMO/WC	$822.38
Rate for Payer: UnitedHealthcare Community & State	$132.13
Rate for Payer: Wellpoint Medicaid Managed Care	$145.29

NCB PP PROX FEM PLT R,L 245MM

Facility

$5,482.50

Service Code	HCPCS C1713
Hospital Charge Code	270679955
Hospital Revenue Code	278
Min. Negotiated Rate	$822.38
Max. Negotiated Rate	$1,326.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,096.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,206.15
Rate for Payer: Qualcare PPO/HMO/WC	$822.38

NCB SCR 5.0 L = 90MM

Facility

$1,223.40

Service Code	HCPCS C1713
Hospital Charge Code	270704137
Hospital Revenue Code	278
Min. Negotiated Rate	$183.51
Max. Negotiated Rate	$296.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$269.15
Rate for Payer: Qualcare PPO/HMO/WC	$183.51

NCB SCR 5.0 L = 90MM

Facility

$1,223.40

Service Code	HCPCS C1713
Hospital Charge Code	270704137
Hospital Revenue Code	278
Min. Negotiated Rate	$29.48
Max. Negotiated Rate	$611.70
Rate for Payer: Aetna Commercial	$464.89
Rate for Payer: Aetna Medicare Advantage	$367.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$311.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$311.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$311.97
Rate for Payer: Cigna Commercial	$611.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$269.15
Rate for Payer: Qualcare PPO/HMO/WC	$183.51
Rate for Payer: UnitedHealthcare Community & State	$29.48
Rate for Payer: Wellpoint Medicaid Managed Care	$32.42

NCB TROC PLATE RIGHT NARROW

Facility

$4,054.50

Service Code	HCPCS C1713
Hospital Charge Code	270679954
Hospital Revenue Code	278
Min. Negotiated Rate	$608.17
Max. Negotiated Rate	$981.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$810.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$981.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$891.99
Rate for Payer: Qualcare PPO/HMO/WC	$608.17

NCB TROC PLATE RIGHT NARROW

Facility

$4,054.50

Service Code	HCPCS C1713
Hospital Charge Code	270679954
Hospital Revenue Code	278
Min. Negotiated Rate	$97.71
Max. Negotiated Rate	$2,027.25
Rate for Payer: Aetna Commercial	$1,540.71
Rate for Payer: Aetna Medicare Advantage	$1,216.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,033.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,033.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$810.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,033.90
Rate for Payer: Cigna Commercial	$2,027.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$981.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$891.99
Rate for Payer: Qualcare PPO/HMO/WC	$608.17
Rate for Payer: UnitedHealthcare Community & State	$97.71
Rate for Payer: Wellpoint Medicaid Managed Care	$107.44

NC NEO TREK RX 1.50 X 15

Facility

$500.00

Hospital Charge Code	270704282
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC NEO TREK RX 1.50 X 15

Facility

$500.00

Hospital Charge Code	270704282
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

NC TREK NEO RX

Facility

$500.00

Hospital Charge Code	270705316
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

NC TREK NEO RX

Facility

$500.00

Hospital Charge Code	270705316
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 1.50 X 12

Facility

$500.00

Hospital Charge Code	270704281
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 1.50 X 12

Facility

$500.00

Hospital Charge Code	270704281
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

NC TREK NEO RX 1.50 X 20

Facility

$500.00

Hospital Charge Code	270704283
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 1.50 X 20

Facility

$500.00

Hospital Charge Code	270704283
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

NC TREK NEO RX 1.50X6

Facility

$500.00

Hospital Charge Code	270704278
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

NC TREK NEO RX 1.50X6

Facility

$500.00

Hospital Charge Code	270704278
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 1.50 X 8

Facility

$500.00

Hospital Charge Code	270704280
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 1.50 X 8

Facility

$500.00

Hospital Charge Code	270704280
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

NC TREK NEO RX 2.00 X 12

Facility

$500.00

Hospital Charge Code	270704291
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

NC TREK NEO RX 2.00 X 12

Facility

$500.00

Hospital Charge Code	270704291
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 2.00 X 15

Facility

$500.00

Hospital Charge Code	270704292
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 2.00 X 15

Facility

$500.00

Hospital Charge Code	270704292
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

NC TREK NEO RX 2.00 X 20

Facility

$500.00

Hospital Charge Code	270704293
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 2.00 X 20

Facility

$500.00

Hospital Charge Code	270704293
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

Know your out-of-pocket cost for care.

All Charges