Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OSTEOSURGE BN MATRIX SYR10CC

Facility

$18,650.00

Service Code	HCPCS C1713
Hospital Charge Code	270672817
Hospital Revenue Code	278
Min. Negotiated Rate	$449.46
Max. Negotiated Rate	$9,325.00
Rate for Payer: Aetna Commercial	$7,087.00
Rate for Payer: Aetna Medicare Advantage	$5,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,755.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,755.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,730.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,755.75
Rate for Payer: Cigna Commercial	$9,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,513.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,103.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,797.50
Rate for Payer: UnitedHealthcare Community & State	$449.46
Rate for Payer: Wellpoint Medicaid Managed Care	$494.23

OSTEOSURGE BONE MATRIX 300CC

Facility

$4,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270694774
Hospital Revenue Code	278
Min. Negotiated Rate	$99.41
Max. Negotiated Rate	$2,062.50
Rate for Payer: Aetna Commercial	$1,567.50
Rate for Payer: Aetna Medicare Advantage	$1,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.88
Rate for Payer: Cigna Commercial	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$618.75
Rate for Payer: UnitedHealthcare Community & State	$99.41
Rate for Payer: Wellpoint Medicaid Managed Care	$109.31

OSTEOSURGE BONE MATRIX 300CC

Facility

$4,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270694774
Hospital Revenue Code	278
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$998.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$618.75

OSTEOT COTTON WEDGE 15X15X4MM

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697160
Hospital Revenue Code	278
Min. Negotiated Rate	$469.95
Max. Negotiated Rate	$9,750.00
Rate for Payer: Aetna Commercial	$7,410.00
Rate for Payer: Aetna Medicare Advantage	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,972.50
Rate for Payer: Cigna Commercial	$9,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,290.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00
Rate for Payer: UnitedHealthcare Community & State	$469.95
Rate for Payer: Wellpoint Medicaid Managed Care	$516.75

OSTEOT COTTON WEDGE 15X15X4MM

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697160
Hospital Revenue Code	278
Min. Negotiated Rate	$2,925.00
Max. Negotiated Rate	$4,719.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,290.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00

OSTEOT COTTON WEDGE 20X15X4MM

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697161
Hospital Revenue Code	278
Min. Negotiated Rate	$2,925.00
Max. Negotiated Rate	$4,719.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,290.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00

OSTEOT COTTON WEDGE 20X15X4MM

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697161
Hospital Revenue Code	278
Min. Negotiated Rate	$469.95
Max. Negotiated Rate	$9,750.00
Rate for Payer: Aetna Commercial	$7,410.00
Rate for Payer: Aetna Medicare Advantage	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,972.50
Rate for Payer: Cigna Commercial	$9,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,290.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00
Rate for Payer: UnitedHealthcare Community & State	$469.95
Rate for Payer: Wellpoint Medicaid Managed Care	$516.75

OSTEOTOME 7MM

Facility

$2,500.00

Hospital Charge Code	270700493
Hospital Revenue Code	272
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$500.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

OSTEOTOME 7MM

Facility

$2,500.00

Hospital Charge Code	270700493
Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

OSTEOTOME BMT 6MM LONG 423890

Facility

$1,556.85

Hospital Charge Code	270615801
Hospital Revenue Code	272
Min. Negotiated Rate	$233.53
Max. Negotiated Rate	$233.53
Rate for Payer: Qualcare PPO/HMO/WC	$233.53

OSTEOTOME BMT 6MM LONG 423890

Facility

$1,556.85

Hospital Charge Code	270615801
Hospital Revenue Code	272
Min. Negotiated Rate	$37.52
Max. Negotiated Rate	$778.42
Rate for Payer: Aetna Commercial	$591.60
Rate for Payer: Aetna Medicare Advantage	$467.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$397.00
Rate for Payer: Cigna Commercial	$778.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.06
Rate for Payer: Oxford Commercial	$311.37
Rate for Payer: Qualcare PPO/HMO/WC	$233.53
Rate for Payer: UnitedHealthcare Commercial	$311.37
Rate for Payer: UnitedHealthcare Community & State	$37.52
Rate for Payer: Wellpoint Medicaid Managed Care	$41.26

OSTEOTOME CEM 3.0-11.5 STR LN

Facility

$930.05

Hospital Charge Code	270670669
Hospital Revenue Code	272
Min. Negotiated Rate	$139.51
Max. Negotiated Rate	$139.51
Rate for Payer: Qualcare PPO/HMO/WC	$139.51

OSTEOTOME CEM 3.0-11.5 STR LN

Facility

$930.05

Hospital Charge Code	270670669
Hospital Revenue Code	272
Min. Negotiated Rate	$22.41
Max. Negotiated Rate	$465.02
Rate for Payer: Aetna Commercial	$353.42
Rate for Payer: Aetna Medicare Advantage	$279.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.16
Rate for Payer: Cigna Commercial	$465.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.01
Rate for Payer: Oxford Commercial	$186.01
Rate for Payer: Qualcare PPO/HMO/WC	$139.51
Rate for Payer: UnitedHealthcare Commercial	$186.01
Rate for Payer: UnitedHealthcare Community & State	$22.41
Rate for Payer: Wellpoint Medicaid Managed Care	$24.65

OSTEOTOME CEM STAG 3 STR LINE

Facility

$930.05

Hospital Charge Code	270670673
Hospital Revenue Code	272
Min. Negotiated Rate	$22.41
Max. Negotiated Rate	$465.02
Rate for Payer: Aetna Commercial	$353.42
Rate for Payer: Aetna Medicare Advantage	$279.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.16
Rate for Payer: Cigna Commercial	$465.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.01
Rate for Payer: Oxford Commercial	$186.01
Rate for Payer: Qualcare PPO/HMO/WC	$139.51
Rate for Payer: UnitedHealthcare Commercial	$186.01
Rate for Payer: UnitedHealthcare Community & State	$22.41
Rate for Payer: Wellpoint Medicaid Managed Care	$24.65

OSTEOTOME CEM STAG 3 STR LINE

Facility

$930.05

Hospital Charge Code	270670673
Hospital Revenue Code	272
Min. Negotiated Rate	$139.51
Max. Negotiated Rate	$139.51
Rate for Payer: Qualcare PPO/HMO/WC	$139.51

OSTEOTOME DRIVER S9 MINI

Facility

$1,300.00

Hospital Charge Code	270696819
Hospital Revenue Code	272
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00

OSTEOTOME DRIVER S9 MINI

Facility

$1,300.00

Hospital Charge Code	270696819
Hospital Revenue Code	272
Min. Negotiated Rate	$31.33
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Commercial	$494.00
Rate for Payer: Aetna Medicare Advantage	$390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.50
Rate for Payer: Cigna Commercial	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.00
Rate for Payer: Oxford Commercial	$260.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00
Rate for Payer: UnitedHealthcare Commercial	$260.00
Rate for Payer: UnitedHealthcare Community & State	$31.33
Rate for Payer: Wellpoint Medicaid Managed Care	$34.45

OSTEOTOME FLAT FLEX NARROW

Facility

$3,500.00

Hospital Charge Code	270668745
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

OSTEOTOME FLAT FLEX NARROW

Facility

$3,500.00

Hospital Charge Code	270668745
Hospital Revenue Code	272
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

OSTEOTOME FLAT FLEX NARRW LONG

Facility

$3,500.00

Hospital Charge Code	270677340
Hospital Revenue Code	272
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

OSTEOTOME FLAT FLEX NARRW LONG

Facility

$3,500.00

Hospital Charge Code	270677340
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

OSTEOTOME FLAT FLEX RND NARROW

Facility

$4,600.00

Hospital Charge Code	270678729
Hospital Revenue Code	272
Min. Negotiated Rate	$110.86
Max. Negotiated Rate	$2,300.00
Rate for Payer: Aetna Commercial	$1,748.00
Rate for Payer: Aetna Medicare Advantage	$1,380.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,173.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,173.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,173.00
Rate for Payer: Cigna Commercial	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,380.00
Rate for Payer: Oxford Commercial	$920.00
Rate for Payer: Qualcare PPO/HMO/WC	$690.00
Rate for Payer: UnitedHealthcare Commercial	$920.00
Rate for Payer: UnitedHealthcare Community & State	$110.86
Rate for Payer: Wellpoint Medicaid Managed Care	$121.90

OSTEOTOME FLAT FLEX RND NARROW

Facility

$4,600.00

Hospital Charge Code	270678729
Hospital Revenue Code	272
Min. Negotiated Rate	$690.00
Max. Negotiated Rate	$690.00
Rate for Payer: Qualcare PPO/HMO/WC	$690.00

OSTEOTOME HOOKED 7MM

Facility

$2,500.00

Service Code	HCPCS A4649
Hospital Charge Code	270699907
Hospital Revenue Code	272
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$500.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

OSTEOTOME HOOKED 7MM

Facility

$2,500.00

Service Code	HCPCS A4649
Hospital Charge Code	270699907
Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

Know your out-of-pocket cost for care.

All Charges