Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PIN APEX STERILE 5MMx200MM

Facility

$930.00

Service Code	HCPCS C1713
Hospital Charge Code	270650708
Hospital Revenue Code	278
Min. Negotiated Rate	$22.41
Max. Negotiated Rate	$465.00
Rate for Payer: Aetna Commercial	$353.40
Rate for Payer: Aetna Medicare Advantage	$279.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$186.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.15
Rate for Payer: Cigna Commercial	$465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$204.60
Rate for Payer: Qualcare PPO/HMO/WC	$139.50
Rate for Payer: UnitedHealthcare Community & State	$22.41
Rate for Payer: Wellpoint Medicaid Managed Care	$24.64

PIN APEX STERILE 5MMx250MM

Facility

$1,025.00

Hospital Charge Code	270650707
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$248.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

PIN APEX STERILE 5MMx250MM

Facility

$1,025.00

Hospital Charge Code	270650707
Hospital Revenue Code	278
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Community & State	$24.70
Rate for Payer: Wellpoint Medicaid Managed Care	$27.16

PIN APEX STERILE 5x180MMPOST 3

Facility

$1,075.00

Hospital Charge Code	270648629
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

PIN APEX STERILE 5x180MMPOST 3

Facility

$1,075.00

Hospital Charge Code	270648629
Hospital Revenue Code	278
Min. Negotiated Rate	$25.91
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$408.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25
Rate for Payer: UnitedHealthcare Community & State	$25.91
Rate for Payer: Wellpoint Medicaid Managed Care	$28.49

PIN APEX TRANSFIXING

Facility

$1,000.00

Hospital Charge Code	270664939
Hospital Revenue Code	270
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

PIN APEX TRANSFIXING

Facility

$1,000.00

Hospital Charge Code	270664939
Hospital Revenue Code	270
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

PIN ATK ACL 4 40 905854

Facility

$1,959.25

Hospital Charge Code	270627858
Hospital Revenue Code	278
Min. Negotiated Rate	$293.89
Max. Negotiated Rate	$474.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$391.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$474.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$431.04
Rate for Payer: Qualcare PPO/HMO/WC	$293.89

PIN ATK ACL 4 40 905854

Facility

$1,959.25

Hospital Charge Code	270627858
Hospital Revenue Code	278
Min. Negotiated Rate	$47.22
Max. Negotiated Rate	$979.62
Rate for Payer: Aetna Commercial	$744.51
Rate for Payer: Aetna Medicare Advantage	$587.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$499.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$499.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$391.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$499.61
Rate for Payer: Cigna Commercial	$979.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$474.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$431.04
Rate for Payer: Qualcare PPO/HMO/WC	$293.89
Rate for Payer: UnitedHealthcare Community & State	$47.22
Rate for Payer: Wellpoint Medicaid Managed Care	$51.92

PIN ATK ACL GRAFT 2.4 905844

Facility

$629.65

Hospital Charge Code	270627859
Hospital Revenue Code	278
Min. Negotiated Rate	$94.45
Max. Negotiated Rate	$152.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$138.52
Rate for Payer: Qualcare PPO/HMO/WC	$94.45

PIN ATK ACL GRAFT 2.4 905844

Facility

$629.65

Hospital Charge Code	270627859
Hospital Revenue Code	278
Min. Negotiated Rate	$15.17
Max. Negotiated Rate	$314.82
Rate for Payer: Aetna Commercial	$239.27
Rate for Payer: Aetna Medicare Advantage	$188.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.56
Rate for Payer: Cigna Commercial	$314.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$138.52
Rate for Payer: Qualcare PPO/HMO/WC	$94.45
Rate for Payer: UnitedHealthcare Community & State	$15.17
Rate for Payer: Wellpoint Medicaid Managed Care	$16.69

PIN ATX DRL GUIDE 2.4 AR1250L

Facility

$576.00

Hospital Charge Code	270621135
Hospital Revenue Code	278
Min. Negotiated Rate	$86.40
Max. Negotiated Rate	$139.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.72
Rate for Payer: Qualcare PPO/HMO/WC	$86.40

PIN ATX DRL GUIDE 2.4 AR1250L

Facility

$576.00

Hospital Charge Code	270621135
Hospital Revenue Code	278
Min. Negotiated Rate	$13.88
Max. Negotiated Rate	$288.00
Rate for Payer: Aetna Commercial	$218.88
Rate for Payer: Aetna Medicare Advantage	$172.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.88
Rate for Payer: Cigna Commercial	$288.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.72
Rate for Payer: Qualcare PPO/HMO/WC	$86.40
Rate for Payer: UnitedHealthcare Community & State	$13.88
Rate for Payer: Wellpoint Medicaid Managed Care	$15.26

PIN ATX GUIDE 1.5MM 1253

Facility

$460.85

Hospital Charge Code	270621134
Hospital Revenue Code	278
Min. Negotiated Rate	$69.13
Max. Negotiated Rate	$111.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$101.39
Rate for Payer: Qualcare PPO/HMO/WC	$69.13

PIN ATX GUIDE 1.5MM 1253

Facility

$460.85

Hospital Charge Code	270621134
Hospital Revenue Code	278
Min. Negotiated Rate	$11.11
Max. Negotiated Rate	$230.43
Rate for Payer: Aetna Commercial	$175.12
Rate for Payer: Aetna Medicare Advantage	$138.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.52
Rate for Payer: Cigna Commercial	$230.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$101.39
Rate for Payer: Qualcare PPO/HMO/WC	$69.13
Rate for Payer: UnitedHealthcare Community & State	$11.11
Rate for Payer: Wellpoint Medicaid Managed Care	$12.21

PINBALL JURGAN REF .028

Facility

$33.65

Hospital Charge Code	270601216
Hospital Revenue Code	272
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$5.05
Rate for Payer: Qualcare PPO/HMO/WC	$5.05

PINBALL JURGAN REF .028

Facility

$33.65

Hospital Charge Code	270601216
Hospital Revenue Code	272
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$16.82
Rate for Payer: Aetna Commercial	$12.79
Rate for Payer: Aetna Medicare Advantage	$10.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.58
Rate for Payer: Cigna Commercial	$16.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.10
Rate for Payer: Oxford Commercial	$6.73
Rate for Payer: Qualcare PPO/HMO/WC	$5.05
Rate for Payer: UnitedHealthcare Commercial	$6.73
Rate for Payer: UnitedHealthcare Community & State	$0.81
Rate for Payer: Wellpoint Medicaid Managed Care	$0.89

PINBALL JURGAN REF .035

Facility

$33.65

Hospital Charge Code	270601217
Hospital Revenue Code	272
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$5.05
Rate for Payer: Qualcare PPO/HMO/WC	$5.05

PINBALL JURGAN REF .035

Facility

$33.65

Hospital Charge Code	270601217
Hospital Revenue Code	272
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$16.82
Rate for Payer: Aetna Commercial	$12.79
Rate for Payer: Aetna Medicare Advantage	$10.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.58
Rate for Payer: Cigna Commercial	$16.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.10
Rate for Payer: Oxford Commercial	$6.73
Rate for Payer: Qualcare PPO/HMO/WC	$5.05
Rate for Payer: UnitedHealthcare Commercial	$6.73
Rate for Payer: UnitedHealthcare Community & State	$0.81
Rate for Payer: Wellpoint Medicaid Managed Care	$0.89

PINBALL JURGAN REF .035 W035

Facility

$23.35

Hospital Charge Code	270638421
Hospital Revenue Code	271
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$11.68
Rate for Payer: Aetna Commercial	$8.87
Rate for Payer: Aetna Medicare Advantage	$7.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.95
Rate for Payer: Cigna Commercial	$11.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.00
Rate for Payer: Oxford Commercial	$4.67
Rate for Payer: Qualcare PPO/HMO/WC	$3.50
Rate for Payer: UnitedHealthcare Commercial	$4.67
Rate for Payer: UnitedHealthcare Community & State	$0.56
Rate for Payer: Wellpoint Medicaid Managed Care	$0.62

PINBALL JURGAN REF .035 W035

Facility

$23.35

Hospital Charge Code	270638421
Hospital Revenue Code	271
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.50

PINBALL JURGAN REF .045

Facility

$31.67

Hospital Charge Code	270601214
Hospital Revenue Code	272
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$15.84
Rate for Payer: Aetna Commercial	$12.03
Rate for Payer: Aetna Medicare Advantage	$9.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.08
Rate for Payer: Cigna Commercial	$15.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.50
Rate for Payer: Oxford Commercial	$6.33
Rate for Payer: Qualcare PPO/HMO/WC	$4.75
Rate for Payer: UnitedHealthcare Commercial	$6.33
Rate for Payer: UnitedHealthcare Community & State	$0.76
Rate for Payer: Wellpoint Medicaid Managed Care	$0.84

PINBALL JURGAN REF .045

Facility

$31.67

Hospital Charge Code	270601214
Hospital Revenue Code	272
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$4.75
Rate for Payer: Qualcare PPO/HMO/WC	$4.75

PINBALL JURGAN REF .062

Facility

$31.67

Hospital Charge Code	270601215
Hospital Revenue Code	272
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$15.84
Rate for Payer: Aetna Commercial	$12.03
Rate for Payer: Aetna Medicare Advantage	$9.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.08
Rate for Payer: Cigna Commercial	$15.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.50
Rate for Payer: Oxford Commercial	$6.33
Rate for Payer: Qualcare PPO/HMO/WC	$4.75
Rate for Payer: UnitedHealthcare Commercial	$6.33
Rate for Payer: UnitedHealthcare Community & State	$0.76
Rate for Payer: Wellpoint Medicaid Managed Care	$0.84

PINBALL JURGAN REF .062

Facility

$31.67

Hospital Charge Code	270601215
Hospital Revenue Code	272
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$4.75
Rate for Payer: Qualcare PPO/HMO/WC	$4.75

Know your out-of-pocket cost for care.

All Charges