Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PIN ORTHOSORB KIT 2.0MM STR

Facility

$1,420.00

Service Code	HCPCS C1713
Hospital Charge Code	270676360
Hospital Revenue Code	278
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$343.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$284.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$343.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$312.40
Rate for Payer: Qualcare PPO/HMO/WC	$213.00

PIN ORTHOSORB TAPERED 841070**

Facility

$146.00

Hospital Charge Code	1604743
Hospital Revenue Code	274
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$73.00
Rate for Payer: Aetna Commercial	$55.48
Rate for Payer: Aetna Medicare Advantage	$43.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.23
Rate for Payer: Cigna Commercial	$73.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$32.12
Rate for Payer: Qualcare PPO/HMO/WC	$21.90
Rate for Payer: UnitedHealthcare Community & State	$3.52
Rate for Payer: Wellpoint Medicaid Managed Care	$3.87

PIN ORTHOSORB TAPERED 841070**

Facility

$146.00

Hospital Charge Code	1604743
Hospital Revenue Code	274
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$35.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$32.12
Rate for Payer: Qualcare PPO/HMO/WC	$21.90

PIN PF 2.7MMx14MM 7117-1228

Facility

$835.00

Hospital Charge Code	270647954
Hospital Revenue Code	272
Min. Negotiated Rate	$20.12
Max. Negotiated Rate	$417.50
Rate for Payer: Aetna Commercial	$317.30
Rate for Payer: Aetna Medicare Advantage	$250.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.93
Rate for Payer: Cigna Commercial	$417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$250.50
Rate for Payer: Oxford Commercial	$167.00
Rate for Payer: Qualcare PPO/HMO/WC	$125.25
Rate for Payer: UnitedHealthcare Commercial	$167.00
Rate for Payer: UnitedHealthcare Community & State	$20.12
Rate for Payer: Wellpoint Medicaid Managed Care	$22.13

PIN PF 2.7MMx14MM 7117-1228

Facility

$835.00

Hospital Charge Code	270647954
Hospital Revenue Code	272
Min. Negotiated Rate	$125.25
Max. Negotiated Rate	$125.25
Rate for Payer: Qualcare PPO/HMO/WC	$125.25

PIN POSITIONING VA 5.0MM

Facility

$976.45

Service Code	HCPCS C1713
Hospital Charge Code	270693773
Hospital Revenue Code	278
Min. Negotiated Rate	$146.47
Max. Negotiated Rate	$236.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$214.82
Rate for Payer: Qualcare PPO/HMO/WC	$146.47

PIN POSITIONING VA 5.0MM

Facility

$976.45

Service Code	HCPCS C1713
Hospital Charge Code	270693773
Hospital Revenue Code	278
Min. Negotiated Rate	$23.53
Max. Negotiated Rate	$488.23
Rate for Payer: Aetna Commercial	$371.05
Rate for Payer: Aetna Medicare Advantage	$292.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.99
Rate for Payer: Cigna Commercial	$488.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$214.82
Rate for Payer: Qualcare PPO/HMO/WC	$146.47
Rate for Payer: UnitedHealthcare Community & State	$23.53
Rate for Payer: Wellpoint Medicaid Managed Care	$25.88

PIN PRECISION TM 3.9X450MM

Facility

$1,395.00

Service Code	HCPCS C1713
Hospital Charge Code	270698905
Hospital Revenue Code	278
Min. Negotiated Rate	$33.62
Max. Negotiated Rate	$697.50
Rate for Payer: Aetna Commercial	$530.10
Rate for Payer: Aetna Medicare Advantage	$418.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$355.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$355.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$279.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$355.73
Rate for Payer: Cigna Commercial	$697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$306.90
Rate for Payer: Qualcare PPO/HMO/WC	$209.25
Rate for Payer: UnitedHealthcare Community & State	$33.62
Rate for Payer: Wellpoint Medicaid Managed Care	$36.97

PIN PRECISION TM 3.9X450MM

Facility

$1,395.00

Service Code	HCPCS C1713
Hospital Charge Code	270698905
Hospital Revenue Code	278
Min. Negotiated Rate	$209.25
Max. Negotiated Rate	$337.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$279.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$306.90
Rate for Payer: Qualcare PPO/HMO/WC	$209.25

PIN RFS 1.5 x 50mm RFS-P015

Facility

$875.00

Hospital Charge Code	270645091
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$211.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$192.50
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

PIN RFS 1.5 x 50mm RFS-P015

Facility

$875.00

Hospital Charge Code	270645091
Hospital Revenue Code	278
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$192.50
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Community & State	$21.09
Rate for Payer: Wellpoint Medicaid Managed Care	$23.19

PIN ROD CLMP 8/4-5 4921-1-020

Facility

$880.00

Hospital Charge Code	270648716
Hospital Revenue Code	278
Min. Negotiated Rate	$21.21
Max. Negotiated Rate	$440.00
Rate for Payer: Aetna Commercial	$334.40
Rate for Payer: Aetna Medicare Advantage	$264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$176.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.40
Rate for Payer: Cigna Commercial	$440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$132.00
Rate for Payer: UnitedHealthcare Community & State	$21.21
Rate for Payer: Wellpoint Medicaid Managed Care	$23.32

PIN ROD CLMP 8/4-5 4921-1-020

Facility

$880.00

Hospital Charge Code	270648716
Hospital Revenue Code	278
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$212.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$176.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$132.00

PIN ROD TO SCREW 14600

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270637345
Hospital Revenue Code	278
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$1,512.50
Rate for Payer: Aetna Commercial	$1,149.50
Rate for Payer: Aetna Medicare Advantage	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$771.38
Rate for Payer: Cigna Commercial	$1,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$453.75
Rate for Payer: UnitedHealthcare Community & State	$72.90
Rate for Payer: Wellpoint Medicaid Managed Care	$80.16

PIN ROD TO SCREW 14600

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270637345
Hospital Revenue Code	278
Min. Negotiated Rate	$453.75
Max. Negotiated Rate	$732.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$453.75

PIN ROD TO SCREW 14605

Facility

$1,880.00

Service Code	HCPCS C1713
Hospital Charge Code	270637346
Hospital Revenue Code	278
Min. Negotiated Rate	$45.31
Max. Negotiated Rate	$940.00
Rate for Payer: Aetna Commercial	$714.40
Rate for Payer: Aetna Medicare Advantage	$564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.40
Rate for Payer: Cigna Commercial	$940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$454.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$413.60
Rate for Payer: Qualcare PPO/HMO/WC	$282.00
Rate for Payer: UnitedHealthcare Community & State	$45.31
Rate for Payer: Wellpoint Medicaid Managed Care	$49.82

PIN ROD TO SCREW 14605

Facility

$1,880.00

Service Code	HCPCS C1713
Hospital Charge Code	270637346
Hospital Revenue Code	278
Min. Negotiated Rate	$282.00
Max. Negotiated Rate	$454.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$454.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$413.60
Rate for Payer: Qualcare PPO/HMO/WC	$282.00

PIN RUSH MED LG SZ A-I****

Facility

$160.00

Hospital Charge Code	1602101
Hospital Revenue Code	274
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$60.80
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$35.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Community & State	$3.86
Rate for Payer: Wellpoint Medicaid Managed Care	$4.24

PIN RUSH MED LG SZ A-I****

Facility

$160.00

Hospital Charge Code	1602101
Hospital Revenue Code	274
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$35.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

PIN RUSH MEDLY SZJ 1/8 8030111

Facility

$262.95

Hospital Charge Code	270632091
Hospital Revenue Code	278
Min. Negotiated Rate	$39.44
Max. Negotiated Rate	$63.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$57.85
Rate for Payer: Qualcare PPO/HMO/WC	$39.44

PIN RUSH MEDLY SZJ 1/8 8030111

Facility

$262.95

Hospital Charge Code	270632091
Hospital Revenue Code	278
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$131.47
Rate for Payer: Aetna Commercial	$99.92
Rate for Payer: Aetna Medicare Advantage	$78.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.05
Rate for Payer: Cigna Commercial	$131.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$57.85
Rate for Payer: Qualcare PPO/HMO/WC	$39.44
Rate for Payer: UnitedHealthcare Community & State	$6.34
Rate for Payer: Wellpoint Medicaid Managed Care	$6.97

PIN RUSH MEDLY SZK 1/8 8030112

Facility

$262.95

Hospital Charge Code	270632092
Hospital Revenue Code	278
Min. Negotiated Rate	$39.44
Max. Negotiated Rate	$63.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$57.85
Rate for Payer: Qualcare PPO/HMO/WC	$39.44

PIN RUSH MEDLY SZK 1/8 8030112

Facility

$262.95

Hospital Charge Code	270632092
Hospital Revenue Code	278
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$131.47
Rate for Payer: Aetna Commercial	$99.92
Rate for Payer: Aetna Medicare Advantage	$78.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.05
Rate for Payer: Cigna Commercial	$131.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$57.85
Rate for Payer: Qualcare PPO/HMO/WC	$39.44
Rate for Payer: UnitedHealthcare Community & State	$6.34
Rate for Payer: Wellpoint Medicaid Managed Care	$6.97

PIN RUSH MED MED A-M***

Facility

$117.00

Hospital Charge Code	1602119
Hospital Revenue Code	274
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$28.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$25.74
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

PIN RUSH MED MED A-M***

Facility

$117.00

Hospital Charge Code	1602119
Hospital Revenue Code	274
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna Commercial	$44.46
Rate for Payer: Aetna Medicare Advantage	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.84
Rate for Payer: Cigna Commercial	$58.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$25.74
Rate for Payer: Qualcare PPO/HMO/WC	$17.55
Rate for Payer: UnitedHealthcare Community & State	$2.82
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

Know your out-of-pocket cost for care.

All Charges