Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

POLRCTH.035 5x100 P510012001

Facility

$3,695.50

Hospital Charge Code	270638809C
Hospital Revenue Code	278
Min. Negotiated Rate	$89.06
Max. Negotiated Rate	$1,847.75
Rate for Payer: Aetna Commercial	$1,404.29
Rate for Payer: Aetna Medicare Advantage	$1,108.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$942.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$942.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$739.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$942.35
Rate for Payer: Cigna Commercial	$1,847.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$894.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$813.01
Rate for Payer: Qualcare PPO/HMO/WC	$554.33
Rate for Payer: UnitedHealthcare Community & State	$89.06
Rate for Payer: Wellpoint Medicaid Managed Care	$97.93

POLY 12 X 71/75

Facility

$12,565.00

Hospital Charge Code	270662791
Hospital Revenue Code	270
Min. Negotiated Rate	$302.82
Max. Negotiated Rate	$6,282.50
Rate for Payer: Aetna Commercial	$4,774.70
Rate for Payer: Aetna Medicare Advantage	$3,769.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,204.07
Rate for Payer: Cigna Commercial	$6,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,769.50
Rate for Payer: Oxford Commercial	$2,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,884.75
Rate for Payer: UnitedHealthcare Commercial	$2,513.00
Rate for Payer: UnitedHealthcare Community & State	$302.82
Rate for Payer: Wellpoint Medicaid Managed Care	$332.97

POLY 12 X 71/75

Facility

$12,565.00

Hospital Charge Code	270662791
Hospital Revenue Code	270
Min. Negotiated Rate	$1,884.75
Max. Negotiated Rate	$1,884.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,884.75

POLY 14X 71/75 IMPLANT

Facility

$5,135.00

Service Code	HCPCS C1776
Hospital Charge Code	270661754
Hospital Revenue Code	278
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$2,567.50
Rate for Payer: Aetna Commercial	$1,951.30
Rate for Payer: Aetna Medicare Advantage	$1,540.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,309.42
Rate for Payer: Cigna Commercial	$2,567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,129.70
Rate for Payer: Qualcare PPO/HMO/WC	$770.25
Rate for Payer: UnitedHealthcare Community & State	$123.75
Rate for Payer: Wellpoint Medicaid Managed Care	$136.08

POLY 14X 71/75 IMPLANT

Facility

$5,135.00

Service Code	HCPCS C1776
Hospital Charge Code	270661754
Hospital Revenue Code	278
Min. Negotiated Rate	$770.25
Max. Negotiated Rate	$1,242.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,129.70
Rate for Payer: Qualcare PPO/HMO/WC	$770.25

POLY 6 ANTMC RT L OXFRD 159585

Facility

$3,605.00

Hospital Charge Code	270639309
Hospital Revenue Code	278
Min. Negotiated Rate	$540.75
Max. Negotiated Rate	$872.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$721.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$872.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$793.10
Rate for Payer: Qualcare PPO/HMO/WC	$540.75

POLY 6 ANTMC RT L OXFRD 159585

Facility

$3,605.00

Hospital Charge Code	270639309
Hospital Revenue Code	278
Min. Negotiated Rate	$86.88
Max. Negotiated Rate	$1,802.50
Rate for Payer: Aetna Commercial	$1,369.90
Rate for Payer: Aetna Medicare Advantage	$1,081.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$919.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$919.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$721.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$919.27
Rate for Payer: Cigna Commercial	$1,802.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$872.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$793.10
Rate for Payer: Qualcare PPO/HMO/WC	$540.75
Rate for Payer: UnitedHealthcare Community & State	$86.88
Rate for Payer: Wellpoint Medicaid Managed Care	$95.53

POLY ALL VE 38 MM DIA

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270691071
Hospital Revenue Code	278
Min. Negotiated Rate	$769.50
Max. Negotiated Rate	$1,241.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,128.60
Rate for Payer: Qualcare PPO/HMO/WC	$769.50

POLY ALL VE 38 MM DIA

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270691071
Hospital Revenue Code	278
Min. Negotiated Rate	$123.63
Max. Negotiated Rate	$2,565.00
Rate for Payer: Aetna Commercial	$1,949.40
Rate for Payer: Aetna Medicare Advantage	$1,539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,308.15
Rate for Payer: Cigna Commercial	$2,565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,128.60
Rate for Payer: Qualcare PPO/HMO/WC	$769.50
Rate for Payer: UnitedHealthcare Community & State	$123.63
Rate for Payer: Wellpoint Medicaid Managed Care	$135.94

POLYAXIAL SCREW 6.5X45MM

Facility

$6,250.00

Hospital Charge Code	270702845
Hospital Revenue Code	278
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

POLYAXIAL SCREW 6.5X45MM

Facility

$6,250.00

Hospital Charge Code	270702845
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

POLYAXIAL SCREW 7.5X40MM

Facility

$6,250.00

Hospital Charge Code	270702846
Hospital Revenue Code	278
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

POLYAXIAL SCREW 7.5X40MM

Facility

$6,250.00

Hospital Charge Code	270702846
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

POLYAXIAL TULIP

Facility

$2,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270704709
Hospital Revenue Code	278
Min. Negotiated Rate	$51.57
Max. Negotiated Rate	$1,070.00
Rate for Payer: Aetna Commercial	$813.20
Rate for Payer: Aetna Medicare Advantage	$642.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$545.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$545.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$428.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$545.70
Rate for Payer: Cigna Commercial	$1,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$517.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$470.80
Rate for Payer: Qualcare PPO/HMO/WC	$321.00
Rate for Payer: UnitedHealthcare Community & State	$51.57
Rate for Payer: Wellpoint Medicaid Managed Care	$56.71

POLYAXIAL TULIP

Facility

$2,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270704709
Hospital Revenue Code	278
Min. Negotiated Rate	$321.00
Max. Negotiated Rate	$517.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$428.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$517.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$470.80
Rate for Payer: Qualcare PPO/HMO/WC	$321.00

POLYCILLIN/250MG/CAP

Facility

$3.00

Hospital Charge Code	60633681
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

POLYCILLIN/250MG/CAP

Facility

$4.00

Hospital Charge Code	60633680
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

POLYCILLIN/250MG/CAP

Facility

$3.00

Hospital Charge Code	60633681
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

POLYCILLIN/250MG/CAP

Facility

$4.00

Hospital Charge Code	60633680
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

POLYCILLIN/500MG/CAP

Facility

$4.00

Hospital Charge Code	60633682
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

POLYCILLIN/500MG/CAP

Facility

$4.00

Hospital Charge Code	60633679
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

POLYCILLIN/500MG/CAP

Facility

$4.00

Hospital Charge Code	60633679
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

POLYCILLIN/500MG/CAP

Facility

$4.00

Hospital Charge Code	60633682
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

POLYCILLIN-N/125MG

Facility

$18.00

Hospital Charge Code	60633683
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

POLYCILLIN-N/125MG

Facility

$18.00

Hospital Charge Code	60633683
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

Know your out-of-pocket cost for care.

All Charges