Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROXIMAL HUMERAL PLATE 3.5MM

Facility

$31,914.40

Service Code	HCPCS C1713
Hospital Charge Code	270705122
Hospital Revenue Code	278
Min. Negotiated Rate	$4,787.16
Max. Negotiated Rate	$7,723.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,382.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,723.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,021.17
Rate for Payer: Qualcare PPO/HMO/WC	$4,787.16

PROXIMAL IMPLANT 6.5

Facility

$1,575.00

Hospital Charge Code	270656749
Hospital Revenue Code	278
Min. Negotiated Rate	$236.25
Max. Negotiated Rate	$381.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$346.50
Rate for Payer: Qualcare PPO/HMO/WC	$236.25

PROXIMAL IMPLANT 6.5

Facility

$1,575.00

Hospital Charge Code	270656749
Hospital Revenue Code	278
Min. Negotiated Rate	$37.96
Max. Negotiated Rate	$787.50
Rate for Payer: Aetna Commercial	$598.50
Rate for Payer: Aetna Medicare Advantage	$472.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.62
Rate for Payer: Cigna Commercial	$787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$346.50
Rate for Payer: Qualcare PPO/HMO/WC	$236.25
Rate for Payer: UnitedHealthcare Community & State	$37.96
Rate for Payer: Wellpoint Medicaid Managed Care	$41.74

PROXIMAL IMPLANT_TONIER

Facility

$340.00

Hospital Charge Code	270339449
Hospital Revenue Code	278
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$82.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$68.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$74.80
Rate for Payer: Qualcare PPO/HMO/WC	$51.00

PROXIMAL IMPLANT_TONIER

Facility

$340.00

Hospital Charge Code	270339449
Hospital Revenue Code	278
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$170.00
Rate for Payer: Aetna Commercial	$129.20
Rate for Payer: Aetna Medicare Advantage	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$68.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.70
Rate for Payer: Cigna Commercial	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$74.80
Rate for Payer: Qualcare PPO/HMO/WC	$51.00
Rate for Payer: UnitedHealthcare Community & State	$8.19
Rate for Payer: Wellpoint Medicaid Managed Care	$9.01

PROXIMAL TIBIA PLATE

Facility

$9,190.00

Hospital Charge Code	270656543
Hospital Revenue Code	278
Min. Negotiated Rate	$1,378.50
Max. Negotiated Rate	$2,223.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,838.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,223.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,021.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,378.50

PROXIMAL TIBIA PLATE

Facility

$9,190.00

Hospital Charge Code	270656543
Hospital Revenue Code	278
Min. Negotiated Rate	$221.48
Max. Negotiated Rate	$4,595.00
Rate for Payer: Aetna Commercial	$3,492.20
Rate for Payer: Aetna Medicare Advantage	$2,757.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,343.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,343.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,838.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,343.45
Rate for Payer: Cigna Commercial	$4,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,223.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,021.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,378.50
Rate for Payer: UnitedHealthcare Community & State	$221.48
Rate for Payer: Wellpoint Medicaid Managed Care	$243.53

PROXIMATE 11 SKIN STAPLER

Facility

$47.00

Hospital Charge Code	270334604
Hospital Revenue Code	272
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$23.50
Rate for Payer: Aetna Commercial	$17.86
Rate for Payer: Aetna Medicare Advantage	$14.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.98
Rate for Payer: Cigna Commercial	$23.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.10
Rate for Payer: Oxford Commercial	$9.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.05
Rate for Payer: UnitedHealthcare Commercial	$9.40
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

PROXIMATE 11 SKIN STAPLER

Facility

$83.00

Hospital Charge Code	270334612
Hospital Revenue Code	272
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Qualcare PPO/HMO/WC	$12.45

PROXIMATE 11 SKIN STAPLER

Facility

$83.00

Hospital Charge Code	270334612
Hospital Revenue Code	272
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$41.50
Rate for Payer: Aetna Commercial	$31.54
Rate for Payer: Aetna Medicare Advantage	$24.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.16
Rate for Payer: Cigna Commercial	$41.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.90
Rate for Payer: Oxford Commercial	$16.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.45
Rate for Payer: UnitedHealthcare Commercial	$16.60
Rate for Payer: UnitedHealthcare Community & State	$2.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2.20

PROXIMATE 11 SKIN STAPLER

Facility

$47.00

Hospital Charge Code	270334604
Hospital Revenue Code	272
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$7.05
Rate for Payer: Qualcare PPO/HMO/WC	$7.05

PROXIMATE CUTTER RELOAD 75

Facility

$566.00

Hospital Charge Code	270334713
Hospital Revenue Code	272
Min. Negotiated Rate	$13.64
Max. Negotiated Rate	$283.00
Rate for Payer: Aetna Commercial	$215.08
Rate for Payer: Aetna Medicare Advantage	$169.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.33
Rate for Payer: Cigna Commercial	$283.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.80
Rate for Payer: Oxford Commercial	$113.20
Rate for Payer: Qualcare PPO/HMO/WC	$84.90
Rate for Payer: UnitedHealthcare Commercial	$113.20
Rate for Payer: UnitedHealthcare Community & State	$13.64
Rate for Payer: Wellpoint Medicaid Managed Care	$15.00

PROXIMATE CUTTER RELOAD 75

Facility

$566.00

Hospital Charge Code	270334713
Hospital Revenue Code	272
Min. Negotiated Rate	$84.90
Max. Negotiated Rate	$84.90
Rate for Payer: Qualcare PPO/HMO/WC	$84.90

PROXIMATE LINEAR CUTTER 50MM

Facility

$762.00

Hospital Charge Code	270334732
Hospital Revenue Code	272
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$381.00
Rate for Payer: Aetna Commercial	$289.56
Rate for Payer: Aetna Medicare Advantage	$228.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$194.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$194.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$194.31
Rate for Payer: Cigna Commercial	$381.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.60
Rate for Payer: Oxford Commercial	$152.40
Rate for Payer: Qualcare PPO/HMO/WC	$114.30
Rate for Payer: UnitedHealthcare Commercial	$152.40
Rate for Payer: UnitedHealthcare Community & State	$18.36
Rate for Payer: Wellpoint Medicaid Managed Care	$20.19

PROXIMATE LINEAR CUTTER 50MM

Facility

$762.00

Hospital Charge Code	270334732
Hospital Revenue Code	272
Min. Negotiated Rate	$114.30
Max. Negotiated Rate	$114.30
Rate for Payer: Qualcare PPO/HMO/WC	$114.30

PROXIMATE LINEAR STAPLER 30MM

Facility

$548.00

Hospital Charge Code	270334720
Hospital Revenue Code	272
Min. Negotiated Rate	$82.20
Max. Negotiated Rate	$82.20
Rate for Payer: Qualcare PPO/HMO/WC	$82.20

PROXIMATE LINEAR STAPLER 30MM

Facility

$548.00

Hospital Charge Code	270334720
Hospital Revenue Code	272
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$274.00
Rate for Payer: Aetna Commercial	$208.24
Rate for Payer: Aetna Medicare Advantage	$164.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.74
Rate for Payer: Cigna Commercial	$274.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.40
Rate for Payer: Oxford Commercial	$109.60
Rate for Payer: Qualcare PPO/HMO/WC	$82.20
Rate for Payer: UnitedHealthcare Commercial	$109.60
Rate for Payer: UnitedHealthcare Community & State	$13.21
Rate for Payer: Wellpoint Medicaid Managed Care	$14.52

PROXIMATE PPH 33MM

Facility

$5,962.95

Hospital Charge Code	270657228
Hospital Revenue Code	278
Min. Negotiated Rate	$143.71
Max. Negotiated Rate	$2,981.47
Rate for Payer: Aetna Commercial	$2,265.92
Rate for Payer: Aetna Medicare Advantage	$1,788.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,520.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,520.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,192.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,520.55
Rate for Payer: Cigna Commercial	$2,981.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,443.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,311.85
Rate for Payer: Qualcare PPO/HMO/WC	$894.44
Rate for Payer: UnitedHealthcare Community & State	$143.71
Rate for Payer: Wellpoint Medicaid Managed Care	$158.02

PROXIMATE PPH 33MM

Facility

$5,962.95

Hospital Charge Code	270657228
Hospital Revenue Code	278
Min. Negotiated Rate	$894.44
Max. Negotiated Rate	$1,443.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,192.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,443.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,311.85
Rate for Payer: Qualcare PPO/HMO/WC	$894.44

PROXMALHUMERALPLATETS3HOLELEFT

Facility

$10,240.00

Service Code	HCPCS C1713
Hospital Charge Code	270663874
Hospital Revenue Code	278
Min. Negotiated Rate	$1,536.00
Max. Negotiated Rate	$2,478.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,048.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,478.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,252.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,536.00

PROXMALHUMERALPLATETS3HOLELEFT

Facility

$10,240.00

Service Code	HCPCS C1713
Hospital Charge Code	270663874
Hospital Revenue Code	278
Min. Negotiated Rate	$246.78
Max. Negotiated Rate	$5,120.00
Rate for Payer: Aetna Commercial	$3,891.20
Rate for Payer: Aetna Medicare Advantage	$3,072.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,611.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,611.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,048.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,611.20
Rate for Payer: Cigna Commercial	$5,120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,478.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,252.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,536.00
Rate for Payer: UnitedHealthcare Community & State	$246.78
Rate for Payer: Wellpoint Medicaid Managed Care	$271.36

PROX TIB LOCK PLATE LT 3H STD

Facility

$5,112.00

Service Code	HCPCS C1713
Hospital Charge Code	270683103
Hospital Revenue Code	278
Min. Negotiated Rate	$766.80
Max. Negotiated Rate	$1,237.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,022.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,237.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,124.64
Rate for Payer: Qualcare PPO/HMO/WC	$766.80

PROX TIB LOCK PLATE LT 3H STD

Facility

$5,112.00

Service Code	HCPCS C1713
Hospital Charge Code	270683103
Hospital Revenue Code	278
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$2,556.00
Rate for Payer: Aetna Commercial	$1,942.56
Rate for Payer: Aetna Medicare Advantage	$1,533.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,303.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,303.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,022.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,303.56
Rate for Payer: Cigna Commercial	$2,556.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,237.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,124.64
Rate for Payer: Qualcare PPO/HMO/WC	$766.80
Rate for Payer: UnitedHealthcare Community & State	$123.20
Rate for Payer: Wellpoint Medicaid Managed Care	$135.47

PROZAC***

Facility

$28.00

Service Code	HCPCS 80299
Hospital Charge Code	3031770
Hospital Revenue Code	309
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.28
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

PROZAC***

Facility

$28.00

Service Code	HCPCS 80299
Hospital Charge Code	3031770
Hospital Revenue Code	309
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

Know your out-of-pocket cost for care.

All Charges