Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PUTTY DBM STAGRAFT 5CC

Facility

$3,845.00

Service Code	HCPCS C9359
Hospital Charge Code	270648288
Hospital Revenue Code	278
Min. Negotiated Rate	$92.66
Max. Negotiated Rate	$1,922.50
Rate for Payer: Aetna Commercial	$1,461.10
Rate for Payer: Aetna Medicare Advantage	$1,153.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$980.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$980.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$769.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$980.48
Rate for Payer: Cigna Commercial	$1,922.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$930.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$845.90
Rate for Payer: Qualcare PPO/HMO/WC	$576.75
Rate for Payer: UnitedHealthcare Community & State	$92.66
Rate for Payer: Wellpoint Medicaid Managed Care	$101.89

PUTTY DBM W/CHIPS 10CC

Facility

$5,165.00

Hospital Charge Code	270671251
Hospital Revenue Code	278
Min. Negotiated Rate	$774.75
Max. Negotiated Rate	$1,249.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,033.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,249.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,136.30
Rate for Payer: Qualcare PPO/HMO/WC	$774.75

PUTTY DBM W/CHIPS 10CC

Facility

$5,165.00

Hospital Charge Code	270671251
Hospital Revenue Code	278
Min. Negotiated Rate	$124.48
Max. Negotiated Rate	$2,582.50
Rate for Payer: Aetna Commercial	$1,962.70
Rate for Payer: Aetna Medicare Advantage	$1,549.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,317.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,317.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,033.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,317.08
Rate for Payer: Cigna Commercial	$2,582.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,249.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,136.30
Rate for Payer: Qualcare PPO/HMO/WC	$774.75
Rate for Payer: UnitedHealthcare Community & State	$124.48
Rate for Payer: Wellpoint Medicaid Managed Care	$136.87

PUTTY DBM W/CHIPS 1CC

Facility

$860.00

Hospital Charge Code	270671248
Hospital Revenue Code	278
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$208.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.20
Rate for Payer: Qualcare PPO/HMO/WC	$129.00

PUTTY DBM W/CHIPS 1CC

Facility

$860.00

Hospital Charge Code	270671248
Hospital Revenue Code	278
Min. Negotiated Rate	$20.73
Max. Negotiated Rate	$430.00
Rate for Payer: Aetna Commercial	$326.80
Rate for Payer: Aetna Medicare Advantage	$258.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.30
Rate for Payer: Cigna Commercial	$430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.20
Rate for Payer: Qualcare PPO/HMO/WC	$129.00
Rate for Payer: UnitedHealthcare Community & State	$20.73
Rate for Payer: Wellpoint Medicaid Managed Care	$22.79

PUTTY DBM W/CHIPS 20CC

Facility

$10,360.00

Hospital Charge Code	270671252
Hospital Revenue Code	278
Min. Negotiated Rate	$1,554.00
Max. Negotiated Rate	$2,507.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,072.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,507.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,279.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,554.00

PUTTY DBM W/CHIPS 20CC

Facility

$10,360.00

Hospital Charge Code	270671252
Hospital Revenue Code	278
Min. Negotiated Rate	$249.68
Max. Negotiated Rate	$5,180.00
Rate for Payer: Aetna Commercial	$3,936.80
Rate for Payer: Aetna Medicare Advantage	$3,108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,641.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,641.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,072.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,641.80
Rate for Payer: Cigna Commercial	$5,180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,507.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,279.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,554.00
Rate for Payer: UnitedHealthcare Community & State	$249.68
Rate for Payer: Wellpoint Medicaid Managed Care	$274.54

PUTTY DBM W/CHIPS 2CC

Facility

$1,715.00

Hospital Charge Code	270671249
Hospital Revenue Code	278
Min. Negotiated Rate	$257.25
Max. Negotiated Rate	$415.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$343.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$415.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$377.30
Rate for Payer: Qualcare PPO/HMO/WC	$257.25

PUTTY DBM W/CHIPS 2CC

Facility

$1,715.00

Hospital Charge Code	270671249
Hospital Revenue Code	278
Min. Negotiated Rate	$41.33
Max. Negotiated Rate	$857.50
Rate for Payer: Aetna Commercial	$651.70
Rate for Payer: Aetna Medicare Advantage	$514.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$437.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$437.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$343.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$437.32
Rate for Payer: Cigna Commercial	$857.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$415.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$377.30
Rate for Payer: Qualcare PPO/HMO/WC	$257.25
Rate for Payer: UnitedHealthcare Community & State	$41.33
Rate for Payer: Wellpoint Medicaid Managed Care	$45.45

PUTTY DBM W/CHIPS .5CC

Facility

$455.00

Hospital Charge Code	270671247
Hospital Revenue Code	278
Min. Negotiated Rate	$10.97
Max. Negotiated Rate	$227.50
Rate for Payer: Aetna Commercial	$172.90
Rate for Payer: Aetna Medicare Advantage	$136.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.03
Rate for Payer: Cigna Commercial	$227.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$100.10
Rate for Payer: Qualcare PPO/HMO/WC	$68.25
Rate for Payer: UnitedHealthcare Community & State	$10.97
Rate for Payer: Wellpoint Medicaid Managed Care	$12.06

PUTTY DBM W/CHIPS .5CC

Facility

$455.00

Hospital Charge Code	270671247
Hospital Revenue Code	278
Min. Negotiated Rate	$68.25
Max. Negotiated Rate	$110.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$100.10
Rate for Payer: Qualcare PPO/HMO/WC	$68.25

PUTTY DBM W/CHIPS 5CC

Facility

$3,360.00

Hospital Charge Code	270671250
Hospital Revenue Code	278
Min. Negotiated Rate	$80.98
Max. Negotiated Rate	$1,680.00
Rate for Payer: Aetna Commercial	$1,276.80
Rate for Payer: Aetna Medicare Advantage	$1,008.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$856.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$856.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$856.80
Rate for Payer: Cigna Commercial	$1,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$813.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$739.20
Rate for Payer: Qualcare PPO/HMO/WC	$504.00
Rate for Payer: UnitedHealthcare Community & State	$80.98
Rate for Payer: Wellpoint Medicaid Managed Care	$89.04

PUTTY DBM W/CHIPS 5CC

Facility

$3,360.00

Hospital Charge Code	270671250
Hospital Revenue Code	278
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$813.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$672.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$813.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$739.20
Rate for Payer: Qualcare PPO/HMO/WC	$504.00

PUTTY DBX 10CC

Facility

$7,800.00

Hospital Charge Code	270670905
Hospital Revenue Code	278
Min. Negotiated Rate	$187.98
Max. Negotiated Rate	$3,900.00
Rate for Payer: Aetna Commercial	$2,964.00
Rate for Payer: Aetna Medicare Advantage	$2,340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,989.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,989.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,989.00
Rate for Payer: Cigna Commercial	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,887.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,716.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.00
Rate for Payer: UnitedHealthcare Community & State	$187.98
Rate for Payer: Wellpoint Medicaid Managed Care	$206.70

PUTTY DBX 10CC

Facility

$5,630.00

Service Code	HCPCS C1713
Hospital Charge Code	270634796
Hospital Revenue Code	278
Min. Negotiated Rate	$844.50
Max. Negotiated Rate	$1,362.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,126.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,362.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,238.60
Rate for Payer: Qualcare PPO/HMO/WC	$844.50

PUTTY DBX 10CC

Facility

$5,630.00

Service Code	HCPCS C1713
Hospital Charge Code	270634796
Hospital Revenue Code	278
Min. Negotiated Rate	$135.68
Max. Negotiated Rate	$2,815.00
Rate for Payer: Aetna Commercial	$2,139.40
Rate for Payer: Aetna Medicare Advantage	$1,689.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,435.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,435.65
Rate for Payer: Cigna Commercial	$2,815.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,362.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,238.60
Rate for Payer: Qualcare PPO/HMO/WC	$844.50
Rate for Payer: UnitedHealthcare Community & State	$135.68
Rate for Payer: Wellpoint Medicaid Managed Care	$149.19

PUTTY DBX 10CC

Facility

$7,800.00

Hospital Charge Code	270670905
Hospital Revenue Code	278
Min. Negotiated Rate	$1,170.00
Max. Negotiated Rate	$1,887.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,887.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,716.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.00

PUTTY DBX 1.CC

Facility

$1,100.00

Service Code	HCPCS C1713
Hospital Charge Code	270651986
Hospital Revenue Code	278
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$266.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00

PUTTY DBX 1.CC

Facility

$1,100.00

Service Code	HCPCS C1713
Hospital Charge Code	270651986
Hospital Revenue Code	278
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$550.00
Rate for Payer: Aetna Commercial	$418.00
Rate for Payer: Aetna Medicare Advantage	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.50
Rate for Payer: Cigna Commercial	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.00
Rate for Payer: UnitedHealthcare Community & State	$26.51
Rate for Payer: Wellpoint Medicaid Managed Care	$29.15

PUTTY DBX 2.5CC

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270634795
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$580.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$528.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

PUTTY DBX 2.5CC

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270634795
Hospital Revenue Code	278
Min. Negotiated Rate	$57.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$528.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Community & State	$57.84
Rate for Payer: Wellpoint Medicaid Managed Care	$63.60

PUTTY DBX 5.0CC

Facility

$5,225.00

Service Code	HCPCS C1713
Hospital Charge Code	270676227
Hospital Revenue Code	278
Min. Negotiated Rate	$783.75
Max. Negotiated Rate	$1,264.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,264.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$783.75

PUTTY DBX 5.0CC

Facility

$5,225.00

Service Code	HCPCS C1713
Hospital Charge Code	270676227
Hospital Revenue Code	278
Min. Negotiated Rate	$125.92
Max. Negotiated Rate	$2,612.50
Rate for Payer: Aetna Commercial	$1,985.50
Rate for Payer: Aetna Medicare Advantage	$1,567.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,332.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,332.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,045.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,332.38
Rate for Payer: Cigna Commercial	$2,612.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,264.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$783.75
Rate for Payer: UnitedHealthcare Community & State	$125.92
Rate for Payer: Wellpoint Medicaid Managed Care	$138.46

PUTTY DBX .5CC

Facility

$695.00

Service Code	HCPCS C1713
Hospital Charge Code	270651984
Hospital Revenue Code	278
Min. Negotiated Rate	$16.75
Max. Negotiated Rate	$347.50
Rate for Payer: Aetna Commercial	$264.10
Rate for Payer: Aetna Medicare Advantage	$208.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.22
Rate for Payer: Cigna Commercial	$347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$152.90
Rate for Payer: Qualcare PPO/HMO/WC	$104.25
Rate for Payer: UnitedHealthcare Community & State	$16.75
Rate for Payer: Wellpoint Medicaid Managed Care	$18.42

PUTTY DBX .5CC

Facility

$695.00

Service Code	HCPCS C1713
Hospital Charge Code	270651984
Hospital Revenue Code	278
Min. Negotiated Rate	$104.25
Max. Negotiated Rate	$168.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$168.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$152.90
Rate for Payer: Qualcare PPO/HMO/WC	$104.25

Know your out-of-pocket cost for care.

All Charges