Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PUTTY DMB MATRIXOSTEOSELECT5CC

Facility

$3,081.25

Service Code	HCPCS C1713
Hospital Charge Code	270698901
Hospital Revenue Code	278
Min. Negotiated Rate	$462.19
Max. Negotiated Rate	$745.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$616.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$745.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$677.88
Rate for Payer: Qualcare PPO/HMO/WC	$462.19

PUTTY DMB MATRIXOSTEOSELECT5CC

Facility

$3,081.25

Service Code	HCPCS C1713
Hospital Charge Code	270698901
Hospital Revenue Code	278
Min. Negotiated Rate	$74.26
Max. Negotiated Rate	$1,540.62
Rate for Payer: Aetna Commercial	$1,170.88
Rate for Payer: Aetna Medicare Advantage	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$785.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$785.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$616.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$785.72
Rate for Payer: Cigna Commercial	$1,540.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$745.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$677.88
Rate for Payer: Qualcare PPO/HMO/WC	$462.19
Rate for Payer: UnitedHealthcare Community & State	$74.26
Rate for Payer: Wellpoint Medicaid Managed Care	$81.65

PUTTY DPM SYRINGE 1 CC

Facility

$2,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270680748
Hospital Revenue Code	278
Min. Negotiated Rate	$58.44
Max. Negotiated Rate	$1,212.50
Rate for Payer: Aetna Commercial	$921.50
Rate for Payer: Aetna Medicare Advantage	$727.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$618.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$618.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$618.38
Rate for Payer: Cigna Commercial	$1,212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$586.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$533.50
Rate for Payer: Qualcare PPO/HMO/WC	$363.75
Rate for Payer: UnitedHealthcare Community & State	$58.44
Rate for Payer: Wellpoint Medicaid Managed Care	$64.26

PUTTY DPM SYRINGE 1 CC

Facility

$2,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270680748
Hospital Revenue Code	278
Min. Negotiated Rate	$363.75
Max. Negotiated Rate	$586.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$485.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$586.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$533.50
Rate for Payer: Qualcare PPO/HMO/WC	$363.75

PUTTY DYNAGRAFT 1CC 71010

Facility

$1,196.85

Hospital Charge Code	270615405
Hospital Revenue Code	278
Min. Negotiated Rate	$179.53
Max. Negotiated Rate	$289.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$239.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$289.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$263.31
Rate for Payer: Qualcare PPO/HMO/WC	$179.53

PUTTY DYNAGRAFT 1CC 71010

Facility

$1,196.85

Hospital Charge Code	270615405
Hospital Revenue Code	278
Min. Negotiated Rate	$28.84
Max. Negotiated Rate	$598.42
Rate for Payer: Aetna Commercial	$454.80
Rate for Payer: Aetna Medicare Advantage	$359.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$305.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$305.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$239.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$305.20
Rate for Payer: Cigna Commercial	$598.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$289.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$263.31
Rate for Payer: Qualcare PPO/HMO/WC	$179.53
Rate for Payer: UnitedHealthcare Community & State	$28.84
Rate for Payer: Wellpoint Medicaid Managed Care	$31.72

PUTTY FAST SET 10cc STERILE

Facility

$11,953.65

Hospital Charge Code	270636083
Hospital Revenue Code	278
Min. Negotiated Rate	$1,793.05
Max. Negotiated Rate	$2,892.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,892.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,629.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,793.05

PUTTY FAST SET 10cc STERILE

Facility

$11,953.65

Hospital Charge Code	270636083
Hospital Revenue Code	278
Min. Negotiated Rate	$288.08
Max. Negotiated Rate	$5,976.82
Rate for Payer: Aetna Commercial	$4,542.39
Rate for Payer: Aetna Medicare Advantage	$3,586.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,048.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,048.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,048.18
Rate for Payer: Cigna Commercial	$5,976.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,892.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,629.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,793.05
Rate for Payer: UnitedHealthcare Community & State	$288.08
Rate for Payer: Wellpoint Medicaid Managed Care	$316.77

PUTTY FAST SET 5cc SRS-005-FSP

Facility

$7,533.00

Hospital Charge Code	270637031
Hospital Revenue Code	278
Min. Negotiated Rate	$181.55
Max. Negotiated Rate	$3,766.50
Rate for Payer: Aetna Commercial	$2,862.54
Rate for Payer: Aetna Medicare Advantage	$2,259.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,920.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,920.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,506.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,920.91
Rate for Payer: Cigna Commercial	$3,766.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,822.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,657.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,129.95
Rate for Payer: UnitedHealthcare Community & State	$181.55
Rate for Payer: Wellpoint Medicaid Managed Care	$199.62

PUTTY FAST SET 5cc SRS-005-FSP

Facility

$7,533.00

Hospital Charge Code	270637031
Hospital Revenue Code	278
Min. Negotiated Rate	$1,129.95
Max. Negotiated Rate	$1,822.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,506.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,822.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,657.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,129.95

PUTTY FIBER APEX 10CC

Facility

$16,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270697835
Hospital Revenue Code	278
Min. Negotiated Rate	$385.60
Max. Negotiated Rate	$8,000.00
Rate for Payer: Aetna Commercial	$6,080.00
Rate for Payer: Aetna Medicare Advantage	$4,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,080.00
Rate for Payer: Cigna Commercial	$8,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00
Rate for Payer: UnitedHealthcare Community & State	$385.60
Rate for Payer: Wellpoint Medicaid Managed Care	$424.00

PUTTY FIBER APEX 10CC

Facility

$16,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270697835
Hospital Revenue Code	278
Min. Negotiated Rate	$2,400.00
Max. Negotiated Rate	$3,872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00

PUTTY FIBERGRAFT BG 1CC

Facility

$2,049.00

Service Code	HCPCS C1713
Hospital Charge Code	270698988
Hospital Revenue Code	278
Min. Negotiated Rate	$307.35
Max. Negotiated Rate	$495.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$409.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$495.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$450.78
Rate for Payer: Qualcare PPO/HMO/WC	$307.35

PUTTY FIBERGRAFT BG 1CC

Facility

$2,049.00

Service Code	HCPCS C1713
Hospital Charge Code	270698988
Hospital Revenue Code	278
Min. Negotiated Rate	$49.38
Max. Negotiated Rate	$1,024.50
Rate for Payer: Aetna Commercial	$778.62
Rate for Payer: Aetna Medicare Advantage	$614.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$409.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.50
Rate for Payer: Cigna Commercial	$1,024.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$495.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$450.78
Rate for Payer: Qualcare PPO/HMO/WC	$307.35
Rate for Payer: UnitedHealthcare Community & State	$49.38
Rate for Payer: Wellpoint Medicaid Managed Care	$54.30

PUTTY FIBERGRAFT BG 6ML

Facility

$9,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270700130
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$2,286.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,079.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50

PUTTY FIBERGRAFT BG 6ML

Facility

$9,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270700130
Hospital Revenue Code	278
Min. Negotiated Rate	$227.75
Max. Negotiated Rate	$4,725.00
Rate for Payer: Aetna Commercial	$3,591.00
Rate for Payer: Aetna Medicare Advantage	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,409.75
Rate for Payer: Cigna Commercial	$4,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,079.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50
Rate for Payer: UnitedHealthcare Community & State	$227.75
Rate for Payer: Wellpoint Medicaid Managed Care	$250.43

PUTTY GRAFTON 10CC 943110

Facility

$3,412.00

Hospital Charge Code	270607537
Hospital Revenue Code	278
Min. Negotiated Rate	$82.23
Max. Negotiated Rate	$1,706.00
Rate for Payer: Aetna Commercial	$1,296.56
Rate for Payer: Aetna Medicare Advantage	$1,023.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$870.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$870.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$682.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$870.06
Rate for Payer: Cigna Commercial	$1,706.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$825.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$750.64
Rate for Payer: Qualcare PPO/HMO/WC	$511.80
Rate for Payer: UnitedHealthcare Community & State	$82.23
Rate for Payer: Wellpoint Medicaid Managed Care	$90.42

PUTTY GRAFTON 10CC 943110

Facility

$3,412.00

Hospital Charge Code	270607537
Hospital Revenue Code	278
Min. Negotiated Rate	$511.80
Max. Negotiated Rate	$825.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$682.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$825.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$750.64
Rate for Payer: Qualcare PPO/HMO/WC	$511.80

PUTTY GRAFTON 10c STER 343110

Facility

$5,410.00

Service Code	HCPCS C9359
Hospital Charge Code	270631283
Hospital Revenue Code	278
Min. Negotiated Rate	$130.38
Max. Negotiated Rate	$2,705.00
Rate for Payer: Aetna Commercial	$2,055.80
Rate for Payer: Aetna Medicare Advantage	$1,623.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,379.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,379.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,082.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,379.55
Rate for Payer: Cigna Commercial	$2,705.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,309.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,190.20
Rate for Payer: Qualcare PPO/HMO/WC	$811.50
Rate for Payer: UnitedHealthcare Community & State	$130.38
Rate for Payer: Wellpoint Medicaid Managed Care	$143.37

PUTTY GRAFTON 10c STER 343110

Facility

$5,410.00

Service Code	HCPCS C9359
Hospital Charge Code	270631283
Hospital Revenue Code	278
Min. Negotiated Rate	$811.50
Max. Negotiated Rate	$1,309.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,082.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,309.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,190.20
Rate for Payer: Qualcare PPO/HMO/WC	$811.50

PUTTY GRAFTON 2.5CC 123103

Facility

$2,525.00

Service Code	HCPCS C9359
Hospital Charge Code	270617953
Hospital Revenue Code	278
Min. Negotiated Rate	$60.85
Max. Negotiated Rate	$1,262.50
Rate for Payer: Aetna Commercial	$959.50
Rate for Payer: Aetna Medicare Advantage	$757.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$643.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$643.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$505.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$643.88
Rate for Payer: Cigna Commercial	$1,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$611.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$555.50
Rate for Payer: Qualcare PPO/HMO/WC	$378.75
Rate for Payer: UnitedHealthcare Community & State	$60.85
Rate for Payer: Wellpoint Medicaid Managed Care	$66.91

PUTTY GRAFTON 2.5CC 123103

Facility

$2,525.00

Service Code	HCPCS C9359
Hospital Charge Code	270617953
Hospital Revenue Code	278
Min. Negotiated Rate	$378.75
Max. Negotiated Rate	$611.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$611.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$555.50
Rate for Payer: Qualcare PPO/HMO/WC	$378.75

PUTTY GRAFTON 5CC 123105

Facility

$4,585.00

Service Code	HCPCS C9359
Hospital Charge Code	270613259
Hospital Revenue Code	278
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$2,292.50
Rate for Payer: Aetna Commercial	$1,742.30
Rate for Payer: Aetna Medicare Advantage	$1,375.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,169.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,169.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$917.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,169.17
Rate for Payer: Cigna Commercial	$2,292.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,109.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,008.70
Rate for Payer: Qualcare PPO/HMO/WC	$687.75
Rate for Payer: UnitedHealthcare Community & State	$110.50
Rate for Payer: Wellpoint Medicaid Managed Care	$121.50

PUTTY GRAFTON 5CC 123105

Facility

$4,585.00

Service Code	HCPCS C9359
Hospital Charge Code	270613259
Hospital Revenue Code	278
Min. Negotiated Rate	$687.75
Max. Negotiated Rate	$1,109.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$917.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,109.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,008.70
Rate for Payer: Qualcare PPO/HMO/WC	$687.75

PUTTY GRAFTON 5CC PRETX 523105

Facility

$3,510.00

Service Code	HCPCS C9359
Hospital Charge Code	270622366
Hospital Revenue Code	278
Min. Negotiated Rate	$84.59
Max. Negotiated Rate	$1,755.00
Rate for Payer: Aetna Commercial	$1,333.80
Rate for Payer: Aetna Medicare Advantage	$1,053.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$895.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$895.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$702.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$895.05
Rate for Payer: Cigna Commercial	$1,755.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$849.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$772.20
Rate for Payer: Qualcare PPO/HMO/WC	$526.50
Rate for Payer: UnitedHealthcare Community & State	$84.59
Rate for Payer: Wellpoint Medicaid Managed Care	$93.02

Know your out-of-pocket cost for care.

All Charges