Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PUTTY NEVOS DBM 2.5CC

Facility

$4,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270693281
Hospital Revenue Code	278
Min. Negotiated Rate	$99.41
Max. Negotiated Rate	$2,062.50
Rate for Payer: Aetna Commercial	$1,567.50
Rate for Payer: Aetna Medicare Advantage	$1,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.88
Rate for Payer: Cigna Commercial	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$618.75
Rate for Payer: UnitedHealthcare Community & State	$99.41
Rate for Payer: Wellpoint Medicaid Managed Care	$109.31

PUTTY NEVOS DBM 2.5CC

Facility

$4,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270693281
Hospital Revenue Code	278
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$998.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$618.75

PUTTY NEVOS DBM 5CC

Facility

$5,670.00

Service Code	HCPCS C1713
Hospital Charge Code	270692644
Hospital Revenue Code	278
Min. Negotiated Rate	$136.65
Max. Negotiated Rate	$2,835.00
Rate for Payer: Aetna Commercial	$2,154.60
Rate for Payer: Aetna Medicare Advantage	$1,701.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,445.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,445.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,134.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,445.85
Rate for Payer: Cigna Commercial	$2,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,372.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,247.40
Rate for Payer: Qualcare PPO/HMO/WC	$850.50
Rate for Payer: UnitedHealthcare Community & State	$136.65
Rate for Payer: Wellpoint Medicaid Managed Care	$150.25

PUTTY NEVOS DBM 5CC

Facility

$5,670.00

Service Code	HCPCS C1713
Hospital Charge Code	270692644
Hospital Revenue Code	278
Min. Negotiated Rate	$850.50
Max. Negotiated Rate	$1,372.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,134.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,372.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,247.40
Rate for Payer: Qualcare PPO/HMO/WC	$850.50

PUTTY NEVOS PLUS 1CC

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692535
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

PUTTY NEVOS PLUS 1CC

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692535
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

PUTTY NORIAN FASTSET 10CC

Facility

$11,916.00

Service Code	HCPCS C1713
Hospital Charge Code	270684301
Hospital Revenue Code	278
Min. Negotiated Rate	$287.18
Max. Negotiated Rate	$5,958.00
Rate for Payer: Aetna Commercial	$4,528.08
Rate for Payer: Aetna Medicare Advantage	$3,574.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,038.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,038.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,383.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,038.58
Rate for Payer: Cigna Commercial	$5,958.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,883.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,621.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,787.40
Rate for Payer: UnitedHealthcare Community & State	$287.18
Rate for Payer: Wellpoint Medicaid Managed Care	$315.77

PUTTY NORIAN FASTSET 10CC

Facility

$11,916.00

Service Code	HCPCS C1713
Hospital Charge Code	270684301
Hospital Revenue Code	278
Min. Negotiated Rate	$1,787.40
Max. Negotiated Rate	$2,883.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,383.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,883.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,621.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,787.40

PUTTY NORIAN FASTSET 3CC

Facility

$3,480.00

Hospital Charge Code	270677457
Hospital Revenue Code	278
Min. Negotiated Rate	$522.00
Max. Negotiated Rate	$842.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$842.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$765.60
Rate for Payer: Qualcare PPO/HMO/WC	$522.00

PUTTY NORIAN FASTSET 3CC

Facility

$3,480.00

Hospital Charge Code	270677457
Hospital Revenue Code	278
Min. Negotiated Rate	$83.87
Max. Negotiated Rate	$1,740.00
Rate for Payer: Aetna Commercial	$1,322.40
Rate for Payer: Aetna Medicare Advantage	$1,044.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$887.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$887.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$696.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$887.40
Rate for Payer: Cigna Commercial	$1,740.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$842.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$765.60
Rate for Payer: Qualcare PPO/HMO/WC	$522.00
Rate for Payer: UnitedHealthcare Community & State	$83.87
Rate for Payer: Wellpoint Medicaid Managed Care	$92.22

PUTTY NORIAN FASTSET 5CC

Facility

$5,715.00

Hospital Charge Code	270677458
Hospital Revenue Code	278
Min. Negotiated Rate	$137.73
Max. Negotiated Rate	$2,857.50
Rate for Payer: Aetna Commercial	$2,171.70
Rate for Payer: Aetna Medicare Advantage	$1,714.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,457.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,457.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,143.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,457.33
Rate for Payer: Cigna Commercial	$2,857.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,383.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,257.30
Rate for Payer: Qualcare PPO/HMO/WC	$857.25
Rate for Payer: UnitedHealthcare Community & State	$137.73
Rate for Payer: Wellpoint Medicaid Managed Care	$151.45

PUTTY NORIAN FASTSET 5CC

Facility

$5,715.00

Hospital Charge Code	270677458
Hospital Revenue Code	278
Min. Negotiated Rate	$857.25
Max. Negotiated Rate	$1,383.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,143.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,383.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,257.30
Rate for Payer: Qualcare PPO/HMO/WC	$857.25

PUTTY NORIAN INJECTABLE 3CC

Facility

$3,691.95

Service Code	HCPCS C1713
Hospital Charge Code	270675388
Hospital Revenue Code	278
Min. Negotiated Rate	$88.98
Max. Negotiated Rate	$1,845.97
Rate for Payer: Aetna Commercial	$1,402.94
Rate for Payer: Aetna Medicare Advantage	$1,107.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$941.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$941.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$738.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$941.45
Rate for Payer: Cigna Commercial	$1,845.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$893.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$812.23
Rate for Payer: Qualcare PPO/HMO/WC	$553.79
Rate for Payer: UnitedHealthcare Community & State	$88.98
Rate for Payer: Wellpoint Medicaid Managed Care	$97.84

PUTTY NORIAN INJECTABLE 3CC

Facility

$3,691.95

Service Code	HCPCS C1713
Hospital Charge Code	270675388
Hospital Revenue Code	278
Min. Negotiated Rate	$553.79
Max. Negotiated Rate	$893.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$738.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$893.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$812.23
Rate for Payer: Qualcare PPO/HMO/WC	$553.79

PUTTY NORIAN INJECTABLE 5CC

Facility

$6,063.05

Service Code	HCPCS C1713
Hospital Charge Code	270675389
Hospital Revenue Code	278
Min. Negotiated Rate	$146.12
Max. Negotiated Rate	$3,031.53
Rate for Payer: Aetna Commercial	$2,303.96
Rate for Payer: Aetna Medicare Advantage	$1,818.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,546.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,546.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,212.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,546.08
Rate for Payer: Cigna Commercial	$3,031.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,467.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,333.87
Rate for Payer: Qualcare PPO/HMO/WC	$909.46
Rate for Payer: UnitedHealthcare Community & State	$146.12
Rate for Payer: Wellpoint Medicaid Managed Care	$160.67

PUTTY NORIAN INJECTABLE 5CC

Facility

$6,063.05

Service Code	HCPCS C1713
Hospital Charge Code	270675389
Hospital Revenue Code	278
Min. Negotiated Rate	$909.46
Max. Negotiated Rate	$1,467.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,212.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,467.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,333.87
Rate for Payer: Qualcare PPO/HMO/WC	$909.46

PUTTY NORIAN INJECTBL 10cc

Facility

$11,916.00

Service Code	HCPCS C1713
Hospital Charge Code	270661250
Hospital Revenue Code	278
Min. Negotiated Rate	$287.18
Max. Negotiated Rate	$5,958.00
Rate for Payer: Aetna Commercial	$4,528.08
Rate for Payer: Aetna Medicare Advantage	$3,574.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,038.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,038.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,383.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,038.58
Rate for Payer: Cigna Commercial	$5,958.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,883.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,621.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,787.40
Rate for Payer: UnitedHealthcare Community & State	$287.18
Rate for Payer: Wellpoint Medicaid Managed Care	$315.77

PUTTY NORIAN INJECTBL 10cc

Facility

$11,916.00

Service Code	HCPCS C1713
Hospital Charge Code	270661250
Hospital Revenue Code	278
Min. Negotiated Rate	$1,787.40
Max. Negotiated Rate	$2,883.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,383.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,883.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,621.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,787.40

PUTTY OPTUM DMB 10CC

Facility

$4,866.00

Service Code	HCPCS C1713
Hospital Charge Code	270657605
Hospital Revenue Code	278
Min. Negotiated Rate	$117.27
Max. Negotiated Rate	$2,433.00
Rate for Payer: Aetna Commercial	$1,849.08
Rate for Payer: Aetna Medicare Advantage	$1,459.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,240.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,240.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$973.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,240.83
Rate for Payer: Cigna Commercial	$2,433.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,177.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,070.52
Rate for Payer: Qualcare PPO/HMO/WC	$729.90
Rate for Payer: UnitedHealthcare Community & State	$117.27
Rate for Payer: Wellpoint Medicaid Managed Care	$128.95

PUTTY OPTUM DMB 10CC

Facility

$4,866.00

Service Code	HCPCS C1713
Hospital Charge Code	270657605
Hospital Revenue Code	278
Min. Negotiated Rate	$729.90
Max. Negotiated Rate	$1,177.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$973.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,177.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,070.52
Rate for Payer: Qualcare PPO/HMO/WC	$729.90

PUTTY OPTUM DMB 5CC

Facility

$3,307.50

Service Code	HCPCS C1713
Hospital Charge Code	270669847
Hospital Revenue Code	278
Min. Negotiated Rate	$496.12
Max. Negotiated Rate	$800.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$661.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$800.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$727.65
Rate for Payer: Qualcare PPO/HMO/WC	$496.12

PUTTY OPTUM DMB 5CC

Facility

$3,307.50

Service Code	HCPCS C1713
Hospital Charge Code	270669847
Hospital Revenue Code	278
Min. Negotiated Rate	$79.71
Max. Negotiated Rate	$1,653.75
Rate for Payer: Aetna Commercial	$1,256.85
Rate for Payer: Aetna Medicare Advantage	$992.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$843.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$843.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$661.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$843.41
Rate for Payer: Cigna Commercial	$1,653.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$800.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$727.65
Rate for Payer: Qualcare PPO/HMO/WC	$496.12
Rate for Payer: UnitedHealthcare Community & State	$79.71
Rate for Payer: Wellpoint Medicaid Managed Care	$87.65

PUTTY OSTEOSTRUX

Facility

$17,675.00

Hospital Charge Code	270674945
Hospital Revenue Code	278
Min. Negotiated Rate	$2,651.25
Max. Negotiated Rate	$4,277.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,277.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,888.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,651.25

PUTTY OSTEOSTRUX

Facility

$17,675.00

Hospital Charge Code	270674945
Hospital Revenue Code	278
Min. Negotiated Rate	$425.97
Max. Negotiated Rate	$8,837.50
Rate for Payer: Aetna Commercial	$6,716.50
Rate for Payer: Aetna Medicare Advantage	$5,302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,507.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,507.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,535.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,507.12
Rate for Payer: Cigna Commercial	$8,837.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,277.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,888.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,651.25
Rate for Payer: UnitedHealthcare Community & State	$425.97
Rate for Payer: Wellpoint Medicaid Managed Care	$468.39

PUTTY OSTEROSURGE 300 10CC

Facility

$10,530.00

Service Code	HCPCS C1713
Hospital Charge Code	270694257
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.50
Max. Negotiated Rate	$2,548.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,106.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.50

Know your out-of-pocket cost for care.

All Charges