Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RELINE O TI ROD 5.5X45 MM LORD

Facility

$3,960.00

Service Code	HCPCS C1713
Hospital Charge Code	270692796
Hospital Revenue Code	278
Min. Negotiated Rate	$95.44
Max. Negotiated Rate	$1,980.00
Rate for Payer: Aetna Commercial	$1,504.80
Rate for Payer: Aetna Medicare Advantage	$1,188.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,009.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,009.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$792.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,009.80
Rate for Payer: Cigna Commercial	$1,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$958.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$871.20
Rate for Payer: Qualcare PPO/HMO/WC	$594.00
Rate for Payer: UnitedHealthcare Community & State	$95.44
Rate for Payer: Wellpoint Medicaid Managed Care	$104.94

RELINE TULIP MOD

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270691445
Hospital Revenue Code	278
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$1,512.50
Rate for Payer: Aetna Commercial	$1,149.50
Rate for Payer: Aetna Medicare Advantage	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$771.38
Rate for Payer: Cigna Commercial	$1,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$453.75
Rate for Payer: UnitedHealthcare Community & State	$72.90
Rate for Payer: Wellpoint Medicaid Managed Care	$80.16

RELINE TULIP MOD

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270691445
Hospital Revenue Code	278
Min. Negotiated Rate	$453.75
Max. Negotiated Rate	$732.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$453.75

RELOAD 45MM (6ROW, X-LONG)

Facility

$184.00

Hospital Charge Code	270338718
Hospital Revenue Code	272
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$27.60
Rate for Payer: Qualcare PPO/HMO/WC	$27.60

RELOAD 45MM (6ROW, X-LONG)

Facility

$184.00

Hospital Charge Code	270338718
Hospital Revenue Code	272
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$92.00
Rate for Payer: Aetna Commercial	$69.92
Rate for Payer: Aetna Medicare Advantage	$55.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.92
Rate for Payer: Cigna Commercial	$92.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.20
Rate for Payer: Oxford Commercial	$36.80
Rate for Payer: Qualcare PPO/HMO/WC	$27.60
Rate for Payer: UnitedHealthcare Commercial	$36.80
Rate for Payer: UnitedHealthcare Community & State	$4.43
Rate for Payer: Wellpoint Medicaid Managed Care	$4.88

RELOADABLE LINEAR STAPLER 30MM

Facility

$585.00

Hospital Charge Code	270334722
Hospital Revenue Code	272
Min. Negotiated Rate	$87.75
Max. Negotiated Rate	$87.75
Rate for Payer: Qualcare PPO/HMO/WC	$87.75

RELOADABLE LINEAR STAPLER 30MM

Facility

$585.00

Hospital Charge Code	270334722
Hospital Revenue Code	272
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$292.50
Rate for Payer: Aetna Commercial	$222.30
Rate for Payer: Aetna Medicare Advantage	$175.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.18
Rate for Payer: Cigna Commercial	$292.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.50
Rate for Payer: Oxford Commercial	$117.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.75
Rate for Payer: UnitedHealthcare Commercial	$117.00
Rate for Payer: UnitedHealthcare Community & State	$14.10
Rate for Payer: Wellpoint Medicaid Managed Care	$15.50

RELOAD ARTICUL CUTTER 35MM WHT

Facility

$274.48

Hospital Charge Code	270608644
Hospital Revenue Code	272
Min. Negotiated Rate	$41.17
Max. Negotiated Rate	$41.17
Rate for Payer: Qualcare PPO/HMO/WC	$41.17

RELOAD ARTICUL CUTTER 35MM WHT

Facility

$274.48

Hospital Charge Code	270608644
Hospital Revenue Code	272
Min. Negotiated Rate	$6.61
Max. Negotiated Rate	$137.24
Rate for Payer: Aetna Commercial	$104.30
Rate for Payer: Aetna Medicare Advantage	$82.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.99
Rate for Payer: Cigna Commercial	$137.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.34
Rate for Payer: Oxford Commercial	$54.90
Rate for Payer: Qualcare PPO/HMO/WC	$41.17
Rate for Payer: UnitedHealthcare Commercial	$54.90
Rate for Payer: UnitedHealthcare Community & State	$6.61
Rate for Payer: Wellpoint Medicaid Managed Care	$7.27

RELOAD ECHELON 35MM WHITE

Facility

$792.08

Hospital Charge Code	270676633
Hospital Revenue Code	272
Min. Negotiated Rate	$118.81
Max. Negotiated Rate	$118.81
Rate for Payer: Qualcare PPO/HMO/WC	$118.81

RELOAD ECHELON 35MM WHITE

Facility

$792.08

Hospital Charge Code	270676633
Hospital Revenue Code	272
Min. Negotiated Rate	$19.09
Max. Negotiated Rate	$396.04
Rate for Payer: Aetna Commercial	$300.99
Rate for Payer: Aetna Medicare Advantage	$237.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.98
Rate for Payer: Cigna Commercial	$396.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.62
Rate for Payer: Oxford Commercial	$158.42
Rate for Payer: Qualcare PPO/HMO/WC	$118.81
Rate for Payer: UnitedHealthcare Commercial	$158.42
Rate for Payer: UnitedHealthcare Community & State	$19.09
Rate for Payer: Wellpoint Medicaid Managed Care	$20.99

RELOAD ECHELON 45 BLUE

Facility

$879.45

Hospital Charge Code	270662759
Hospital Revenue Code	272
Min. Negotiated Rate	$131.92
Max. Negotiated Rate	$131.92
Rate for Payer: Qualcare PPO/HMO/WC	$131.92

RELOAD ECHELON 45 BLUE

Facility

$879.45

Hospital Charge Code	270662759
Hospital Revenue Code	272
Min. Negotiated Rate	$21.19
Max. Negotiated Rate	$439.73
Rate for Payer: Aetna Commercial	$334.19
Rate for Payer: Aetna Medicare Advantage	$263.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.26
Rate for Payer: Cigna Commercial	$439.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$263.83
Rate for Payer: Oxford Commercial	$175.89
Rate for Payer: Qualcare PPO/HMO/WC	$131.92
Rate for Payer: UnitedHealthcare Commercial	$175.89
Rate for Payer: UnitedHealthcare Community & State	$21.19
Rate for Payer: Wellpoint Medicaid Managed Care	$23.31

RELOAD ECHELON 45 GOLD

Facility

$1,367.20

Hospital Charge Code	270662921
Hospital Revenue Code	272
Min. Negotiated Rate	$32.95
Max. Negotiated Rate	$683.60
Rate for Payer: Aetna Commercial	$519.54
Rate for Payer: Aetna Medicare Advantage	$410.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$348.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$348.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$348.64
Rate for Payer: Cigna Commercial	$683.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$410.16
Rate for Payer: Oxford Commercial	$273.44
Rate for Payer: Qualcare PPO/HMO/WC	$205.08
Rate for Payer: UnitedHealthcare Commercial	$273.44
Rate for Payer: UnitedHealthcare Community & State	$32.95
Rate for Payer: Wellpoint Medicaid Managed Care	$36.23

RELOAD ECHELON 45 GOLD

Facility

$1,367.20

Hospital Charge Code	270662921
Hospital Revenue Code	272
Min. Negotiated Rate	$205.08
Max. Negotiated Rate	$205.08
Rate for Payer: Qualcare PPO/HMO/WC	$205.08

RELOAD ECHELON 45 GRAY

Facility

$879.45

Hospital Charge Code	270662923
Hospital Revenue Code	272
Min. Negotiated Rate	$131.92
Max. Negotiated Rate	$131.92
Rate for Payer: Qualcare PPO/HMO/WC	$131.92

RELOAD ECHELON 45 GRAY

Facility

$879.45

Hospital Charge Code	270662923
Hospital Revenue Code	272
Min. Negotiated Rate	$21.19
Max. Negotiated Rate	$439.73
Rate for Payer: Aetna Commercial	$334.19
Rate for Payer: Aetna Medicare Advantage	$263.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.26
Rate for Payer: Cigna Commercial	$439.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$263.83
Rate for Payer: Oxford Commercial	$175.89
Rate for Payer: Qualcare PPO/HMO/WC	$131.92
Rate for Payer: UnitedHealthcare Commercial	$175.89
Rate for Payer: UnitedHealthcare Community & State	$21.19
Rate for Payer: Wellpoint Medicaid Managed Care	$23.31

RELOAD ECHELON 45 GREEN

Facility

$877.45

Hospital Charge Code	270662922
Hospital Revenue Code	272
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$438.73
Rate for Payer: Aetna Commercial	$333.43
Rate for Payer: Aetna Medicare Advantage	$263.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.75
Rate for Payer: Cigna Commercial	$438.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$263.24
Rate for Payer: Oxford Commercial	$175.49
Rate for Payer: Qualcare PPO/HMO/WC	$131.62
Rate for Payer: UnitedHealthcare Commercial	$175.49
Rate for Payer: UnitedHealthcare Community & State	$21.15
Rate for Payer: Wellpoint Medicaid Managed Care	$23.25

RELOAD ECHELON 45 GREEN

Facility

$877.45

Hospital Charge Code	270662922
Hospital Revenue Code	272
Min. Negotiated Rate	$131.62
Max. Negotiated Rate	$131.62
Rate for Payer: Qualcare PPO/HMO/WC	$131.62

RELOAD ECHELON 45 WHITE

Facility

$1,535.82

Hospital Charge Code	270662789
Hospital Revenue Code	272
Min. Negotiated Rate	$230.37
Max. Negotiated Rate	$230.37
Rate for Payer: Qualcare PPO/HMO/WC	$230.37

RELOAD ECHELON 45 WHITE

Facility

$1,535.82

Hospital Charge Code	270662789
Hospital Revenue Code	272
Min. Negotiated Rate	$37.01
Max. Negotiated Rate	$767.91
Rate for Payer: Aetna Commercial	$583.61
Rate for Payer: Aetna Medicare Advantage	$460.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$391.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$391.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$391.63
Rate for Payer: Cigna Commercial	$767.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$460.75
Rate for Payer: Oxford Commercial	$307.16
Rate for Payer: Qualcare PPO/HMO/WC	$230.37
Rate for Payer: UnitedHealthcare Commercial	$307.16
Rate for Payer: UnitedHealthcare Community & State	$37.01
Rate for Payer: Wellpoint Medicaid Managed Care	$40.70

RELOAD ECHELON 60MM BLACK

Facility

$950.95

Hospital Charge Code	270670862
Hospital Revenue Code	272
Min. Negotiated Rate	$142.64
Max. Negotiated Rate	$142.64
Rate for Payer: Qualcare PPO/HMO/WC	$142.64

RELOAD ECHELON 60MM BLACK

Facility

$950.95

Hospital Charge Code	270670862
Hospital Revenue Code	272
Min. Negotiated Rate	$22.92
Max. Negotiated Rate	$475.48
Rate for Payer: Aetna Commercial	$361.36
Rate for Payer: Aetna Medicare Advantage	$285.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.49
Rate for Payer: Cigna Commercial	$475.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.29
Rate for Payer: Oxford Commercial	$190.19
Rate for Payer: Qualcare PPO/HMO/WC	$142.64
Rate for Payer: UnitedHealthcare Commercial	$190.19
Rate for Payer: UnitedHealthcare Community & State	$22.92
Rate for Payer: Wellpoint Medicaid Managed Care	$25.20

RELOAD ECHELON 60MM BLUE

Facility

$950.95

Hospital Charge Code	270670860
Hospital Revenue Code	272
Min. Negotiated Rate	$142.64
Max. Negotiated Rate	$142.64
Rate for Payer: Qualcare PPO/HMO/WC	$142.64

RELOAD ECHELON 60MM BLUE

Facility

$950.95

Hospital Charge Code	270670860
Hospital Revenue Code	272
Min. Negotiated Rate	$22.92
Max. Negotiated Rate	$475.48
Rate for Payer: Aetna Commercial	$361.36
Rate for Payer: Aetna Medicare Advantage	$285.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.49
Rate for Payer: Cigna Commercial	$475.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.29
Rate for Payer: Oxford Commercial	$190.19
Rate for Payer: Qualcare PPO/HMO/WC	$142.64
Rate for Payer: UnitedHealthcare Commercial	$190.19
Rate for Payer: UnitedHealthcare Community & State	$22.92
Rate for Payer: Wellpoint Medicaid Managed Care	$25.20

Know your out-of-pocket cost for care.

All Charges