Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RESTRICTOR BUCKS CEMENT

Facility

$784.00

Hospital Charge Code	270600346
Hospital Revenue Code	274
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$189.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$189.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$172.48
Rate for Payer: Qualcare PPO/HMO/WC	$117.60

RESTRICTOR BUCKS CEMENT

Facility

$784.00

Hospital Charge Code	270600346
Hospital Revenue Code	274
Min. Negotiated Rate	$18.89
Max. Negotiated Rate	$392.00
Rate for Payer: Aetna Commercial	$297.92
Rate for Payer: Aetna Medicare Advantage	$235.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.92
Rate for Payer: Cigna Commercial	$392.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$189.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$172.48
Rate for Payer: Qualcare PPO/HMO/WC	$117.60
Rate for Payer: UnitedHealthcare Community & State	$18.89
Rate for Payer: Wellpoint Medicaid Managed Care	$20.78

RESTRICTOR BUCKS CEMENT PLUG

Facility

$668.00

Hospital Charge Code	270600347
Hospital Revenue Code	272
Min. Negotiated Rate	$100.20
Max. Negotiated Rate	$100.20
Rate for Payer: Qualcare PPO/HMO/WC	$100.20

RESTRICTOR BUCKS CEMENT PLUG

Facility

$668.00

Hospital Charge Code	270600347
Hospital Revenue Code	272
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$334.00
Rate for Payer: Aetna Commercial	$253.84
Rate for Payer: Aetna Medicare Advantage	$200.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.34
Rate for Payer: Cigna Commercial	$334.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.40
Rate for Payer: Oxford Commercial	$133.60
Rate for Payer: Qualcare PPO/HMO/WC	$100.20
Rate for Payer: UnitedHealthcare Commercial	$133.60
Rate for Payer: UnitedHealthcare Community & State	$16.10
Rate for Payer: Wellpoint Medicaid Managed Care	$17.70

RESTRICTOR CEMENT 8-13MM

Facility

$475.00

Hospital Charge Code	270668557
Hospital Revenue Code	278
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

RESTRICTOR CEMENT 8-13MM

Facility

$475.00

Hospital Charge Code	270668557
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

RESTRICTOR CEM SZ2 10.75MM FEM

Facility

$1,255.00

Service Code	HCPCS C1776
Hospital Charge Code	270697345
Hospital Revenue Code	278
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$627.50
Rate for Payer: Aetna Commercial	$476.90
Rate for Payer: Aetna Medicare Advantage	$376.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.02
Rate for Payer: Cigna Commercial	$627.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$276.10
Rate for Payer: Qualcare PPO/HMO/WC	$188.25
Rate for Payer: UnitedHealthcare Community & State	$30.25
Rate for Payer: Wellpoint Medicaid Managed Care	$33.26

RESTRICTOR CEM SZ2 10.75MM FEM

Facility

$1,255.00

Service Code	HCPCS C1776
Hospital Charge Code	270697345
Hospital Revenue Code	278
Min. Negotiated Rate	$188.25
Max. Negotiated Rate	$303.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$276.10
Rate for Payer: Qualcare PPO/HMO/WC	$188.25

RESTRICTOR FEM CEMENT 25MM

Facility

$668.00

Hospital Charge Code	270601213
Hospital Revenue Code	272
Min. Negotiated Rate	$100.20
Max. Negotiated Rate	$100.20
Rate for Payer: Qualcare PPO/HMO/WC	$100.20

RESTRICTOR FEM CEMENT 25MM

Facility

$668.00

Hospital Charge Code	270601213
Hospital Revenue Code	272
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$334.00
Rate for Payer: Aetna Commercial	$253.84
Rate for Payer: Aetna Medicare Advantage	$200.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.34
Rate for Payer: Cigna Commercial	$334.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.40
Rate for Payer: Oxford Commercial	$133.60
Rate for Payer: Qualcare PPO/HMO/WC	$100.20
Rate for Payer: UnitedHealthcare Commercial	$133.60
Rate for Payer: UnitedHealthcare Community & State	$16.10
Rate for Payer: Wellpoint Medicaid Managed Care	$17.70

RESTRICTOR FEMORAL CANAL******

Facility

$48.50

Hospital Charge Code	1601632
Hospital Revenue Code	272
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$24.25
Rate for Payer: Aetna Commercial	$18.43
Rate for Payer: Aetna Medicare Advantage	$14.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.37
Rate for Payer: Cigna Commercial	$24.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.55
Rate for Payer: Oxford Commercial	$9.70
Rate for Payer: Qualcare PPO/HMO/WC	$7.28
Rate for Payer: UnitedHealthcare Commercial	$9.70
Rate for Payer: UnitedHealthcare Community & State	$1.17
Rate for Payer: Wellpoint Medicaid Managed Care	$1.29

RESTRICTOR FEMORAL CANAL******

Facility

$48.50

Hospital Charge Code	1601632
Hospital Revenue Code	272
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$7.28
Rate for Payer: Qualcare PPO/HMO/WC	$7.28

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	74117002
Hospital Revenue Code	341
Min. Negotiated Rate	$256.78
Max. Negotiated Rate	$5,552.01
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,552.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,552.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,552.01
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,076.66
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,196.41
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$256.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$282.35

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	74116002
Hospital Revenue Code	341
Min. Negotiated Rate	$1,598.21
Max. Negotiated Rate	$1,598.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21

REST TEST

Facility

$6,315.40

Service Code	HCPCS 78452
Hospital Charge Code	36540010
Hospital Revenue Code	341
Min. Negotiated Rate	$947.31
Max. Negotiated Rate	$947.31
Rate for Payer: Qualcare PPO/HMO/WC	$947.31

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	74115002
Hospital Revenue Code	341
Min. Negotiated Rate	$1,598.21
Max. Negotiated Rate	$1,598.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	74116002
Hospital Revenue Code	341
Min. Negotiated Rate	$256.78
Max. Negotiated Rate	$5,552.01
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,552.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,552.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,552.01
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,076.66
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,196.41
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$256.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$282.35

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	5307001
Hospital Revenue Code	341
Min. Negotiated Rate	$256.78
Max. Negotiated Rate	$5,552.01
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,552.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,552.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,552.01
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,076.66
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,196.41
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$256.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$282.35

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	74115002
Hospital Revenue Code	341
Min. Negotiated Rate	$256.78
Max. Negotiated Rate	$5,552.01
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,552.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,552.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,552.01
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,076.66
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,196.41
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$256.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$282.35

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	94053001
Hospital Revenue Code	341
Min. Negotiated Rate	$256.78
Max. Negotiated Rate	$5,552.01
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,552.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,552.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,552.01
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,076.66
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,196.41
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$256.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$282.35

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	5307001
Hospital Revenue Code	341
Min. Negotiated Rate	$1,598.21
Max. Negotiated Rate	$1,598.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	74117002
Hospital Revenue Code	341
Min. Negotiated Rate	$1,598.21
Max. Negotiated Rate	$1,598.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21

REST TEST

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	94053001
Hospital Revenue Code	341
Min. Negotiated Rate	$1,598.21
Max. Negotiated Rate	$1,598.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21

REST TEST

Facility

$6,315.40

Service Code	HCPCS 78452
Hospital Charge Code	36540010
Hospital Revenue Code	341
Min. Negotiated Rate	$152.20
Max. Negotiated Rate	$5,552.01
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,552.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,552.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,552.01
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,076.66
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,894.62
Rate for Payer: Oxford Commercial	$3,120.00
Rate for Payer: Qualcare PPO/HMO/WC	$947.31
Rate for Payer: UnitedHealthcare Commercial	$5,021.00
Rate for Payer: UnitedHealthcare Community & State	$152.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$167.36

RESURFACING PATELLA

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677547
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

Know your out-of-pocket cost for care.

All Charges