Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

36MM LINER 10 58 CUP

Facility

$6,221.55

Hospital Charge Code	270656897
Hospital Revenue Code	278
Min. Negotiated Rate	$149.94
Max. Negotiated Rate	$3,110.78
Rate for Payer: Aetna Commercial	$2,364.19
Rate for Payer: Aetna Medicare Advantage	$1,866.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,586.50
Rate for Payer: Cigna Commercial	$3,110.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,368.74
Rate for Payer: Qualcare PPO/HMO/WC	$933.23
Rate for Payer: UnitedHealthcare Community & State	$149.94
Rate for Payer: Wellpoint Medicaid Managed Care	$164.87

36MM MODULAR HEAD +6MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270666902
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

36MM MODULAR HEAD +6MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270666902
Hospital Revenue Code	278
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

375-950-000 ROUND BUR

Facility

$323.73

Service Code	HCPCS C1713
Hospital Charge Code	270656364
Hospital Revenue Code	278
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$161.87
Rate for Payer: Aetna Commercial	$123.02
Rate for Payer: Aetna Medicare Advantage	$97.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.55
Rate for Payer: Cigna Commercial	$161.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$71.22
Rate for Payer: Qualcare PPO/HMO/WC	$48.56
Rate for Payer: UnitedHealthcare Community & State	$7.80
Rate for Payer: Wellpoint Medicaid Managed Care	$8.58

375-950-000 ROUND BUR

Facility

$323.73

Service Code	HCPCS C1713
Hospital Charge Code	270656364
Hospital Revenue Code	278
Min. Negotiated Rate	$48.56
Max. Negotiated Rate	$78.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$71.22
Rate for Payer: Qualcare PPO/HMO/WC	$48.56

38#2 PE SUT W 1/2 CIR TPR ND

Facility

$300.00

Hospital Charge Code	270688976
Hospital Revenue Code	272
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.00
Rate for Payer: Oxford Commercial	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$60.00
Rate for Payer: UnitedHealthcare Community & State	$7.23
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

38#2 PE SUT W 1/2 CIR TPR ND

Facility

$300.00

Hospital Charge Code	270688976
Hospital Revenue Code	272
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

38MM BRIGADE PLATE, LORDOTIC

Facility

$14,406.00

Service Code	HCPCS C1713
Hospital Charge Code	270703757
Hospital Revenue Code	278
Min. Negotiated Rate	$2,160.90
Max. Negotiated Rate	$3,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,881.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,486.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,169.32
Rate for Payer: Qualcare PPO/HMO/WC	$2,160.90

38MM BRIGADE PLATE, LORDOTIC

Facility

$14,406.00

Service Code	HCPCS C1713
Hospital Charge Code	270703757
Hospital Revenue Code	278
Min. Negotiated Rate	$347.18
Max. Negotiated Rate	$7,203.00
Rate for Payer: Aetna Commercial	$5,474.28
Rate for Payer: Aetna Medicare Advantage	$4,321.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,673.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,673.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,881.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,673.53
Rate for Payer: Cigna Commercial	$7,203.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,486.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,169.32
Rate for Payer: Qualcare PPO/HMO/WC	$2,160.90
Rate for Payer: UnitedHealthcare Community & State	$347.18
Rate for Payer: Wellpoint Medicaid Managed Care	$381.76

3.8MM DRILL BIT

Facility

$1,025.00

Hospital Charge Code	270685090
Hospital Revenue Code	272
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.50
Rate for Payer: Oxford Commercial	$205.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Commercial	$205.00
Rate for Payer: UnitedHealthcare Community & State	$24.70
Rate for Payer: Wellpoint Medicaid Managed Care	$27.16

3.8MM DRILL BIT

Facility

$1,025.00

Hospital Charge Code	270685090
Hospital Revenue Code	272
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$153.75
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

38W X 26L X 17H 15DEGREE CAGE

Facility

$26,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270705949
Hospital Revenue Code	278
Min. Negotiated Rate	$650.10
Max. Negotiated Rate	$13,487.50
Rate for Payer: Aetna Commercial	$10,250.50
Rate for Payer: Aetna Medicare Advantage	$8,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,878.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,878.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,878.62
Rate for Payer: Cigna Commercial	$13,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,527.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,934.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,046.25
Rate for Payer: UnitedHealthcare Community & State	$650.10
Rate for Payer: Wellpoint Medicaid Managed Care	$714.84

38W X 26L X 17H 15DEGREE CAGE

Facility

$26,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270705949
Hospital Revenue Code	278
Min. Negotiated Rate	$4,046.25
Max. Negotiated Rate	$6,527.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,527.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,934.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,046.25

3.8X14MM SCREW

Facility

$4,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270704994
Hospital Revenue Code	278
Min. Negotiated Rate	$103.03
Max. Negotiated Rate	$2,137.50
Rate for Payer: Aetna Commercial	$1,624.50
Rate for Payer: Aetna Medicare Advantage	$1,282.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,090.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,090.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,090.12
Rate for Payer: Cigna Commercial	$2,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$940.50
Rate for Payer: Qualcare PPO/HMO/WC	$641.25
Rate for Payer: UnitedHealthcare Community & State	$103.03
Rate for Payer: Wellpoint Medicaid Managed Care	$113.29

3.8X14MM SCREW

Facility

$4,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270704994
Hospital Revenue Code	278
Min. Negotiated Rate	$641.25
Max. Negotiated Rate	$1,034.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$940.50
Rate for Payer: Qualcare PPO/HMO/WC	$641.25

3.9MM MIS ACHILLES SPDBRG

Facility

$16,454.25

Service Code	HCPCS C1713
Hospital Charge Code	270704142
Hospital Revenue Code	278
Min. Negotiated Rate	$2,468.14
Max. Negotiated Rate	$3,981.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,290.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,981.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,619.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,468.14

3.9MM MIS ACHILLES SPDBRG

Facility

$16,454.25

Service Code	HCPCS C1713
Hospital Charge Code	270704142
Hospital Revenue Code	278
Min. Negotiated Rate	$396.55
Max. Negotiated Rate	$8,227.12
Rate for Payer: Aetna Commercial	$6,252.61
Rate for Payer: Aetna Medicare Advantage	$4,936.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,195.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,195.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,290.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,195.83
Rate for Payer: Cigna Commercial	$8,227.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,981.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,619.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,468.14
Rate for Payer: UnitedHealthcare Community & State	$396.55
Rate for Payer: Wellpoint Medicaid Managed Care	$436.04

3D MAX MESH MEDIUM LEFT

Facility

$1,162.00

Service Code	HCPCS C1781
Hospital Charge Code	270686357
Hospital Revenue Code	278
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$581.00
Rate for Payer: Aetna Commercial	$441.56
Rate for Payer: Aetna Medicare Advantage	$348.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.31
Rate for Payer: Cigna Commercial	$581.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$255.64
Rate for Payer: Qualcare PPO/HMO/WC	$174.30
Rate for Payer: UnitedHealthcare Community & State	$28.00
Rate for Payer: Wellpoint Medicaid Managed Care	$30.79

3D MAX MESH MEDIUM LEFT

Facility

$1,162.00

Service Code	HCPCS C1781
Hospital Charge Code	270686357
Hospital Revenue Code	278
Min. Negotiated Rate	$174.30
Max. Negotiated Rate	$281.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$255.64
Rate for Payer: Qualcare PPO/HMO/WC	$174.30

3D MAX Right Medium (Mesh)

Facility

$1,162.50

Service Code	HCPCS C1781
Hospital Charge Code	270686358
Hospital Revenue Code	278
Min. Negotiated Rate	$28.02
Max. Negotiated Rate	$581.25
Rate for Payer: Aetna Commercial	$441.75
Rate for Payer: Aetna Medicare Advantage	$348.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.44
Rate for Payer: Cigna Commercial	$581.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$255.75
Rate for Payer: Qualcare PPO/HMO/WC	$174.38
Rate for Payer: UnitedHealthcare Community & State	$28.02
Rate for Payer: Wellpoint Medicaid Managed Care	$30.81

3D MAX Right Medium (Mesh)

Facility

$1,162.50

Service Code	HCPCS C1781
Hospital Charge Code	270686358
Hospital Revenue Code	278
Min. Negotiated Rate	$174.38
Max. Negotiated Rate	$281.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$255.75
Rate for Payer: Qualcare PPO/HMO/WC	$174.38

3D RENDER W/INTRP POSTPROCES

Facility

$5,100.00

Service Code	HCPCS 76377
Hospital Charge Code	411076377
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

3D RENDER W/INTRP POSTPROCES

Facility

$5,100.00

Service Code	HCPCS 76377
Hospital Charge Code	366876377
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

3D RENDER W/INTRP POSTPROCES

Facility

$5,100.00

Service Code	HCPCS 76377
Hospital Charge Code	411076377
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

3D RENDER W/INTRP POSTPROCES

Facility

$5,100.00

Service Code	HCPCS 76377
Hospital Charge Code	366876377
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

Know your out-of-pocket cost for care.

All Charges