Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHELL FREEDOM CONSTR 36MM TAPE

Facility

$7,920.00

Service Code	HCPCS C1776
Hospital Charge Code	270692924
Hospital Revenue Code	278
Min. Negotiated Rate	$190.87
Max. Negotiated Rate	$3,960.00
Rate for Payer: Aetna Commercial	$3,009.60
Rate for Payer: Aetna Medicare Advantage	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,019.60
Rate for Payer: Cigna Commercial	$3,960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,742.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,188.00
Rate for Payer: UnitedHealthcare Community & State	$190.87
Rate for Payer: Wellpoint Medicaid Managed Care	$209.88

SHELL G7 OSSEOTI 3H 48MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270694570
Hospital Revenue Code	278
Min. Negotiated Rate	$378.85
Max. Negotiated Rate	$7,860.00
Rate for Payer: Aetna Commercial	$5,973.60
Rate for Payer: Aetna Medicare Advantage	$4,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,008.60
Rate for Payer: Cigna Commercial	$7,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,458.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00
Rate for Payer: UnitedHealthcare Community & State	$378.85
Rate for Payer: Wellpoint Medicaid Managed Care	$416.58

SHELL G7 OSSEOTI 3H 48MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270694570
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$3,804.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,458.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

SHELL G7 OSSEO TI 4H 58MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270693728
Hospital Revenue Code	278
Min. Negotiated Rate	$378.85
Max. Negotiated Rate	$7,860.00
Rate for Payer: Aetna Commercial	$5,973.60
Rate for Payer: Aetna Medicare Advantage	$4,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,008.60
Rate for Payer: Cigna Commercial	$7,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,458.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00
Rate for Payer: UnitedHealthcare Community & State	$378.85
Rate for Payer: Wellpoint Medicaid Managed Care	$416.58

SHELL G7 OSSEO TI 4H 58MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270693728
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$3,804.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,458.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

SHELL G7 OSSEOTI 4HOLE 60MM G

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270694751
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$3,804.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,458.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

SHELL G7 OSSEOTI 4HOLE 60MM G

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270694751
Hospital Revenue Code	278
Min. Negotiated Rate	$378.85
Max. Negotiated Rate	$7,860.00
Rate for Payer: Aetna Commercial	$5,973.60
Rate for Payer: Aetna Medicare Advantage	$4,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,008.60
Rate for Payer: Cigna Commercial	$7,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,458.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00
Rate for Payer: UnitedHealthcare Community & State	$378.85
Rate for Payer: Wellpoint Medicaid Managed Care	$416.58

SHELLG7OSSEOTMULTIHOLE58MMG

Facility

$18,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270693415
Hospital Revenue Code	278
Min. Negotiated Rate	$457.66
Max. Negotiated Rate	$9,495.00
Rate for Payer: Aetna Commercial	$7,216.20
Rate for Payer: Aetna Medicare Advantage	$5,697.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,842.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,842.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,798.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,842.45
Rate for Payer: Cigna Commercial	$9,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,595.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,177.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,848.50
Rate for Payer: UnitedHealthcare Community & State	$457.66
Rate for Payer: Wellpoint Medicaid Managed Care	$503.24

SHELLG7OSSEOTMULTIHOLE58MMG

Facility

$18,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270693415
Hospital Revenue Code	278
Min. Negotiated Rate	$2,848.50
Max. Negotiated Rate	$4,595.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,798.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,595.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,177.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,848.50

SHELL GRIPTON 50MM

Facility

$6,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688139
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

SHELL GRIPTON 50MM

Facility

$6,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688139
Hospital Revenue Code	278
Min. Negotiated Rate	$162.68
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$162.68
Rate for Payer: Wellpoint Medicaid Managed Care	$178.88

SHELL GRIPTON 52MM

Facility

$6,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688177
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

SHELL GRIPTON 52MM

Facility

$6,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688177
Hospital Revenue Code	278
Min. Negotiated Rate	$162.68
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$162.68
Rate for Payer: Wellpoint Medicaid Managed Care	$178.88

SHELL HEMI SOLID BACK 52MM

Facility

$12,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270679082
Hospital Revenue Code	278
Min. Negotiated Rate	$1,866.75
Max. Negotiated Rate	$3,011.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,489.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,011.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,737.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,866.75

SHELL HEMI SOLID BACK 52MM

Facility

$12,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270679082
Hospital Revenue Code	278
Min. Negotiated Rate	$299.92
Max. Negotiated Rate	$6,222.50
Rate for Payer: Aetna Commercial	$4,729.10
Rate for Payer: Aetna Medicare Advantage	$3,733.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,173.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,173.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,489.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,173.47
Rate for Payer: Cigna Commercial	$6,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,011.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,737.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,866.75
Rate for Payer: UnitedHealthcare Community & State	$299.92
Rate for Payer: Wellpoint Medicaid Managed Care	$329.79

SHELL HEMI SOLID BACK 54MM

Facility

$12,447.50

Service Code	HCPCS C1776
Hospital Charge Code	270678862
Hospital Revenue Code	278
Min. Negotiated Rate	$1,867.12
Max. Negotiated Rate	$3,012.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,489.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,012.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,738.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,867.12

SHELL HEMI SOLID BACK 54MM

Facility

$12,447.50

Service Code	HCPCS C1776
Hospital Charge Code	270678862
Hospital Revenue Code	278
Min. Negotiated Rate	$299.98
Max. Negotiated Rate	$6,223.75
Rate for Payer: Aetna Commercial	$4,730.05
Rate for Payer: Aetna Medicare Advantage	$3,734.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,174.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,174.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,489.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,174.11
Rate for Payer: Cigna Commercial	$6,223.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,012.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,738.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,867.12
Rate for Payer: UnitedHealthcare Community & State	$299.98
Rate for Payer: Wellpoint Medicaid Managed Care	$329.86

SHELL HEMI SOLID BACK 58MM

Facility

$5,754.90

Hospital Charge Code	270677483
Hospital Revenue Code	278
Min. Negotiated Rate	$863.24
Max. Negotiated Rate	$1,392.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,392.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,266.08
Rate for Payer: Qualcare PPO/HMO/WC	$863.24

SHELL HEMI SOLID BACK 58MM

Facility

$5,754.90

Hospital Charge Code	270677483
Hospital Revenue Code	278
Min. Negotiated Rate	$138.69
Max. Negotiated Rate	$2,877.45
Rate for Payer: Aetna Commercial	$2,186.86
Rate for Payer: Aetna Medicare Advantage	$1,726.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,467.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,467.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,467.50
Rate for Payer: Cigna Commercial	$2,877.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,392.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,266.08
Rate for Payer: Qualcare PPO/HMO/WC	$863.24
Rate for Payer: UnitedHealthcare Community & State	$138.69
Rate for Payer: Wellpoint Medicaid Managed Care	$152.50

SHELL LORDOT H11 FLHWK 25MM

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270696183
Hospital Revenue Code	278
Min. Negotiated Rate	$475.98
Max. Negotiated Rate	$9,875.00
Rate for Payer: Aetna Commercial	$7,505.00
Rate for Payer: Aetna Medicare Advantage	$5,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,036.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,036.25
Rate for Payer: Cigna Commercial	$9,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,345.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50
Rate for Payer: UnitedHealthcare Community & State	$475.98
Rate for Payer: Wellpoint Medicaid Managed Care	$523.38

SHELL LORDOT H11 FLHWK 25MM

Facility

$19,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270696183
Hospital Revenue Code	278
Min. Negotiated Rate	$2,962.50
Max. Negotiated Rate	$4,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,779.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,345.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,962.50

SHELL LORDOTIC 29 MM TI 9 DEG

Facility

$18,975.00

Service Code	HCPCS L8699
Hospital Charge Code	270692917
Hospital Revenue Code	278
Min. Negotiated Rate	$457.30
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$7,210.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25
Rate for Payer: UnitedHealthcare Community & State	$457.30
Rate for Payer: Wellpoint Medicaid Managed Care	$502.84

SHELL LORDOTIC 29 MM TI 9 DEG

Facility

$18,975.00

Service Code	HCPCS L8699
Hospital Charge Code	270692917
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

SHELL M2A 60x54 US157860

Facility

$16,195.00

Hospital Charge Code	270638624
Hospital Revenue Code	278
Min. Negotiated Rate	$390.30
Max. Negotiated Rate	$8,097.50
Rate for Payer: Aetna Commercial	$6,154.10
Rate for Payer: Aetna Medicare Advantage	$4,858.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,129.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,129.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,239.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,129.73
Rate for Payer: Cigna Commercial	$8,097.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,919.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,562.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,429.25
Rate for Payer: UnitedHealthcare Community & State	$390.30
Rate for Payer: Wellpoint Medicaid Managed Care	$429.17

SHELL M2A 60x54 US157860

Facility

$16,195.00

Hospital Charge Code	270638624
Hospital Revenue Code	278
Min. Negotiated Rate	$2,429.25
Max. Negotiated Rate	$3,919.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,239.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,919.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,562.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,429.25

Know your out-of-pocket cost for care.

All Charges