Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SIZE 15 LIM FMT

Facility

$15,948.55

Hospital Charge Code	270657093
Hospital Revenue Code	278
Min. Negotiated Rate	$2,392.28
Max. Negotiated Rate	$3,859.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,859.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,508.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,392.28

SIZE 16 LM FINT

Facility

$15,948.55

Hospital Charge Code	270657094
Hospital Revenue Code	278
Min. Negotiated Rate	$384.36
Max. Negotiated Rate	$7,974.27
Rate for Payer: Aetna Commercial	$6,060.45
Rate for Payer: Aetna Medicare Advantage	$4,784.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,066.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,066.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,066.88
Rate for Payer: Cigna Commercial	$7,974.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,859.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,508.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,392.28
Rate for Payer: UnitedHealthcare Community & State	$384.36
Rate for Payer: Wellpoint Medicaid Managed Care	$422.64

SIZE 16 LM FINT

Facility

$15,948.55

Hospital Charge Code	270657094
Hospital Revenue Code	278
Min. Negotiated Rate	$2,392.28
Max. Negotiated Rate	$3,859.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,859.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,508.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,392.28

SIZE 16 VESYS ADUCATE

Facility

$10,646.15

Hospital Charge Code	270657095
Hospital Revenue Code	278
Min. Negotiated Rate	$256.57
Max. Negotiated Rate	$5,323.07
Rate for Payer: Aetna Commercial	$4,045.54
Rate for Payer: Aetna Medicare Advantage	$3,193.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,714.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,714.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,129.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,714.77
Rate for Payer: Cigna Commercial	$5,323.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,576.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,342.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,596.92
Rate for Payer: UnitedHealthcare Community & State	$256.57
Rate for Payer: Wellpoint Medicaid Managed Care	$282.12

SIZE 16 VESYS ADUCATE

Facility

$10,646.15

Hospital Charge Code	270657095
Hospital Revenue Code	278
Min. Negotiated Rate	$1,596.92
Max. Negotiated Rate	$2,576.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,129.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,576.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,342.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,596.92

SIZE 1 STD STEM REF:8810003201

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703598
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

SIZE 1 STD STEM REF:8810003201

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703598
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

SIZE 2 PRECOAT TIBIAL, STEMMED

Facility

$6,156.70

Hospital Charge Code	270657096
Hospital Revenue Code	278
Min. Negotiated Rate	$148.38
Max. Negotiated Rate	$3,078.35
Rate for Payer: Aetna Commercial	$2,339.55
Rate for Payer: Aetna Medicare Advantage	$1,847.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,569.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,569.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,231.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,569.96
Rate for Payer: Cigna Commercial	$3,078.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,489.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,354.47
Rate for Payer: Qualcare PPO/HMO/WC	$923.50
Rate for Payer: UnitedHealthcare Community & State	$148.38
Rate for Payer: Wellpoint Medicaid Managed Care	$163.15

SIZE 2 PRECOAT TIBIAL, STEMMED

Facility

$6,156.70

Hospital Charge Code	270657096
Hospital Revenue Code	278
Min. Negotiated Rate	$923.50
Max. Negotiated Rate	$1,489.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,231.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,489.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,354.47
Rate for Payer: Qualcare PPO/HMO/WC	$923.50

SIZE 3.4 20MM C,D POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270657098
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

SIZE 3.4 20MM C,D POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270657098
Hospital Revenue Code	278
Min. Negotiated Rate	$141.28
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$141.28
Rate for Payer: Wellpoint Medicaid Managed Care	$155.35

SIZE 3 C,D 10MM MONOBLOCK TM

Facility

$12,048.30

Hospital Charge Code	270657097
Hospital Revenue Code	278
Min. Negotiated Rate	$290.36
Max. Negotiated Rate	$6,024.15
Rate for Payer: Aetna Commercial	$4,578.35
Rate for Payer: Aetna Medicare Advantage	$3,614.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,072.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,072.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,409.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,072.32
Rate for Payer: Cigna Commercial	$6,024.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,915.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,650.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,807.24
Rate for Payer: UnitedHealthcare Community & State	$290.36
Rate for Payer: Wellpoint Medicaid Managed Care	$319.28

SIZE 3 C,D 10MM MONOBLOCK TM

Facility

$12,048.30

Hospital Charge Code	270657097
Hospital Revenue Code	278
Min. Negotiated Rate	$1,807.24
Max. Negotiated Rate	$2,915.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,409.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,915.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,650.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,807.24

SIZE .5 (A105-20122118-0/0)

Facility

$4,475.00

Hospital Charge Code	270662434
Hospital Revenue Code	270
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$671.25
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

SIZE .5 (A105-20122118-0/0)

Facility

$4,475.00

Hospital Charge Code	270662434
Hospital Revenue Code	270
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,700.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,342.50
Rate for Payer: Oxford Commercial	$895.00
Rate for Payer: Qualcare PPO/HMO/WC	$671.25
Rate for Payer: UnitedHealthcare Commercial	$895.00
Rate for Payer: UnitedHealthcare Community & State	$107.85
Rate for Payer: Wellpoint Medicaid Managed Care	$118.59

SIZE 6 LEFT LPS FLEX

Facility

$11,724.30

Hospital Charge Code	270657099
Hospital Revenue Code	278
Min. Negotiated Rate	$282.56
Max. Negotiated Rate	$5,862.15
Rate for Payer: Aetna Commercial	$4,455.23
Rate for Payer: Aetna Medicare Advantage	$3,517.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,989.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,989.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,344.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,989.70
Rate for Payer: Cigna Commercial	$5,862.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,837.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,579.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,758.64
Rate for Payer: UnitedHealthcare Community & State	$282.56
Rate for Payer: Wellpoint Medicaid Managed Care	$310.69

SIZE 6 LEFT LPS FLEX

Facility

$11,724.30

Hospital Charge Code	270657099
Hospital Revenue Code	278
Min. Negotiated Rate	$1,758.64
Max. Negotiated Rate	$2,837.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,344.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,837.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,579.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,758.64

SIZE 8 OR 10 **********

Facility

$34.00

Hospital Charge Code	8002792
Hospital Revenue Code	279
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$17.00
Rate for Payer: Aetna Commercial	$12.92
Rate for Payer: Aetna Medicare Advantage	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.67
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.20
Rate for Payer: Oxford Commercial	$6.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$6.80
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

SIZE 8 OR 10 **********

Facility

$34.00

Hospital Charge Code	8002792
Hospital Revenue Code	279
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

SIZE C 6ST GSF-FLEX

Facility

$12,166.15

Hospital Charge Code	270657100
Hospital Revenue Code	278
Min. Negotiated Rate	$1,824.92
Max. Negotiated Rate	$2,944.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,433.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,944.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,676.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,824.92

SIZE C 6ST GSF-FLEX

Facility

$12,166.15

Hospital Charge Code	270657100
Hospital Revenue Code	278
Min. Negotiated Rate	$293.20
Max. Negotiated Rate	$6,083.07
Rate for Payer: Aetna Commercial	$4,623.14
Rate for Payer: Aetna Medicare Advantage	$3,649.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,102.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,102.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,433.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,102.37
Rate for Payer: Cigna Commercial	$6,083.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,944.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,676.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,824.92
Rate for Payer: UnitedHealthcare Community & State	$293.20
Rate for Payer: Wellpoint Medicaid Managed Care	$322.40

SIZE C,D 17MM 3,4 POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270657104
Hospital Revenue Code	278
Min. Negotiated Rate	$141.28
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$141.28
Rate for Payer: Wellpoint Medicaid Managed Care	$155.35

SIZE C,D 17MM 3,4 POLY INSERT

Facility

$5,862.10

Hospital Charge Code	270657104
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

SIZE C D 17MM POLY IMMUT -5, 6

Facility

$5,862.10

Hospital Charge Code	270657101
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

SIZE C D 17MM POLY IMMUT -5, 6

Facility

$5,862.10

Hospital Charge Code	270657101
Hospital Revenue Code	278
Min. Negotiated Rate	$141.28
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,289.66
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$141.28
Rate for Payer: Wellpoint Medicaid Managed Care	$155.35

Know your out-of-pocket cost for care.

All Charges