Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SLEEVE ADAPTER FEMORAL 5MM

Facility

$2,015.00

Service Code	HCPCS C1776
Hospital Charge Code	270696296
Hospital Revenue Code	278
Min. Negotiated Rate	$302.25
Max. Negotiated Rate	$487.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$403.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$443.30
Rate for Payer: Qualcare PPO/HMO/WC	$302.25

SLEEVE BIOLOX DELTA CERAMIC

Facility

$525.00

Service Code	HCPCS C1776
Hospital Charge Code	270692214
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

SLEEVE BIOLOX DELTA CERAMIC

Facility

$525.00

Service Code	HCPCS C1776
Hospital Charge Code	270692214
Hospital Revenue Code	278
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$12.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.91

SLEEVE BLOOD PRESSURE XL

Facility

$89.96

Hospital Charge Code	270655514
Hospital Revenue Code	270
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$44.98
Rate for Payer: Aetna Commercial	$34.18
Rate for Payer: Aetna Medicare Advantage	$26.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.94
Rate for Payer: Cigna Commercial	$44.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.99
Rate for Payer: Oxford Commercial	$17.99
Rate for Payer: Qualcare PPO/HMO/WC	$13.49
Rate for Payer: UnitedHealthcare Commercial	$17.99
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

SLEEVE BLOOD PRESSURE XL

Facility

$89.96

Hospital Charge Code	270655514
Hospital Revenue Code	270
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$13.49
Rate for Payer: Qualcare PPO/HMO/WC	$13.49

SLEEVE BMT CTR 10MM 113793

Facility

$981.65

Hospital Charge Code	270617587
Hospital Revenue Code	272
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$490.82
Rate for Payer: Aetna Commercial	$373.03
Rate for Payer: Aetna Medicare Advantage	$294.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$250.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$250.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$250.32
Rate for Payer: Cigna Commercial	$490.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.50
Rate for Payer: Oxford Commercial	$196.33
Rate for Payer: Qualcare PPO/HMO/WC	$147.25
Rate for Payer: UnitedHealthcare Commercial	$196.33
Rate for Payer: UnitedHealthcare Community & State	$23.66
Rate for Payer: Wellpoint Medicaid Managed Care	$26.01

SLEEVE BMT CTR 10MM 113793

Facility

$981.65

Hospital Charge Code	270617587
Hospital Revenue Code	272
Min. Negotiated Rate	$147.25
Max. Negotiated Rate	$147.25
Rate for Payer: Qualcare PPO/HMO/WC	$147.25

SLEEVE BMT CTR 7MM 113790

Facility

$981.65

Hospital Charge Code	270619989
Hospital Revenue Code	278
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$490.82
Rate for Payer: Aetna Commercial	$373.03
Rate for Payer: Aetna Medicare Advantage	$294.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$250.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$250.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$250.32
Rate for Payer: Cigna Commercial	$490.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$215.96
Rate for Payer: Qualcare PPO/HMO/WC	$147.25
Rate for Payer: UnitedHealthcare Community & State	$23.66
Rate for Payer: Wellpoint Medicaid Managed Care	$26.01

SLEEVE BMT CTR 7MM 113790

Facility

$981.65

Hospital Charge Code	270619989
Hospital Revenue Code	278
Min. Negotiated Rate	$147.25
Max. Negotiated Rate	$237.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$215.96
Rate for Payer: Qualcare PPO/HMO/WC	$147.25

SLEEVE BMT CTR 8MM 113791

Facility

$764.00

Hospital Charge Code	270627728
Hospital Revenue Code	272
Min. Negotiated Rate	$114.60
Max. Negotiated Rate	$114.60
Rate for Payer: Qualcare PPO/HMO/WC	$114.60

SLEEVE BMT CTR 8MM 113791

Facility

$764.00

Hospital Charge Code	270627728
Hospital Revenue Code	272
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$382.00
Rate for Payer: Aetna Commercial	$290.32
Rate for Payer: Aetna Medicare Advantage	$229.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$194.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$194.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$194.82
Rate for Payer: Cigna Commercial	$382.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.20
Rate for Payer: Oxford Commercial	$152.80
Rate for Payer: Qualcare PPO/HMO/WC	$114.60
Rate for Payer: UnitedHealthcare Commercial	$152.80
Rate for Payer: UnitedHealthcare Community & State	$18.41
Rate for Payer: Wellpoint Medicaid Managed Care	$20.25

SLEEVE BMT CTR 9MM 113792

Facility

$981.65

Hospital Charge Code	270620287
Hospital Revenue Code	278
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$490.82
Rate for Payer: Aetna Commercial	$373.03
Rate for Payer: Aetna Medicare Advantage	$294.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$250.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$250.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$250.32
Rate for Payer: Cigna Commercial	$490.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$215.96
Rate for Payer: Qualcare PPO/HMO/WC	$147.25
Rate for Payer: UnitedHealthcare Community & State	$23.66
Rate for Payer: Wellpoint Medicaid Managed Care	$26.01

SLEEVE BMT CTR 9MM 113792

Facility

$981.65

Hospital Charge Code	270620287
Hospital Revenue Code	278
Min. Negotiated Rate	$147.25
Max. Negotiated Rate	$237.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$215.96
Rate for Payer: Qualcare PPO/HMO/WC	$147.25

SLEEVE DBL DRILL 4.0/2.9MM

Facility

$1,239.10

Hospital Charge Code	270677605
Hospital Revenue Code	272
Min. Negotiated Rate	$185.87
Max. Negotiated Rate	$185.87
Rate for Payer: Qualcare PPO/HMO/WC	$185.87

SLEEVE DBL DRILL 4.0/2.9MM

Facility

$1,239.10

Hospital Charge Code	270677605
Hospital Revenue Code	272
Min. Negotiated Rate	$29.86
Max. Negotiated Rate	$619.55
Rate for Payer: Aetna Commercial	$470.86
Rate for Payer: Aetna Medicare Advantage	$371.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$315.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$315.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$315.97
Rate for Payer: Cigna Commercial	$619.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$371.73
Rate for Payer: Oxford Commercial	$247.82
Rate for Payer: Qualcare PPO/HMO/WC	$185.87
Rate for Payer: UnitedHealthcare Commercial	$247.82
Rate for Payer: UnitedHealthcare Community & State	$29.86
Rate for Payer: Wellpoint Medicaid Managed Care	$32.84

SLEEVE DELTA BIOLOX NEUTRAL

Facility

$525.00

Service Code	HCPCS C1776
Hospital Charge Code	270692220
Hospital Revenue Code	278
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$12.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.91

SLEEVE DELTA BIOLOX NEUTRAL

Facility

$525.00

Service Code	HCPCS C1776
Hospital Charge Code	270692220
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

SLEEVE DRILL 27MM

Facility

$800.00

Hospital Charge Code	270661801
Hospital Revenue Code	272
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

SLEEVE DRILL 27MM

Facility

$800.00

Hospital Charge Code	270661801
Hospital Revenue Code	272
Min. Negotiated Rate	$19.28
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$304.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.00
Rate for Payer: Oxford Commercial	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Commercial	$160.00
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$21.20

SLEEVE DRILL 4.0x2.5mm LONG

Facility

$513.00

Hospital Charge Code	270666876
Hospital Revenue Code	272
Min. Negotiated Rate	$76.95
Max. Negotiated Rate	$76.95
Rate for Payer: Qualcare PPO/HMO/WC	$76.95

SLEEVE DRILL 4.0x2.5mm LONG

Facility

$513.00

Hospital Charge Code	270666876
Hospital Revenue Code	272
Min. Negotiated Rate	$12.36
Max. Negotiated Rate	$256.50
Rate for Payer: Aetna Commercial	$194.94
Rate for Payer: Aetna Medicare Advantage	$153.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.81
Rate for Payer: Cigna Commercial	$256.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.90
Rate for Payer: Oxford Commercial	$102.60
Rate for Payer: Qualcare PPO/HMO/WC	$76.95
Rate for Payer: UnitedHealthcare Commercial	$102.60
Rate for Payer: UnitedHealthcare Community & State	$12.36
Rate for Payer: Wellpoint Medicaid Managed Care	$13.59

SLEEVE DRILL 4.0x2.5mm SHORT

Facility

$1,506.00

Hospital Charge Code	270666875
Hospital Revenue Code	272
Min. Negotiated Rate	$225.90
Max. Negotiated Rate	$225.90
Rate for Payer: Qualcare PPO/HMO/WC	$225.90

SLEEVE DRILL 4.0x2.5mm SHORT

Facility

$1,506.00

Hospital Charge Code	270666875
Hospital Revenue Code	272
Min. Negotiated Rate	$36.29
Max. Negotiated Rate	$753.00
Rate for Payer: Aetna Commercial	$572.28
Rate for Payer: Aetna Medicare Advantage	$451.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$384.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$384.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$384.03
Rate for Payer: Cigna Commercial	$753.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.80
Rate for Payer: Oxford Commercial	$301.20
Rate for Payer: Qualcare PPO/HMO/WC	$225.90
Rate for Payer: UnitedHealthcare Commercial	$301.20
Rate for Payer: UnitedHealthcare Community & State	$36.29
Rate for Payer: Wellpoint Medicaid Managed Care	$39.91

SLEEVE DRILL INSERT PARALL 2.0

Facility

$1,545.00

Hospital Charge Code	270666877
Hospital Revenue Code	272
Min. Negotiated Rate	$231.75
Max. Negotiated Rate	$231.75
Rate for Payer: Qualcare PPO/HMO/WC	$231.75

SLEEVE DRILL INSERT PARALL 2.0

Facility

$1,545.00

Hospital Charge Code	270666877
Hospital Revenue Code	272
Min. Negotiated Rate	$37.23
Max. Negotiated Rate	$772.50
Rate for Payer: Aetna Commercial	$587.10
Rate for Payer: Aetna Medicare Advantage	$463.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$393.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$393.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$393.98
Rate for Payer: Cigna Commercial	$772.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.50
Rate for Payer: Oxford Commercial	$309.00
Rate for Payer: Qualcare PPO/HMO/WC	$231.75
Rate for Payer: UnitedHealthcare Commercial	$309.00
Rate for Payer: UnitedHealthcare Community & State	$37.23
Rate for Payer: Wellpoint Medicaid Managed Care	$40.94

Know your out-of-pocket cost for care.

All Charges