Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SMR SHOULDER /SPALLA

Facility

$18,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270678828
Hospital Revenue Code	278
Min. Negotiated Rate	$451.88
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$7,125.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50
Rate for Payer: UnitedHealthcare Community & State	$451.88
Rate for Payer: Wellpoint Medicaid Managed Care	$496.88

SM & SM/RNP AB

Facility

$143.99

Service Code	HCPCS 86235
Hospital Charge Code	3000943
Hospital Revenue Code	302
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$48.77
Rate for Payer: Aetna Medicare Advantage	$58.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.72
Rate for Payer: Cigna Commercial	$72.00
Rate for Payer: Cigna Medicare Advantage	$17.93
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.20
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$3.82

SM & SM/RNP AB

Facility

$143.99

Service Code	HCPCS 86235
Hospital Charge Code	3000943
Hospital Revenue Code	302
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

SM UNI CEMENT RESTRICTOR W/DI

Facility

$927.00

Service Code	HCPCS C1776
Hospital Charge Code	270660305
Hospital Revenue Code	278
Min. Negotiated Rate	$22.34
Max. Negotiated Rate	$463.50
Rate for Payer: Aetna Commercial	$352.26
Rate for Payer: Aetna Medicare Advantage	$278.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$236.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$236.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$236.38
Rate for Payer: Cigna Commercial	$463.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$203.94
Rate for Payer: Qualcare PPO/HMO/WC	$139.05
Rate for Payer: UnitedHealthcare Community & State	$22.34
Rate for Payer: Wellpoint Medicaid Managed Care	$24.57

SM UNI CEMENT RESTRICTOR W/DI

Facility

$927.00

Service Code	HCPCS C1776
Hospital Charge Code	270660305
Hospital Revenue Code	278
Min. Negotiated Rate	$139.05
Max. Negotiated Rate	$224.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$203.94
Rate for Payer: Qualcare PPO/HMO/WC	$139.05

SNAP COVER 36x28 0052013628

Facility

$5.85

Hospital Charge Code	270606705C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.88

SNAP COVER 36x28 0052013628

Facility

$5.85

Hospital Charge Code	270606705C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna Commercial	$2.22
Rate for Payer: Aetna Medicare Advantage	$1.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.49
Rate for Payer: Cigna Commercial	$2.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.75
Rate for Payer: Oxford Commercial	$1.17
Rate for Payer: Qualcare PPO/HMO/WC	$0.88
Rate for Payer: UnitedHealthcare Commercial	$1.17
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

SNAP COVER 48X65 5210EZ4865

Facility

$12.53

Hospital Charge Code	270609407C
Hospital Revenue Code	272
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.88

SNAP COVER 48X65 5210EZ4865

Facility

$12.53

Hospital Charge Code	270609407C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$6.26
Rate for Payer: Aetna Commercial	$4.76
Rate for Payer: Aetna Medicare Advantage	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.20
Rate for Payer: Cigna Commercial	$6.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.76
Rate for Payer: Oxford Commercial	$2.51
Rate for Payer: Qualcare PPO/HMO/WC	$1.88
Rate for Payer: UnitedHealthcare Commercial	$2.51
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

SNAP COVER 50X50 01-5050

Facility

$19.80

Hospital Charge Code	270606706C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$9.90
Rate for Payer: Aetna Commercial	$7.52
Rate for Payer: Aetna Medicare Advantage	$5.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.05
Rate for Payer: Cigna Commercial	$9.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.94
Rate for Payer: Oxford Commercial	$3.96
Rate for Payer: Qualcare PPO/HMO/WC	$2.97
Rate for Payer: UnitedHealthcare Commercial	$3.96
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.52

SNAP COVER 50X50 01-5050

Facility

$19.80

Hospital Charge Code	270606706C
Hospital Revenue Code	272
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$2.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.97

SNAP-OFF FT PIN 1.9MMX12MM

Facility

$1,802.50

Hospital Charge Code	270703050
Hospital Revenue Code	278
Min. Negotiated Rate	$270.38
Max. Negotiated Rate	$436.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$436.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$396.55
Rate for Payer: Qualcare PPO/HMO/WC	$270.38

SNAP-OFF FT PIN 1.9MMX12MM

Facility

$1,802.50

Hospital Charge Code	270703050
Hospital Revenue Code	278
Min. Negotiated Rate	$43.44
Max. Negotiated Rate	$901.25
Rate for Payer: Aetna Commercial	$684.95
Rate for Payer: Aetna Medicare Advantage	$540.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.64
Rate for Payer: Cigna Commercial	$901.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$436.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$396.55
Rate for Payer: Qualcare PPO/HMO/WC	$270.38
Rate for Payer: UnitedHealthcare Community & State	$43.44
Rate for Payer: Wellpoint Medicaid Managed Care	$47.77

SNAP-OFF PIN 1.9MMX14MM

Facility

$1,802.50

Hospital Charge Code	270703051
Hospital Revenue Code	278
Min. Negotiated Rate	$43.44
Max. Negotiated Rate	$901.25
Rate for Payer: Aetna Commercial	$684.95
Rate for Payer: Aetna Medicare Advantage	$540.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.64
Rate for Payer: Cigna Commercial	$901.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$436.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$396.55
Rate for Payer: Qualcare PPO/HMO/WC	$270.38
Rate for Payer: UnitedHealthcare Community & State	$43.44
Rate for Payer: Wellpoint Medicaid Managed Care	$47.77

SNAP-OFF PIN 1.9MMX14MM

Facility

$1,802.50

Hospital Charge Code	270703051
Hospital Revenue Code	278
Min. Negotiated Rate	$270.38
Max. Negotiated Rate	$436.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$436.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$396.55
Rate for Payer: Qualcare PPO/HMO/WC	$270.38

SNAP OFF SCREW 2.MM X 11M

Facility

$382.50

Hospital Charge Code	270339452
Hospital Revenue Code	278
Min. Negotiated Rate	$57.38
Max. Negotiated Rate	$92.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$84.15
Rate for Payer: Qualcare PPO/HMO/WC	$57.38

SNAP OFF SCREW 2.MM X 11M

Facility

$382.50

Hospital Charge Code	270339452
Hospital Revenue Code	278
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$191.25
Rate for Payer: Aetna Commercial	$145.35
Rate for Payer: Aetna Medicare Advantage	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.54
Rate for Payer: Cigna Commercial	$191.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$84.15
Rate for Payer: Qualcare PPO/HMO/WC	$57.38
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: Wellpoint Medicaid Managed Care	$10.14

SNAPP OFF SCREW 2.0MM X 13MM C

Facility

$3,707.00

Service Code	HCPCS C1713
Hospital Charge Code	270704138
Hospital Revenue Code	278
Min. Negotiated Rate	$556.05
Max. Negotiated Rate	$897.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$741.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$897.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$815.54
Rate for Payer: Qualcare PPO/HMO/WC	$556.05

SNAPP OFF SCREW 2.0MM X 13MM C

Facility

$3,707.00

Service Code	HCPCS C1713
Hospital Charge Code	270704138
Hospital Revenue Code	278
Min. Negotiated Rate	$89.34
Max. Negotiated Rate	$1,853.50
Rate for Payer: Aetna Commercial	$1,408.66
Rate for Payer: Aetna Medicare Advantage	$1,112.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$945.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$945.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$741.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$945.28
Rate for Payer: Cigna Commercial	$1,853.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$897.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$815.54
Rate for Payer: Qualcare PPO/HMO/WC	$556.05
Rate for Payer: UnitedHealthcare Community & State	$89.34
Rate for Payer: Wellpoint Medicaid Managed Care	$98.24

SNARE 10MM 4FR x 120CM

Facility

$1,450.00

Hospital Charge Code	270668886
Hospital Revenue Code	272
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

SNARE 10MM 4FR x 120CM

Facility

$1,800.00

Hospital Charge Code	270668886N
Hospital Revenue Code	272
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$270.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00

SNARE 10MM 4FR x 120CM

Facility

$1,450.00

Hospital Charge Code	270668886
Hospital Revenue Code	272
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.00
Rate for Payer: Oxford Commercial	$290.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.50
Rate for Payer: UnitedHealthcare Commercial	$290.00
Rate for Payer: UnitedHealthcare Community & State	$34.95
Rate for Payer: Wellpoint Medicaid Managed Care	$38.42

SNARE 10MM 4FR x 120CM

Facility

$1,800.00

Hospital Charge Code	270668886N
Hospital Revenue Code	272
Min. Negotiated Rate	$43.38
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$684.00
Rate for Payer: Aetna Medicare Advantage	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.00
Rate for Payer: Cigna Commercial	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$540.00
Rate for Payer: Oxford Commercial	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00
Rate for Payer: UnitedHealthcare Commercial	$360.00
Rate for Payer: UnitedHealthcare Community & State	$43.38
Rate for Payer: Wellpoint Medicaid Managed Care	$47.70

SNARE 10MM 4FR x 120CM

Facility

$1,450.00

Hospital Charge Code	270668886S
Hospital Revenue Code	272
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$217.50
Rate for Payer: Qualcare PPO/HMO/WC	$217.50

SNARE 10MM 4FR x 120CM

Facility

$1,450.00

Hospital Charge Code	270668886S
Hospital Revenue Code	272
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$725.00
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: Aetna Medicare Advantage	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$369.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$369.75
Rate for Payer: Cigna Commercial	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.00
Rate for Payer: Oxford Commercial	$290.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.50
Rate for Payer: UnitedHealthcare Commercial	$290.00
Rate for Payer: UnitedHealthcare Community & State	$34.95
Rate for Payer: Wellpoint Medicaid Managed Care	$38.42

Know your out-of-pocket cost for care.

All Charges