Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BASEPLATE UNIVERSAL TIBIAL SZ4

Facility

$4,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270691262
Hospital Revenue Code	278
Min. Negotiated Rate	$117.37
Max. Negotiated Rate	$2,435.00
Rate for Payer: Aetna Commercial	$1,850.60
Rate for Payer: Aetna Medicare Advantage	$1,461.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,241.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,241.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$974.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,241.85
Rate for Payer: Cigna Commercial	$2,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,178.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,071.40
Rate for Payer: Qualcare PPO/HMO/WC	$730.50
Rate for Payer: UnitedHealthcare Community & State	$117.37
Rate for Payer: Wellpoint Medicaid Managed Care	$129.06

BASE TIBIAL LONG OSS 63mm

Facility

$18,655.00

Service Code	HCPCS C1776
Hospital Charge Code	270673540
Hospital Revenue Code	278
Min. Negotiated Rate	$449.59
Max. Negotiated Rate	$9,327.50
Rate for Payer: Aetna Commercial	$7,088.90
Rate for Payer: Aetna Medicare Advantage	$5,596.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,757.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,757.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,731.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,757.02
Rate for Payer: Cigna Commercial	$9,327.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,514.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,104.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,798.25
Rate for Payer: UnitedHealthcare Community & State	$449.59
Rate for Payer: Wellpoint Medicaid Managed Care	$494.36

BASE TIBIAL LONG OSS 63mm

Facility

$18,655.00

Service Code	HCPCS C1776
Hospital Charge Code	270673540
Hospital Revenue Code	278
Min. Negotiated Rate	$2,798.25
Max. Negotiated Rate	$4,514.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,731.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,514.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,104.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,798.25

BASIC LIFE SUPP(BLS) ER

Facility

$1,600.00

Hospital Charge Code	26000513
Hospital Revenue Code	540
Min. Negotiated Rate	$38.56
Max. Negotiated Rate	$3,643.00
Rate for Payer: Aetna Commercial	$608.00
Rate for Payer: Aetna Medicare Advantage	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$408.00
Rate for Payer: Cigna Commercial	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.00
Rate for Payer: Oxford Commercial	$2,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00
Rate for Payer: UnitedHealthcare Commercial	$3,643.00
Rate for Payer: UnitedHealthcare Community & State	$38.56
Rate for Payer: Wellpoint Medicaid Managed Care	$42.40

BASIC LIFE SUPP(BLS) ER

Facility

$1,600.00

Hospital Charge Code	26000513
Hospital Revenue Code	540
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$240.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00

BASIC LIFE SUPP(BLS) NON ER

Facility

$1,200.00

Hospital Charge Code	26000512
Hospital Revenue Code	540
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$3,643.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$360.00
Rate for Payer: Oxford Commercial	$2,078.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00
Rate for Payer: UnitedHealthcare Commercial	$3,643.00
Rate for Payer: UnitedHealthcare Community & State	$28.92
Rate for Payer: Wellpoint Medicaid Managed Care	$31.80

BASIC LIFE SUPP(BLS) NON ER

Facility

$1,200.00

Hospital Charge Code	26000512
Hospital Revenue Code	540
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

BASIC METABOLIC

Facility

$365.40

Service Code	HCPCS 80048
Hospital Charge Code	38472014
Hospital Revenue Code	301
Min. Negotiated Rate	$6.77
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna Commercial	$23.01
Rate for Payer: Aetna Medicare Advantage	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.54
Rate for Payer: Cigna Commercial	$182.70
Rate for Payer: Cigna Medicare Advantage	$8.46
Rate for Payer: Clover Medicare Advantage	$8.04
Rate for Payer: EmblemHealth Commercial	$25.38
Rate for Payer: Humana Medicare Advantage	$8.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.62
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.81
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.46
Rate for Payer: Wellcare Medicare Advantage	$8.46
Rate for Payer: Wellpoint Medicaid Managed Care	$9.68

BASIC METABOLIC

Facility

$365.40

Service Code	HCPCS 80048
Hospital Charge Code	38472014
Hospital Revenue Code	301
Min. Negotiated Rate	$54.81
Max. Negotiated Rate	$54.81
Rate for Payer: Qualcare PPO/HMO/WC	$54.81

BASIC METABOLIC PANEL 8

Facility

$483.60

Service Code	HCPCS 80048
Hospital Charge Code	402080048
Hospital Revenue Code	301
Min. Negotiated Rate	$72.54
Max. Negotiated Rate	$72.54
Rate for Payer: Qualcare PPO/HMO/WC	$72.54

BASIC METABOLIC PANEL 8

Facility

$483.60

Service Code	HCPCS 80048
Hospital Charge Code	402080048
Hospital Revenue Code	301
Min. Negotiated Rate	$6.77
Max. Negotiated Rate	$241.80
Rate for Payer: Aetna Commercial	$23.01
Rate for Payer: Aetna Medicare Advantage	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.54
Rate for Payer: Cigna Commercial	$241.80
Rate for Payer: Cigna Medicare Advantage	$8.46
Rate for Payer: Clover Medicare Advantage	$8.04
Rate for Payer: EmblemHealth Commercial	$25.38
Rate for Payer: Humana Medicare Advantage	$8.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.08
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.54
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.46
Rate for Payer: Wellcare Medicare Advantage	$8.46
Rate for Payer: Wellpoint Medicaid Managed Care	$12.82

BASIC METABOLIC PROFILE

Facility

$697.90

Service Code	HCPCS 80048
Hospital Charge Code	3004877
Hospital Revenue Code	301
Min. Negotiated Rate	$6.77
Max. Negotiated Rate	$348.95
Rate for Payer: Aetna Commercial	$23.01
Rate for Payer: Aetna Medicare Advantage	$27.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.54
Rate for Payer: Cigna Commercial	$348.95
Rate for Payer: Cigna Medicare Advantage	$8.46
Rate for Payer: Clover Medicare Advantage	$8.04
Rate for Payer: EmblemHealth Commercial	$25.38
Rate for Payer: Humana Medicare Advantage	$8.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$209.37
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$104.69
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$6.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.46
Rate for Payer: Wellcare Medicare Advantage	$8.46
Rate for Payer: Wellpoint Medicaid Managed Care	$18.49

BASIC METABOLIC PROFILE

Facility

$697.90

Service Code	HCPCS 80048
Hospital Charge Code	3004877
Hospital Revenue Code	301
Min. Negotiated Rate	$104.69
Max. Negotiated Rate	$104.69
Rate for Payer: Qualcare PPO/HMO/WC	$104.69

BASIN EMESIS 9 DISP

Facility

$4.00

Hospital Charge Code	270300261
Hospital Revenue Code	272
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BASIN EMESIS 9 DISP

Facility

$4.00

Hospital Charge Code	270300261
Hospital Revenue Code	272
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

BASIN FOOT **********

Facility

$55.00

Hospital Charge Code	8000721
Hospital Revenue Code	279
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$27.50
Rate for Payer: Aetna Commercial	$20.90
Rate for Payer: Aetna Medicare Advantage	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.03
Rate for Payer: Cigna Commercial	$27.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.50
Rate for Payer: Oxford Commercial	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.25
Rate for Payer: UnitedHealthcare Commercial	$11.00
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

BASIN FOOT **********

Facility

$55.00

Hospital Charge Code	8000721
Hospital Revenue Code	279
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$8.25

BASKET 2.4 SEGURA TIP 120 CM 1

Facility

$1,585.55

Hospital Charge Code	270684766
Hospital Revenue Code	272
Min. Negotiated Rate	$237.83
Max. Negotiated Rate	$237.83
Rate for Payer: Qualcare PPO/HMO/WC	$237.83

BASKET 2.4 SEGURA TIP 120 CM 1

Facility

$1,585.55

Hospital Charge Code	270684766
Hospital Revenue Code	272
Min. Negotiated Rate	$38.21
Max. Negotiated Rate	$792.77
Rate for Payer: Aetna Commercial	$602.51
Rate for Payer: Aetna Medicare Advantage	$475.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$404.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$404.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$404.32
Rate for Payer: Cigna Commercial	$792.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$475.67
Rate for Payer: Oxford Commercial	$317.11
Rate for Payer: Qualcare PPO/HMO/WC	$237.83
Rate for Payer: UnitedHealthcare Commercial	$317.11
Rate for Payer: UnitedHealthcare Community & State	$38.21
Rate for Payer: Wellpoint Medicaid Managed Care	$42.02

Basket 3.0F x 120cm x 4

Facility

$1,585.55

Hospital Charge Code	270645386
Hospital Revenue Code	272
Min. Negotiated Rate	$237.83
Max. Negotiated Rate	$237.83
Rate for Payer: Qualcare PPO/HMO/WC	$237.83

Basket 3.0F x 120cm x 4

Facility

$1,585.55

Hospital Charge Code	270645386
Hospital Revenue Code	272
Min. Negotiated Rate	$38.21
Max. Negotiated Rate	$792.77
Rate for Payer: Aetna Commercial	$602.51
Rate for Payer: Aetna Medicare Advantage	$475.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$404.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$404.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$404.32
Rate for Payer: Cigna Commercial	$792.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$475.67
Rate for Payer: Oxford Commercial	$317.11
Rate for Payer: Qualcare PPO/HMO/WC	$237.83
Rate for Payer: UnitedHealthcare Commercial	$317.11
Rate for Payer: UnitedHealthcare Community & State	$38.21
Rate for Payer: Wellpoint Medicaid Managed Care	$42.02

BASKET CAPTURA HELICAL 1.7FR

Facility

$883.05

Hospital Charge Code	270647886
Hospital Revenue Code	272
Min. Negotiated Rate	$132.46
Max. Negotiated Rate	$132.46
Rate for Payer: Qualcare PPO/HMO/WC	$132.46

BASKET CAPTURA HELICAL 1.7FR

Facility

$883.05

Hospital Charge Code	270647886
Hospital Revenue Code	272
Min. Negotiated Rate	$21.28
Max. Negotiated Rate	$441.52
Rate for Payer: Aetna Commercial	$335.56
Rate for Payer: Aetna Medicare Advantage	$264.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.18
Rate for Payer: Cigna Commercial	$441.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$264.92
Rate for Payer: Oxford Commercial	$176.61
Rate for Payer: Qualcare PPO/HMO/WC	$132.46
Rate for Payer: UnitedHealthcare Commercial	$176.61
Rate for Payer: UnitedHealthcare Community & State	$21.28
Rate for Payer: Wellpoint Medicaid Managed Care	$23.40

BASKET ENGAGE 2.8FRx115cm

Facility

$918.40

Hospital Charge Code	270650763
Hospital Revenue Code	272
Min. Negotiated Rate	$22.13
Max. Negotiated Rate	$459.20
Rate for Payer: Aetna Commercial	$348.99
Rate for Payer: Aetna Medicare Advantage	$275.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.19
Rate for Payer: Cigna Commercial	$459.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.52
Rate for Payer: Oxford Commercial	$183.68
Rate for Payer: Qualcare PPO/HMO/WC	$137.76
Rate for Payer: UnitedHealthcare Commercial	$183.68
Rate for Payer: UnitedHealthcare Community & State	$22.13
Rate for Payer: Wellpoint Medicaid Managed Care	$24.34

BASKET ENGAGE 2.8FRx115cm

Facility

$918.40

Hospital Charge Code	270650763
Hospital Revenue Code	272
Min. Negotiated Rate	$137.76
Max. Negotiated Rate	$137.76
Rate for Payer: Qualcare PPO/HMO/WC	$137.76

Know your out-of-pocket cost for care.

All Charges