Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SYSTM CLLCTION DUAL HYGIENIKIT

Facility

$557.25

Hospital Charge Code	270662661
Hospital Revenue Code	270
Min. Negotiated Rate	$13.43
Max. Negotiated Rate	$278.62
Rate for Payer: Aetna Commercial	$211.75
Rate for Payer: Aetna Medicare Advantage	$167.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.10
Rate for Payer: Cigna Commercial	$278.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.18
Rate for Payer: Oxford Commercial	$111.45
Rate for Payer: Qualcare PPO/HMO/WC	$83.59
Rate for Payer: UnitedHealthcare Commercial	$111.45
Rate for Payer: UnitedHealthcare Community & State	$13.43
Rate for Payer: Wellpoint Medicaid Managed Care	$14.77

SYSTM MIXNG CMPACT 50493501

Facility

$891.90

Hospital Charge Code	270635863
Hospital Revenue Code	272
Min. Negotiated Rate	$133.78
Max. Negotiated Rate	$133.78
Rate for Payer: Qualcare PPO/HMO/WC	$133.78

SYSTM MIXNG CMPACT 50493501

Facility

$891.90

Hospital Charge Code	270635863
Hospital Revenue Code	272
Min. Negotiated Rate	$21.49
Max. Negotiated Rate	$445.95
Rate for Payer: Aetna Commercial	$338.92
Rate for Payer: Aetna Medicare Advantage	$267.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.43
Rate for Payer: Cigna Commercial	$445.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.57
Rate for Payer: Oxford Commercial	$178.38
Rate for Payer: Qualcare PPO/HMO/WC	$133.78
Rate for Payer: UnitedHealthcare Commercial	$178.38
Rate for Payer: UnitedHealthcare Community & State	$21.49
Rate for Payer: Wellpoint Medicaid Managed Care	$23.64

SYSTM TRNSVAGINL ANCHOR 820145

Facility

$1,724.00

Hospital Charge Code	270629480
Hospital Revenue Code	272
Min. Negotiated Rate	$258.60
Max. Negotiated Rate	$258.60
Rate for Payer: Qualcare PPO/HMO/WC	$258.60

SYSTM TRNSVAGINL ANCHOR 820145

Facility

$1,724.00

Hospital Charge Code	270629480
Hospital Revenue Code	272
Min. Negotiated Rate	$41.55
Max. Negotiated Rate	$862.00
Rate for Payer: Aetna Commercial	$655.12
Rate for Payer: Aetna Medicare Advantage	$517.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$439.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$439.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.62
Rate for Payer: Cigna Commercial	$862.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$517.20
Rate for Payer: Oxford Commercial	$344.80
Rate for Payer: Qualcare PPO/HMO/WC	$258.60
Rate for Payer: UnitedHealthcare Commercial	$344.80
Rate for Payer: UnitedHealthcare Community & State	$41.55
Rate for Payer: Wellpoint Medicaid Managed Care	$45.69

SYST PICO NEG PRESS 10X20CM

Facility

$1,149.50

Hospital Charge Code	270678297
Hospital Revenue Code	272
Min. Negotiated Rate	$27.70
Max. Negotiated Rate	$574.75
Rate for Payer: Aetna Commercial	$436.81
Rate for Payer: Aetna Medicare Advantage	$344.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.12
Rate for Payer: Cigna Commercial	$574.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.85
Rate for Payer: Oxford Commercial	$229.90
Rate for Payer: Qualcare PPO/HMO/WC	$172.43
Rate for Payer: UnitedHealthcare Commercial	$229.90
Rate for Payer: UnitedHealthcare Community & State	$27.70
Rate for Payer: Wellpoint Medicaid Managed Care	$30.46

SYST PICO NEG PRESS 10X20CM

Facility

$1,149.50

Hospital Charge Code	270678297
Hospital Revenue Code	272
Min. Negotiated Rate	$172.43
Max. Negotiated Rate	$172.43
Rate for Payer: Qualcare PPO/HMO/WC	$172.43

SYST PICO NEG PRESS 15x15CM

Facility

$1,149.50

Hospital Charge Code	270677028
Hospital Revenue Code	272
Min. Negotiated Rate	$172.43
Max. Negotiated Rate	$172.43
Rate for Payer: Qualcare PPO/HMO/WC	$172.43

SYST PICO NEG PRESS 15x15CM

Facility

$1,149.50

Hospital Charge Code	270677028
Hospital Revenue Code	272
Min. Negotiated Rate	$27.70
Max. Negotiated Rate	$574.75
Rate for Payer: Aetna Commercial	$436.81
Rate for Payer: Aetna Medicare Advantage	$344.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.12
Rate for Payer: Cigna Commercial	$574.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.85
Rate for Payer: Oxford Commercial	$229.90
Rate for Payer: Qualcare PPO/HMO/WC	$172.43
Rate for Payer: UnitedHealthcare Commercial	$229.90
Rate for Payer: UnitedHealthcare Community & State	$27.70
Rate for Payer: Wellpoint Medicaid Managed Care	$30.46

SYST PICO NEG PRESS 15x30CM

Facility

$1,149.50

Hospital Charge Code	270678298
Hospital Revenue Code	272
Min. Negotiated Rate	$172.43
Max. Negotiated Rate	$172.43
Rate for Payer: Qualcare PPO/HMO/WC	$172.43

SYST PICO NEG PRESS 15x30CM

Facility

$1,149.50

Hospital Charge Code	270678298
Hospital Revenue Code	272
Min. Negotiated Rate	$27.70
Max. Negotiated Rate	$574.75
Rate for Payer: Aetna Commercial	$436.81
Rate for Payer: Aetna Medicare Advantage	$344.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.12
Rate for Payer: Cigna Commercial	$574.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.85
Rate for Payer: Oxford Commercial	$229.90
Rate for Payer: Qualcare PPO/HMO/WC	$172.43
Rate for Payer: UnitedHealthcare Commercial	$229.90
Rate for Payer: UnitedHealthcare Community & State	$27.70
Rate for Payer: Wellpoint Medicaid Managed Care	$30.46

SYST PICO NEG PRESS 4x11

Facility

$3,448.50

Hospital Charge Code	270678394
Hospital Revenue Code	272
Min. Negotiated Rate	$83.11
Max. Negotiated Rate	$1,724.25
Rate for Payer: Aetna Commercial	$1,310.43
Rate for Payer: Aetna Medicare Advantage	$1,034.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.37
Rate for Payer: Cigna Commercial	$1,724.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.55
Rate for Payer: Oxford Commercial	$689.70
Rate for Payer: Qualcare PPO/HMO/WC	$517.27
Rate for Payer: UnitedHealthcare Commercial	$689.70
Rate for Payer: UnitedHealthcare Community & State	$83.11
Rate for Payer: Wellpoint Medicaid Managed Care	$91.39

SYST PICO NEG PRESS 4x11

Facility

$3,448.50

Hospital Charge Code	270678394
Hospital Revenue Code	272
Min. Negotiated Rate	$517.27
Max. Negotiated Rate	$517.27
Rate for Payer: Qualcare PPO/HMO/WC	$517.27

SYST PICO NEG PRESS 4x16x3/4

Facility

$1,149.50

Hospital Charge Code	270678395
Hospital Revenue Code	272
Min. Negotiated Rate	$172.43
Max. Negotiated Rate	$172.43
Rate for Payer: Qualcare PPO/HMO/WC	$172.43

SYST PICO NEG PRESS 4x16x3/4

Facility

$1,149.50

Hospital Charge Code	270678395
Hospital Revenue Code	272
Min. Negotiated Rate	$27.70
Max. Negotiated Rate	$574.75
Rate for Payer: Aetna Commercial	$436.81
Rate for Payer: Aetna Medicare Advantage	$344.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.12
Rate for Payer: Cigna Commercial	$574.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.85
Rate for Payer: Oxford Commercial	$229.90
Rate for Payer: Qualcare PPO/HMO/WC	$172.43
Rate for Payer: UnitedHealthcare Commercial	$229.90
Rate for Payer: UnitedHealthcare Community & State	$27.70
Rate for Payer: Wellpoint Medicaid Managed Care	$30.46

SYST UPHOLD LITE W/CAPIO SLIM

Facility

$11,600.00

Service Code	HCPCS C1763
Hospital Charge Code	270677082
Hospital Revenue Code	278
Min. Negotiated Rate	$279.56
Max. Negotiated Rate	$5,800.00
Rate for Payer: Aetna Commercial	$4,408.00
Rate for Payer: Aetna Medicare Advantage	$3,480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,958.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,958.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,958.00
Rate for Payer: Cigna Commercial	$5,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,807.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,552.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,740.00
Rate for Payer: UnitedHealthcare Community & State	$279.56
Rate for Payer: Wellpoint Medicaid Managed Care	$307.40

SYST UPHOLD LITE W/CAPIO SLIM

Facility

$11,600.00

Service Code	HCPCS C1763
Hospital Charge Code	270677082
Hospital Revenue Code	278
Min. Negotiated Rate	$1,740.00
Max. Negotiated Rate	$2,807.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,807.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,552.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,740.00

SYTHROID/0.088MG

Facility

$3.00

Hospital Charge Code	60634782
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SYTHROID/0.088MG

Facility

$3.00

Hospital Charge Code	60634782
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

SZ.4 42 INSERT 28HEAD DUAL MOB

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705864
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

SZ.4 42 INSERT 28HEAD DUAL MOB

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705864
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

SZ.4 DUAL MOBILITY LINER

Facility

$4,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270705866
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

SZ.4 DUAL MOBILITY LINER

Facility

$4,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270705866
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

SZ.8 CEMENTLESS HIP SYSTEM

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270705865
Hospital Revenue Code	278
Min. Negotiated Rate	$277.15
Max. Negotiated Rate	$5,750.00
Rate for Payer: Aetna Commercial	$4,370.00
Rate for Payer: Aetna Medicare Advantage	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,932.50
Rate for Payer: Cigna Commercial	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,530.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00
Rate for Payer: UnitedHealthcare Community & State	$277.15
Rate for Payer: Wellpoint Medicaid Managed Care	$304.75

SZ.8 CEMENTLESS HIP SYSTEM

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270705865
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$2,783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,530.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

Know your out-of-pocket cost for care.

All Charges