Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TENDON ACHILLES W/BONE 021604

Facility

$3,729.65

Hospital Charge Code	270617936
Hospital Revenue Code	278
Min. Negotiated Rate	$559.45
Max. Negotiated Rate	$902.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$745.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$902.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$820.52
Rate for Payer: Qualcare PPO/HMO/WC	$559.45

TENDON ACHILLES W/CALCANEOUS

Facility

$4,439.25

Hospital Charge Code	270633002
Hospital Revenue Code	278
Min. Negotiated Rate	$106.99
Max. Negotiated Rate	$2,219.62
Rate for Payer: Aetna Commercial	$1,686.91
Rate for Payer: Aetna Medicare Advantage	$1,331.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,132.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,132.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$887.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,132.01
Rate for Payer: Cigna Commercial	$2,219.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,074.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$976.63
Rate for Payer: Qualcare PPO/HMO/WC	$665.89
Rate for Payer: UnitedHealthcare Community & State	$106.99
Rate for Payer: Wellpoint Medicaid Managed Care	$117.64

TENDON ACHILLES W/CALCANEOUS

Facility

$4,439.25

Hospital Charge Code	270633002
Hospital Revenue Code	278
Min. Negotiated Rate	$665.89
Max. Negotiated Rate	$1,074.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$887.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,074.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$976.63
Rate for Payer: Qualcare PPO/HMO/WC	$665.89

TENDON ACHIL W/BONE STR 770765

Facility

$7,440.00

Hospital Charge Code	270627269
Hospital Revenue Code	278
Min. Negotiated Rate	$179.30
Max. Negotiated Rate	$3,720.00
Rate for Payer: Aetna Commercial	$2,827.20
Rate for Payer: Aetna Medicare Advantage	$2,232.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,897.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,897.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,488.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,897.20
Rate for Payer: Cigna Commercial	$3,720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,800.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,636.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,116.00
Rate for Payer: UnitedHealthcare Community & State	$179.30
Rate for Payer: Wellpoint Medicaid Managed Care	$197.16

TENDON ACHIL W/BONE STR 770765

Facility

$7,440.00

Hospital Charge Code	270627269
Hospital Revenue Code	278
Min. Negotiated Rate	$1,116.00
Max. Negotiated Rate	$1,800.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,488.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,800.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,636.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,116.00

TENDON ANCHORS 8

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270687116
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

TENDON ANCHORS 8

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270687116
Hospital Revenue Code	278
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

TENDON ANCHORS 8

Facility

$3,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270690426
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

TENDON ANCHORS 8

Facility

$3,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270690426
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

TENDON ANTEOR TIBIALIS 77-0332

Facility

$5,456.00

Hospital Charge Code	270625868
Hospital Revenue Code	278
Min. Negotiated Rate	$818.40
Max. Negotiated Rate	$1,320.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,091.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,320.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,200.32
Rate for Payer: Qualcare PPO/HMO/WC	$818.40

TENDON ANTEOR TIBIALIS 77-0332

Facility

$5,456.00

Hospital Charge Code	270625868
Hospital Revenue Code	278
Min. Negotiated Rate	$131.49
Max. Negotiated Rate	$2,728.00
Rate for Payer: Aetna Commercial	$2,073.28
Rate for Payer: Aetna Medicare Advantage	$1,636.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,391.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,391.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,091.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,391.28
Rate for Payer: Cigna Commercial	$2,728.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,320.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,200.32
Rate for Payer: Qualcare PPO/HMO/WC	$818.40
Rate for Payer: UnitedHealthcare Community & State	$131.49
Rate for Payer: Wellpoint Medicaid Managed Care	$144.58

TENDON ANTERIOR 11X325 TIBIAL

Facility

$11,010.00

Hospital Charge Code	270647883
Hospital Revenue Code	278
Min. Negotiated Rate	$1,651.50
Max. Negotiated Rate	$2,664.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,422.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50

TENDON ANTERIOR 11X325 TIBIAL

Facility

$11,010.00

Hospital Charge Code	270647883
Hospital Revenue Code	278
Min. Negotiated Rate	$265.34
Max. Negotiated Rate	$5,505.00
Rate for Payer: Aetna Commercial	$4,183.80
Rate for Payer: Aetna Medicare Advantage	$3,303.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,807.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,807.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,807.55
Rate for Payer: Cigna Commercial	$5,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,422.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50
Rate for Payer: UnitedHealthcare Community & State	$265.34
Rate for Payer: Wellpoint Medicaid Managed Care	$291.76

TENDON ANTERIOR TIBIALIS *22cm

Facility

$7,075.00

Hospital Charge Code	270639509
Hospital Revenue Code	272
Min. Negotiated Rate	$1,061.25
Max. Negotiated Rate	$1,061.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,061.25

TENDON ANTERIOR TIBIALIS *22cm

Facility

$7,075.00

Hospital Charge Code	270639509
Hospital Revenue Code	272
Min. Negotiated Rate	$170.51
Max. Negotiated Rate	$3,537.50
Rate for Payer: Aetna Commercial	$2,688.50
Rate for Payer: Aetna Medicare Advantage	$2,122.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,804.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,804.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,804.12
Rate for Payer: Cigna Commercial	$3,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,122.50
Rate for Payer: Oxford Commercial	$1,415.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,061.25
Rate for Payer: UnitedHealthcare Commercial	$1,415.00
Rate for Payer: UnitedHealthcare Community & State	$170.51
Rate for Payer: Wellpoint Medicaid Managed Care	$187.49

TENDON ANTERIOR TIBIALIS 26cm

Facility

$6,815.10

Hospital Charge Code	270630691
Hospital Revenue Code	278
Min. Negotiated Rate	$1,022.26
Max. Negotiated Rate	$1,649.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,363.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,649.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,499.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,022.26

TENDON ANTERIOR TIBIALIS 26cm

Facility

$6,815.10

Hospital Charge Code	270630691
Hospital Revenue Code	278
Min. Negotiated Rate	$164.24
Max. Negotiated Rate	$3,407.55
Rate for Payer: Aetna Commercial	$2,589.74
Rate for Payer: Aetna Medicare Advantage	$2,044.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,737.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,737.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,363.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,737.85
Rate for Payer: Cigna Commercial	$3,407.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,649.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,499.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,022.26
Rate for Payer: UnitedHealthcare Community & State	$164.24
Rate for Payer: Wellpoint Medicaid Managed Care	$180.60

TENDON ANTERIOR TIBIALS 430335

Facility

$7,075.00

Hospital Charge Code	270635223
Hospital Revenue Code	278
Min. Negotiated Rate	$1,061.25
Max. Negotiated Rate	$1,712.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,415.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,712.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,556.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,061.25

TENDON ANTERIOR TIBIALS 430335

Facility

$7,075.00

Hospital Charge Code	270635223
Hospital Revenue Code	278
Min. Negotiated Rate	$170.51
Max. Negotiated Rate	$3,537.50
Rate for Payer: Aetna Commercial	$2,688.50
Rate for Payer: Aetna Medicare Advantage	$2,122.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,804.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,804.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,415.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,804.12
Rate for Payer: Cigna Commercial	$3,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,712.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,556.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,061.25
Rate for Payer: UnitedHealthcare Community & State	$170.51
Rate for Payer: Wellpoint Medicaid Managed Care	$187.49

TENDON ANT TIBIA *22cm 443017

Facility

$12,000.00

Hospital Charge Code	270640524
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

TENDON ANT TIBIA *22cm 443017

Facility

$12,000.00

Hospital Charge Code	270640524
Hospital Revenue Code	278
Min. Negotiated Rate	$289.20
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

TENDON ANT TIBIALIS 30 453017

Facility

$8,475.00

Hospital Charge Code	270637459
Hospital Revenue Code	278
Min. Negotiated Rate	$1,271.25
Max. Negotiated Rate	$2,050.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,050.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,864.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.25

TENDON ANT TIBIALIS 30 453017

Facility

$8,475.00

Hospital Charge Code	270637459
Hospital Revenue Code	278
Min. Negotiated Rate	$204.25
Max. Negotiated Rate	$4,237.50
Rate for Payer: Aetna Commercial	$3,220.50
Rate for Payer: Aetna Medicare Advantage	$2,542.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,161.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,161.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,161.12
Rate for Payer: Cigna Commercial	$4,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,050.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,864.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.25
Rate for Payer: UnitedHealthcare Community & State	$204.25
Rate for Payer: Wellpoint Medicaid Managed Care	$224.59

TENDON ANT TIBIALS 30X9 430335

Facility

$8,175.00

Hospital Charge Code	270642495
Hospital Revenue Code	278
Min. Negotiated Rate	$1,226.25
Max. Negotiated Rate	$1,978.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,635.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,978.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,798.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,226.25

TENDON ANT TIBIALS 30X9 430335

Facility

$8,175.00

Hospital Charge Code	270642495
Hospital Revenue Code	278
Min. Negotiated Rate	$197.02
Max. Negotiated Rate	$4,087.50
Rate for Payer: Aetna Commercial	$3,106.50
Rate for Payer: Aetna Medicare Advantage	$2,452.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,084.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,084.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,635.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,084.62
Rate for Payer: Cigna Commercial	$4,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,978.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,798.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,226.25
Rate for Payer: UnitedHealthcare Community & State	$197.02
Rate for Payer: Wellpoint Medicaid Managed Care	$216.64

Know your out-of-pocket cost for care.

All Charges