Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TENDONASIS SEMI 8x250MM

Facility

$7,565.00

Service Code	HCPCS C1762
Hospital Charge Code	270660383
Hospital Revenue Code	278
Min. Negotiated Rate	$1,134.75
Max. Negotiated Rate	$1,830.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,513.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,830.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,664.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,134.75

TENDONASIS SEMI 8x250MM

Facility

$7,565.00

Service Code	HCPCS C1762
Hospital Charge Code	270660383
Hospital Revenue Code	278
Min. Negotiated Rate	$182.32
Max. Negotiated Rate	$3,782.50
Rate for Payer: Aetna Commercial	$2,874.70
Rate for Payer: Aetna Medicare Advantage	$2,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,929.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,929.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,513.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,929.08
Rate for Payer: Cigna Commercial	$3,782.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,830.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,664.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,134.75
Rate for Payer: UnitedHealthcare Community & State	$182.32
Rate for Payer: Wellpoint Medicaid Managed Care	$200.47

TENDON BIOCLEANSE TIBIAL POSTE

Facility

$13,000.00

Service Code	HCPCS C1762
Hospital Charge Code	270663884
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$3,146.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,860.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00

TENDON BIOCLEANSE TIBIAL POSTE

Facility

$13,000.00

Service Code	HCPCS C1762
Hospital Charge Code	270663884
Hospital Revenue Code	278
Min. Negotiated Rate	$313.30
Max. Negotiated Rate	$6,500.00
Rate for Payer: Aetna Commercial	$4,940.00
Rate for Payer: Aetna Medicare Advantage	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,315.00
Rate for Payer: Cigna Commercial	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,860.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00
Rate for Payer: UnitedHealthcare Community & State	$313.30
Rate for Payer: Wellpoint Medicaid Managed Care	$344.50

TENDON BMT 77-0783

Facility

$5,825.65

Hospital Charge Code	270625869
Hospital Revenue Code	278
Min. Negotiated Rate	$873.85
Max. Negotiated Rate	$1,409.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,165.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,409.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,281.64
Rate for Payer: Qualcare PPO/HMO/WC	$873.85

TENDON BMT 77-0783

Facility

$5,825.65

Hospital Charge Code	270625869
Hospital Revenue Code	278
Min. Negotiated Rate	$140.40
Max. Negotiated Rate	$2,912.82
Rate for Payer: Aetna Commercial	$2,213.75
Rate for Payer: Aetna Medicare Advantage	$1,747.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,485.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,485.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,165.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,485.54
Rate for Payer: Cigna Commercial	$2,912.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,409.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,281.64
Rate for Payer: Qualcare PPO/HMO/WC	$873.85
Rate for Payer: UnitedHealthcare Community & State	$140.40
Rate for Payer: Wellpoint Medicaid Managed Care	$154.38

TENDON BONE HEMI W/QUAD 130010

Facility

$12,796.90

Hospital Charge Code	270638616
Hospital Revenue Code	278
Min. Negotiated Rate	$308.41
Max. Negotiated Rate	$6,398.45
Rate for Payer: Aetna Commercial	$4,862.82
Rate for Payer: Aetna Medicare Advantage	$3,839.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,263.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,263.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,559.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,263.21
Rate for Payer: Cigna Commercial	$6,398.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,096.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,815.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,919.54
Rate for Payer: UnitedHealthcare Community & State	$308.41
Rate for Payer: Wellpoint Medicaid Managed Care	$339.12

TENDON BONE HEMI W/QUAD 130010

Facility

$12,796.90

Hospital Charge Code	270638616
Hospital Revenue Code	278
Min. Negotiated Rate	$1,919.54
Max. Negotiated Rate	$3,096.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,559.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,096.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,815.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,919.54

TENDON GRACILIS

Facility

$5,512.50

Service Code	HCPCS C1762
Hospital Charge Code	270668349
Hospital Revenue Code	278
Min. Negotiated Rate	$132.85
Max. Negotiated Rate	$2,756.25
Rate for Payer: Aetna Commercial	$2,094.75
Rate for Payer: Aetna Medicare Advantage	$1,653.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,405.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,405.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,102.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,405.69
Rate for Payer: Cigna Commercial	$2,756.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,334.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,212.75
Rate for Payer: Qualcare PPO/HMO/WC	$826.88
Rate for Payer: UnitedHealthcare Community & State	$132.85
Rate for Payer: Wellpoint Medicaid Managed Care	$146.08

TENDON GRACILIS

Facility

$5,512.50

Service Code	HCPCS C1762
Hospital Charge Code	270668349
Hospital Revenue Code	278
Min. Negotiated Rate	$826.88
Max. Negotiated Rate	$1,334.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,102.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,334.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,212.75
Rate for Payer: Qualcare PPO/HMO/WC	$826.88

TENDON GRACLLIS 200-259 330165

Facility

$2,856.85

Hospital Charge Code	270621432
Hospital Revenue Code	278
Min. Negotiated Rate	$428.53
Max. Negotiated Rate	$691.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$571.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$691.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$628.51
Rate for Payer: Qualcare PPO/HMO/WC	$428.53

TENDON GRACLLIS 200-259 330165

Facility

$2,856.85

Hospital Charge Code	270621432
Hospital Revenue Code	278
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$1,428.42
Rate for Payer: Aetna Commercial	$1,085.60
Rate for Payer: Aetna Medicare Advantage	$857.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$728.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$728.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$571.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$728.50
Rate for Payer: Cigna Commercial	$1,428.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$691.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$628.51
Rate for Payer: Qualcare PPO/HMO/WC	$428.53
Rate for Payer: UnitedHealthcare Community & State	$68.85
Rate for Payer: Wellpoint Medicaid Managed Care	$75.71

TENDONITIS, MYOSITIS AND BURSITIS WITH MCC

Facility

$50,193.12

Service Code	MSDRG 557
Min. Negotiated Rate	$15,283.16
Max. Negotiated Rate	$50,193.12
Rate for Payer: Aetna Commercial	$34,745.73
Rate for Payer: Aetna Medicare Advantage	$50,193.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36,287.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36,287.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,087.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36,287.16
Rate for Payer: Cigna Commercial	$27,825.85
Rate for Payer: Cigna Medicare Advantage	$16,087.54
Rate for Payer: Clover Medicare Advantage	$15,283.16
Rate for Payer: EmblemHealth Commercial	$48,262.62
Rate for Payer: Humana Medicare Advantage	$16,570.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,087.54
Rate for Payer: Oxford Commercial	$19,998.81
Rate for Payer: UnitedHealthcare Commercial	$35,068.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,087.54
Rate for Payer: Wellcare Medicare Advantage	$16,087.54

TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC

Facility

$31,003.75

Service Code	MSDRG 558
Min. Negotiated Rate	$9,440.25
Max. Negotiated Rate	$31,003.75
Rate for Payer: Aetna Commercial	$21,560.44
Rate for Payer: Aetna Medicare Advantage	$31,003.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20,469.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20,469.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,937.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20,469.68
Rate for Payer: Cigna Commercial	$16,715.34
Rate for Payer: Cigna Medicare Advantage	$9,937.10
Rate for Payer: Clover Medicare Advantage	$9,440.25
Rate for Payer: EmblemHealth Commercial	$29,811.30
Rate for Payer: Humana Medicare Advantage	$10,235.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,937.10
Rate for Payer: Oxford Commercial	$12,013.54
Rate for Payer: UnitedHealthcare Commercial	$21,066.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,937.10
Rate for Payer: Wellcare Medicare Advantage	$9,937.10

TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES

Facility

$42,197.79

Service Code	APR-DRG 3174
Min. Negotiated Rate	$41,370.38
Max. Negotiated Rate	$42,197.79
Rate for Payer: UnitedHealthcare Community & State	$41,370.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$42,197.79
Rate for Payer: Wellpoint Medicaid Managed Care	$41,370.38

TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES

Facility

$12,015.11

Service Code	APR-DRG 3171
Min. Negotiated Rate	$11,779.52
Max. Negotiated Rate	$12,015.11
Rate for Payer: UnitedHealthcare Community & State	$11,779.52
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,015.11
Rate for Payer: Wellpoint Medicaid Managed Care	$11,779.52

TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES

Facility

$15,496.68

Service Code	APR-DRG 3172
Min. Negotiated Rate	$15,192.82
Max. Negotiated Rate	$15,496.68
Rate for Payer: UnitedHealthcare Community & State	$15,192.82
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,496.68
Rate for Payer: Wellpoint Medicaid Managed Care	$15,192.82

TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES

Facility

$23,393.12

Service Code	APR-DRG 3173
Min. Negotiated Rate	$22,934.43
Max. Negotiated Rate	$23,393.12
Rate for Payer: UnitedHealthcare Community & State	$22,934.43
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,393.12
Rate for Payer: Wellpoint Medicaid Managed Care	$22,934.43

TENDON POST TIBIALS 2000550000

Facility

$6,944.00

Hospital Charge Code	270634061
Hospital Revenue Code	278
Min. Negotiated Rate	$167.35
Max. Negotiated Rate	$3,472.00
Rate for Payer: Aetna Commercial	$2,638.72
Rate for Payer: Aetna Medicare Advantage	$2,083.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,770.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,770.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,770.72
Rate for Payer: Cigna Commercial	$3,472.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,680.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,527.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.60
Rate for Payer: UnitedHealthcare Community & State	$167.35
Rate for Payer: Wellpoint Medicaid Managed Care	$184.02

TENDON POST TIBIALS 2000550000

Facility

$6,944.00

Hospital Charge Code	270634061
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.60
Max. Negotiated Rate	$1,680.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,680.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,527.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.60

TENDON PULLEY RECONSTRUCTION

Facility

$28,255.00

Service Code	HCPCS 26500
Hospital Charge Code	16000848
Hospital Revenue Code	360
Min. Negotiated Rate	$680.95
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,476.50
Rate for Payer: Oxford Commercial	$3,248.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,238.25
Rate for Payer: UnitedHealthcare Commercial	$5,311.00
Rate for Payer: UnitedHealthcare Community & State	$680.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$748.76

TENDON PULLEY RECONSTRUCTION

Facility

$28,255.00

Service Code	HCPCS 26500
Hospital Charge Code	16000848
Hospital Revenue Code	360
Min. Negotiated Rate	$4,238.25
Max. Negotiated Rate	$4,238.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,238.25

TENDON SEMITENDINOSIS 330170

Facility

$3,273.65

Hospital Charge Code	270621434
Hospital Revenue Code	278
Min. Negotiated Rate	$491.05
Max. Negotiated Rate	$792.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$654.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$792.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$720.20
Rate for Payer: Qualcare PPO/HMO/WC	$491.05

TENDON SEMITENDINOSIS 330170

Facility

$3,273.65

Hospital Charge Code	270621434
Hospital Revenue Code	278
Min. Negotiated Rate	$78.89
Max. Negotiated Rate	$1,636.83
Rate for Payer: Aetna Commercial	$1,243.99
Rate for Payer: Aetna Medicare Advantage	$982.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$834.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$834.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$654.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$834.78
Rate for Payer: Cigna Commercial	$1,636.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$792.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$720.20
Rate for Payer: Qualcare PPO/HMO/WC	$491.05
Rate for Payer: UnitedHealthcare Community & State	$78.89
Rate for Payer: Wellpoint Medicaid Managed Care	$86.75

TENDON SEMITENDINOSUS 92-0784

Facility

$6,448.00

Hospital Charge Code	270628576
Hospital Revenue Code	278
Min. Negotiated Rate	$967.20
Max. Negotiated Rate	$1,560.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,418.56
Rate for Payer: Qualcare PPO/HMO/WC	$967.20

Know your out-of-pocket cost for care.

All Charges