Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TRAY TIBIAL SZ3 58420302

Facility

$6,437.75

Hospital Charge Code	270635698
Hospital Revenue Code	278
Min. Negotiated Rate	$965.66
Max. Negotiated Rate	$1,557.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,287.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,557.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,416.31
Rate for Payer: Qualcare PPO/HMO/WC	$965.66

TRAY TIBIAL SZ3 58420302

Facility

$6,437.75

Hospital Charge Code	270635698
Hospital Revenue Code	278
Min. Negotiated Rate	$155.15
Max. Negotiated Rate	$3,218.88
Rate for Payer: Aetna Commercial	$2,446.34
Rate for Payer: Aetna Medicare Advantage	$1,931.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,641.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,641.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,287.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,641.63
Rate for Payer: Cigna Commercial	$3,218.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,557.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,416.31
Rate for Payer: Qualcare PPO/HMO/WC	$965.66
Rate for Payer: UnitedHealthcare Community & State	$155.15
Rate for Payer: Wellpoint Medicaid Managed Care	$170.60

TRAY TIBIAL SZ E RT MED 154727

Facility

$7,650.00

Hospital Charge Code	270638796
Hospital Revenue Code	278
Min. Negotiated Rate	$1,147.50
Max. Negotiated Rate	$1,851.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,530.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,851.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,683.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,147.50

TRAY TIBIAL SZ E RT MED 154727

Facility

$7,650.00

Hospital Charge Code	270638796
Hospital Revenue Code	278
Min. Negotiated Rate	$184.37
Max. Negotiated Rate	$3,825.00
Rate for Payer: Aetna Commercial	$2,907.00
Rate for Payer: Aetna Medicare Advantage	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,950.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,950.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,950.75
Rate for Payer: Cigna Commercial	$3,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,851.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,683.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,147.50
Rate for Payer: UnitedHealthcare Community & State	$184.37
Rate for Payer: Wellpoint Medicaid Managed Care	$202.72

TRAY TIBIAL TRAPEZOID SZ 3F/2T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677100
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

TRAY TIBIAL TRAPEZOID SZ 3F/2T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677100
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

TRAY TIBIAL TRAPEZOID SZ 3F/3T

Facility

$8,310.00

Service Code	HCPCS C1776
Hospital Charge Code	270668746
Hospital Revenue Code	278
Min. Negotiated Rate	$200.27
Max. Negotiated Rate	$4,155.00
Rate for Payer: Aetna Commercial	$3,157.80
Rate for Payer: Aetna Medicare Advantage	$2,493.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,119.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,119.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,662.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,119.05
Rate for Payer: Cigna Commercial	$4,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,011.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,828.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,246.50
Rate for Payer: UnitedHealthcare Community & State	$200.27
Rate for Payer: Wellpoint Medicaid Managed Care	$220.22

TRAY TIBIAL TRAPEZOID SZ 3F/3T

Facility

$8,310.00

Service Code	HCPCS C1776
Hospital Charge Code	270668746
Hospital Revenue Code	278
Min. Negotiated Rate	$1,246.50
Max. Negotiated Rate	$2,011.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,662.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,011.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,828.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,246.50

TRAY TIBIAL TRAPEZOID SZ 4FT/4

Facility

$8,903.25

Hospital Charge Code	270669600
Hospital Revenue Code	278
Min. Negotiated Rate	$214.57
Max. Negotiated Rate	$4,451.62
Rate for Payer: Aetna Commercial	$3,383.24
Rate for Payer: Aetna Medicare Advantage	$2,670.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,270.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,270.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,270.33
Rate for Payer: Cigna Commercial	$4,451.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,154.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,958.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.49
Rate for Payer: UnitedHealthcare Community & State	$214.57
Rate for Payer: Wellpoint Medicaid Managed Care	$235.94

TRAY TIBIAL TRAPEZOID SZ 4FT/4

Facility

$8,903.25

Hospital Charge Code	270669600
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.49
Max. Negotiated Rate	$2,154.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,154.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,958.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.49

TRAY TIBIAL TRAPEZOID SZ 5F/4T

Facility

$5,000.00

Hospital Charge Code	270677252
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

TRAY TIBIAL TRAPEZOID SZ 5F/4T

Facility

$5,000.00

Hospital Charge Code	270677252
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

TRAY TIBIAL TRAPEZOID SZ 6F/6T

Facility

$11,560.00

Hospital Charge Code	270668934
Hospital Revenue Code	278
Min. Negotiated Rate	$1,734.00
Max. Negotiated Rate	$2,797.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,312.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,797.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,543.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,734.00

TRAY TIBIAL TRAPEZOID SZ 6F/6T

Facility

$11,560.00

Hospital Charge Code	270668934
Hospital Revenue Code	278
Min. Negotiated Rate	$278.60
Max. Negotiated Rate	$5,780.00
Rate for Payer: Aetna Commercial	$4,392.80
Rate for Payer: Aetna Medicare Advantage	$3,468.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,947.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,947.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,312.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,947.80
Rate for Payer: Cigna Commercial	$5,780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,797.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,543.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,734.00
Rate for Payer: UnitedHealthcare Community & State	$278.60
Rate for Payer: Wellpoint Medicaid Managed Care	$306.34

TRAY TIB PLT STEM SZ1 59802701

Facility

$7,647.25

Hospital Charge Code	270633690
Hospital Revenue Code	278
Min. Negotiated Rate	$184.30
Max. Negotiated Rate	$3,823.62
Rate for Payer: Aetna Commercial	$2,905.95
Rate for Payer: Aetna Medicare Advantage	$2,294.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,950.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,950.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,529.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,950.05
Rate for Payer: Cigna Commercial	$3,823.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,850.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,682.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,147.09
Rate for Payer: UnitedHealthcare Community & State	$184.30
Rate for Payer: Wellpoint Medicaid Managed Care	$202.65

TRAY TIB PLT STEM SZ1 59802701

Facility

$7,647.25

Hospital Charge Code	270633690
Hospital Revenue Code	278
Min. Negotiated Rate	$1,147.09
Max. Negotiated Rate	$1,850.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,529.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,850.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,682.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,147.09

TRAY TIB SZ C RIGHT MED 154723

Facility

$7,715.00

Hospital Charge Code	270639865
Hospital Revenue Code	278
Min. Negotiated Rate	$185.93
Max. Negotiated Rate	$3,857.50
Rate for Payer: Aetna Commercial	$2,931.70
Rate for Payer: Aetna Medicare Advantage	$2,314.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,967.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,967.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,543.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,967.33
Rate for Payer: Cigna Commercial	$3,857.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,867.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,697.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,157.25
Rate for Payer: UnitedHealthcare Community & State	$185.93
Rate for Payer: Wellpoint Medicaid Managed Care	$204.45

TRAY TIB SZ C RIGHT MED 154723

Facility

$7,715.00

Hospital Charge Code	270639865
Hospital Revenue Code	278
Min. Negotiated Rate	$1,157.25
Max. Negotiated Rate	$1,867.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,867.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,697.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,157.25

TRAY TOTAL HIP

Facility

$690.00

Hospital Charge Code	270654124
Hospital Revenue Code	272
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$345.00
Rate for Payer: Aetna Commercial	$262.20
Rate for Payer: Aetna Medicare Advantage	$207.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.95
Rate for Payer: Cigna Commercial	$345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.00
Rate for Payer: Oxford Commercial	$138.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.50
Rate for Payer: UnitedHealthcare Commercial	$138.00
Rate for Payer: UnitedHealthcare Community & State	$16.63
Rate for Payer: Wellpoint Medicaid Managed Care	$18.29

TRAY TOTAL HIP

Facility

$690.00

Hospital Charge Code	270654124
Hospital Revenue Code	272
Min. Negotiated Rate	$103.50
Max. Negotiated Rate	$103.50
Rate for Payer: Qualcare PPO/HMO/WC	$103.50

TRAY TOTAL KNEE

Facility

$1,431.40

Hospital Charge Code	270654127
Hospital Revenue Code	272
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$715.70
Rate for Payer: Aetna Commercial	$543.93
Rate for Payer: Aetna Medicare Advantage	$429.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.01
Rate for Payer: Cigna Commercial	$715.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.42
Rate for Payer: Oxford Commercial	$286.28
Rate for Payer: Qualcare PPO/HMO/WC	$214.71
Rate for Payer: UnitedHealthcare Commercial	$286.28
Rate for Payer: UnitedHealthcare Community & State	$34.50
Rate for Payer: Wellpoint Medicaid Managed Care	$37.93

TRAY TOTAL KNEE

Facility

$1,431.40

Hospital Charge Code	270654127
Hospital Revenue Code	272
Min. Negotiated Rate	$214.71
Max. Negotiated Rate	$214.71
Rate for Payer: Qualcare PPO/HMO/WC	$214.71

TRAY TPN CO #0637 *******

Facility

$25.00

Hospital Charge Code	8001703
Hospital Revenue Code	279
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

TRAY TPN CO #0637 *******

Facility

$25.00

Hospital Charge Code	8001703
Hospital Revenue Code	279
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.50
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$5.00
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

TRAY TPN CO #0769 *******

Facility

$40.00

Hospital Charge Code	8002917
Hospital Revenue Code	279
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

Know your out-of-pocket cost for care.

All Charges