Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BODY POS GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8982GPCN
Hospital Charge Code	84202020CN
Hospital Revenue Code	420
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

BODY POS GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8982GOCN
Hospital Charge Code	74203095CN
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BODY POS GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8982GPCN
Hospital Charge Code	84202020CN
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BODY POS GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8982GOCN
Hospital Charge Code	74203095CN
Hospital Revenue Code	430
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

BODY STANDARD REVERSE SHOULDER

Facility

$12,318.15

Service Code	HCPCS C1776
Hospital Charge Code	270689616
Hospital Revenue Code	278
Min. Negotiated Rate	$1,847.72
Max. Negotiated Rate	$2,980.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,463.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,980.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,709.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,847.72

BODY STANDARD REVERSE SHOULDER

Facility

$12,318.15

Service Code	HCPCS C1776
Hospital Charge Code	270689616
Hospital Revenue Code	278
Min. Negotiated Rate	$296.87
Max. Negotiated Rate	$6,159.07
Rate for Payer: Aetna Commercial	$4,680.90
Rate for Payer: Aetna Medicare Advantage	$3,695.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,141.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,141.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,463.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,141.13
Rate for Payer: Cigna Commercial	$6,159.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,980.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,709.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,847.72
Rate for Payer: UnitedHealthcare Community & State	$296.87
Rate for Payer: Wellpoint Medicaid Managed Care	$326.43

BODY XXL PROX 135DEGREESX35mm

Facility

$15,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677751
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

BODY XXL PROX 135DEGREESX35mm

Facility

$15,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677751
Hospital Revenue Code	278
Min. Negotiated Rate	$361.50
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$361.50
Rate for Payer: Wellpoint Medicaid Managed Care	$397.50

BOJRAB ALT PLS HAMD ER IMP 625

Facility

$1,790.00

Hospital Charge Code	270639214
Hospital Revenue Code	272
Min. Negotiated Rate	$43.14
Max. Negotiated Rate	$895.00
Rate for Payer: Aetna Commercial	$680.20
Rate for Payer: Aetna Medicare Advantage	$537.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$456.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$456.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$456.45
Rate for Payer: Cigna Commercial	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$537.00
Rate for Payer: Oxford Commercial	$358.00
Rate for Payer: Qualcare PPO/HMO/WC	$268.50
Rate for Payer: UnitedHealthcare Commercial	$358.00
Rate for Payer: UnitedHealthcare Community & State	$43.14
Rate for Payer: Wellpoint Medicaid Managed Care	$47.44

BOJRAB ALT PLS HAMD ER IMP 625

Facility

$1,790.00

Hospital Charge Code	270639214
Hospital Revenue Code	272
Min. Negotiated Rate	$268.50
Max. Negotiated Rate	$268.50
Rate for Payer: Qualcare PPO/HMO/WC	$268.50

BOJRAB PTL A MID EAR IMPLT 675

Facility

$1,790.00

Hospital Charge Code	270639215
Hospital Revenue Code	278
Min. Negotiated Rate	$268.50
Max. Negotiated Rate	$433.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$358.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$433.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$393.80
Rate for Payer: Qualcare PPO/HMO/WC	$268.50

BOJRAB PTL A MID EAR IMPLT 675

Facility

$1,790.00

Hospital Charge Code	270639215
Hospital Revenue Code	278
Min. Negotiated Rate	$43.14
Max. Negotiated Rate	$895.00
Rate for Payer: Aetna Commercial	$680.20
Rate for Payer: Aetna Medicare Advantage	$537.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$456.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$456.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$358.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$456.45
Rate for Payer: Cigna Commercial	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$433.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$393.80
Rate for Payer: Qualcare PPO/HMO/WC	$268.50
Rate for Payer: UnitedHealthcare Community & State	$43.14
Rate for Payer: Wellpoint Medicaid Managed Care	$47.44

BOJRAB UNIV PROST MID EAR 606

Facility

$2,100.00

Hospital Charge Code	270641524
Hospital Revenue Code	278
Min. Negotiated Rate	$50.61
Max. Negotiated Rate	$1,050.00
Rate for Payer: Aetna Commercial	$798.00
Rate for Payer: Aetna Medicare Advantage	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$535.50
Rate for Payer: Cigna Commercial	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$462.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00
Rate for Payer: UnitedHealthcare Community & State	$50.61
Rate for Payer: Wellpoint Medicaid Managed Care	$55.65

BOJRAB UNIV PROST MID EAR 606

Facility

$2,100.00

Hospital Charge Code	270641524
Hospital Revenue Code	278
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$508.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$462.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

BOLDS CEMENT TIBIAL 65mm

Facility

$3,785.00

Hospital Charge Code	270672078
Hospital Revenue Code	278
Min. Negotiated Rate	$567.75
Max. Negotiated Rate	$915.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$757.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$915.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$832.70
Rate for Payer: Qualcare PPO/HMO/WC	$567.75

BOLDS CEMENT TIBIAL 65mm

Facility

$3,785.00

Hospital Charge Code	270672078
Hospital Revenue Code	278
Min. Negotiated Rate	$91.22
Max. Negotiated Rate	$1,892.50
Rate for Payer: Aetna Commercial	$1,438.30
Rate for Payer: Aetna Medicare Advantage	$1,135.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$965.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$965.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$757.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$965.17
Rate for Payer: Cigna Commercial	$1,892.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$915.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$832.70
Rate for Payer: Qualcare PPO/HMO/WC	$567.75
Rate for Payer: UnitedHealthcare Community & State	$91.22
Rate for Payer: Wellpoint Medicaid Managed Care	$100.30

BOLSTER ETH SUTURE RETENT 450G

Facility

$14.45

Hospital Charge Code	270616314
Hospital Revenue Code	272
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$2.17
Rate for Payer: Qualcare PPO/HMO/WC	$2.17

BOLSTER ETH SUTURE RETENT 450G

Facility

$14.45

Hospital Charge Code	270616314
Hospital Revenue Code	272
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.22
Rate for Payer: Aetna Commercial	$5.49
Rate for Payer: Aetna Medicare Advantage	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.68
Rate for Payer: Cigna Commercial	$7.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.33
Rate for Payer: Oxford Commercial	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.17
Rate for Payer: UnitedHealthcare Commercial	$2.89
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

BOLT 5 X 120

Facility

$8,195.00

Service Code	HCPCS C1716
Hospital Charge Code	270702617
Hospital Revenue Code	278
Min. Negotiated Rate	$1,229.25
Max. Negotiated Rate	$1,983.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,639.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,983.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,802.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,229.25

BOLT 5 X 120

Facility

$8,195.00

Service Code	HCPCS C1716
Hospital Charge Code	270702617
Hospital Revenue Code	278
Min. Negotiated Rate	$197.50
Max. Negotiated Rate	$2,155.71
Rate for Payer: Aetna Commercial	$1,624.38
Rate for Payer: Aetna Medicare Advantage	$1,934.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,639.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,155.71
Rate for Payer: Cigna Commercial	$1,197.08
Rate for Payer: Cigna Medicare Advantage	$597.20
Rate for Payer: Clover Medicare Advantage	$567.34
Rate for Payer: EmblemHealth Commercial	$1,791.60
Rate for Payer: Humana Medicare Advantage	$615.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$597.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,983.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,802.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,229.25
Rate for Payer: UnitedHealthcare Community & State	$197.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$597.20
Rate for Payer: Wellcare Medicare Advantage	$597.20
Rate for Payer: Wellpoint Medicaid Managed Care	$217.17

BOLT 6MMX 5.25

Facility

$1,610.00

Service Code	HCPCS C1713
Hospital Charge Code	270687842
Hospital Revenue Code	278
Min. Negotiated Rate	$241.50
Max. Negotiated Rate	$389.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$322.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$389.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$354.20
Rate for Payer: Qualcare PPO/HMO/WC	$241.50

BOLT 6MMX 5.25

Facility

$1,610.00

Service Code	HCPCS C1713
Hospital Charge Code	270687842
Hospital Revenue Code	278
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$805.00
Rate for Payer: Aetna Commercial	$611.80
Rate for Payer: Aetna Medicare Advantage	$483.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$410.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$410.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$322.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$410.55
Rate for Payer: Cigna Commercial	$805.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$389.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$354.20
Rate for Payer: Qualcare PPO/HMO/WC	$241.50
Rate for Payer: UnitedHealthcare Community & State	$38.80
Rate for Payer: Wellpoint Medicaid Managed Care	$42.66

BOLT 8.5X25

Facility

$5,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270704071
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$1,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,127.50
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

BOLT 8.5X25

Facility

$5,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270704071
Hospital Revenue Code	278
Min. Negotiated Rate	$123.51
Max. Negotiated Rate	$2,562.50
Rate for Payer: Aetna Commercial	$1,947.50
Rate for Payer: Aetna Medicare Advantage	$1,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.88
Rate for Payer: Cigna Commercial	$2,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,127.50
Rate for Payer: Qualcare PPO/HMO/WC	$768.75
Rate for Payer: UnitedHealthcare Community & State	$123.51
Rate for Payer: Wellpoint Medicaid Managed Care	$135.81

BOLT 8.5X25MM

Facility

$5,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705888
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$1,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,127.50
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

Know your out-of-pocket cost for care.

All Charges