Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BOLT 8.5X25MM

Facility

$5,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705888
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 8.5 X30MM

Facility

$5,210.00

Hospital Charge Code	270703005
Hospital Revenue Code	278
Min. Negotiated Rate	$781.50
Max. Negotiated Rate	$1,260.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,042.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,260.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,146.20
Rate for Payer: Qualcare PPO/HMO/WC	$781.50

BOLT 8.5 X30MM

Facility

$5,210.00

Hospital Charge Code	270703005
Hospital Revenue Code	278
Min. Negotiated Rate	$125.56
Max. Negotiated Rate	$2,605.00
Rate for Payer: Aetna Commercial	$1,979.80
Rate for Payer: Aetna Medicare Advantage	$1,563.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,328.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,328.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,042.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,328.55
Rate for Payer: Cigna Commercial	$2,605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,260.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,146.20
Rate for Payer: Qualcare PPO/HMO/WC	$781.50
Rate for Payer: UnitedHealthcare Community & State	$125.56
Rate for Payer: Wellpoint Medicaid Managed Care	$138.06

BOLT BMT TRANS 5 60 33-345462

Facility

$944.85

Hospital Charge Code	270618209
Hospital Revenue Code	278
Min. Negotiated Rate	$141.73
Max. Negotiated Rate	$228.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$207.87
Rate for Payer: Qualcare PPO/HMO/WC	$141.73

BOLT BMT TRANS 5 60 33-345462

Facility

$944.85

Hospital Charge Code	270618209
Hospital Revenue Code	278
Min. Negotiated Rate	$22.77
Max. Negotiated Rate	$472.43
Rate for Payer: Aetna Commercial	$359.04
Rate for Payer: Aetna Medicare Advantage	$283.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.94
Rate for Payer: Cigna Commercial	$472.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$207.87
Rate for Payer: Qualcare PPO/HMO/WC	$141.73
Rate for Payer: UnitedHealthcare Community & State	$22.77
Rate for Payer: Wellpoint Medicaid Managed Care	$25.04

BOLT BMT TRANS 5 70 33-345464

Facility

$944.85

Hospital Charge Code	270618210
Hospital Revenue Code	278
Min. Negotiated Rate	$141.73
Max. Negotiated Rate	$228.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$207.87
Rate for Payer: Qualcare PPO/HMO/WC	$141.73

BOLT BMT TRANS 5 70 33-345464

Facility

$944.85

Hospital Charge Code	270618210
Hospital Revenue Code	278
Min. Negotiated Rate	$22.77
Max. Negotiated Rate	$472.43
Rate for Payer: Aetna Commercial	$359.04
Rate for Payer: Aetna Medicare Advantage	$283.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.94
Rate for Payer: Cigna Commercial	$472.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$207.87
Rate for Payer: Qualcare PPO/HMO/WC	$141.73
Rate for Payer: UnitedHealthcare Community & State	$22.77
Rate for Payer: Wellpoint Medicaid Managed Care	$25.04

BOLT BMT TROCHANTER 13-104756

Facility

$2,527.25

Hospital Charge Code	270611652
Hospital Revenue Code	278
Min. Negotiated Rate	$379.09
Max. Negotiated Rate	$611.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$505.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$611.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$556.00
Rate for Payer: Qualcare PPO/HMO/WC	$379.09

BOLT BMT TROCHANTER 13-104756

Facility

$2,527.25

Hospital Charge Code	270611652
Hospital Revenue Code	278
Min. Negotiated Rate	$60.91
Max. Negotiated Rate	$1,263.62
Rate for Payer: Aetna Commercial	$960.36
Rate for Payer: Aetna Medicare Advantage	$758.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$644.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$644.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$505.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$644.45
Rate for Payer: Cigna Commercial	$1,263.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$611.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$556.00
Rate for Payer: Qualcare PPO/HMO/WC	$379.09
Rate for Payer: UnitedHealthcare Community & State	$60.91
Rate for Payer: Wellpoint Medicaid Managed Care	$66.97

BOLT CONNECTING

Facility

$53.30

Hospital Charge Code	270681236
Hospital Revenue Code	272
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.00

BOLT CONNECTING

Facility

$53.30

Hospital Charge Code	270681236
Hospital Revenue Code	272
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$26.65
Rate for Payer: Aetna Commercial	$20.25
Rate for Payer: Aetna Medicare Advantage	$15.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.59
Rate for Payer: Cigna Commercial	$26.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.99
Rate for Payer: Oxford Commercial	$10.66
Rate for Payer: Qualcare PPO/HMO/WC	$8.00
Rate for Payer: UnitedHealthcare Commercial	$10.66
Rate for Payer: UnitedHealthcare Community & State	$1.28
Rate for Payer: Wellpoint Medicaid Managed Care	$1.41

BOLT FEM NECK 90MM STERILE

Facility

$1,597.55

Service Code	HCPCS C1713
Hospital Charge Code	270686943
Hospital Revenue Code	278
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$798.77
Rate for Payer: Aetna Commercial	$607.07
Rate for Payer: Aetna Medicare Advantage	$479.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$407.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$407.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$319.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$407.38
Rate for Payer: Cigna Commercial	$798.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$386.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$351.46
Rate for Payer: Qualcare PPO/HMO/WC	$239.63
Rate for Payer: UnitedHealthcare Community & State	$38.50
Rate for Payer: Wellpoint Medicaid Managed Care	$42.34

BOLT FEM NECK 90MM STERILE

Facility

$1,597.55

Service Code	HCPCS C1713
Hospital Charge Code	270686943
Hospital Revenue Code	278
Min. Negotiated Rate	$239.63
Max. Negotiated Rate	$386.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$319.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$386.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$351.46
Rate for Payer: Qualcare PPO/HMO/WC	$239.63

BOLT FEMORAL NECK SYSTEM 95MM

Facility

$3,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270697922
Hospital Revenue Code	278
Min. Negotiated Rate	$495.00
Max. Negotiated Rate	$798.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$660.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$798.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$495.00

BOLT FEMORAL NECK SYSTEM 95MM

Facility

$3,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270697922
Hospital Revenue Code	278
Min. Negotiated Rate	$79.53
Max. Negotiated Rate	$1,650.00
Rate for Payer: Aetna Commercial	$1,254.00
Rate for Payer: Aetna Medicare Advantage	$990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$841.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$841.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$660.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$841.50
Rate for Payer: Cigna Commercial	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$798.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$495.00
Rate for Payer: UnitedHealthcare Community & State	$79.53
Rate for Payer: Wellpoint Medicaid Managed Care	$87.45

BOLT FOOT PLATE

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Charge Code	270697188
Hospital Revenue Code	278
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$399.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

BOLT FOOT PLATE

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Charge Code	270697188
Hospital Revenue Code	278
Min. Negotiated Rate	$39.77
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$627.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50
Rate for Payer: UnitedHealthcare Community & State	$39.77
Rate for Payer: Wellpoint Medicaid Managed Care	$43.73

BOLT FOR FEMORAL NECK SYS 75MM

Facility

$1,825.00

Service Code	HCPCS C1713
Hospital Charge Code	270687503
Hospital Revenue Code	278
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$441.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$401.50
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

BOLT FOR FEMORAL NECK SYS 75MM

Facility

$1,825.00

Service Code	HCPCS C1713
Hospital Charge Code	270687503
Hospital Revenue Code	278
Min. Negotiated Rate	$43.98
Max. Negotiated Rate	$912.50
Rate for Payer: Aetna Commercial	$693.50
Rate for Payer: Aetna Medicare Advantage	$547.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$365.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.38
Rate for Payer: Cigna Commercial	$912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$401.50
Rate for Payer: Qualcare PPO/HMO/WC	$273.75
Rate for Payer: UnitedHealthcare Community & State	$43.98
Rate for Payer: Wellpoint Medicaid Managed Care	$48.36

BOLT FOR FEMORAL NECK SYS 90MM

Facility

$1,551.00

Service Code	HCPCS C1713
Hospital Charge Code	270687815
Hospital Revenue Code	278
Min. Negotiated Rate	$232.65
Max. Negotiated Rate	$375.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$310.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$341.22
Rate for Payer: Qualcare PPO/HMO/WC	$232.65

BOLT FOR FEMORAL NECK SYS 90MM

Facility

$1,551.00

Service Code	HCPCS C1713
Hospital Charge Code	270687815
Hospital Revenue Code	278
Min. Negotiated Rate	$37.38
Max. Negotiated Rate	$775.50
Rate for Payer: Aetna Commercial	$589.38
Rate for Payer: Aetna Medicare Advantage	$465.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$395.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$395.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$310.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$395.50
Rate for Payer: Cigna Commercial	$775.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$341.22
Rate for Payer: Qualcare PPO/HMO/WC	$232.65
Rate for Payer: UnitedHealthcare Community & State	$37.38
Rate for Payer: Wellpoint Medicaid Managed Care	$41.10

BOLT FOR FEMORAL NECK SYSTEM 8

Facility

$1,980.00

Service Code	HCPCS C1713
Hospital Charge Code	270687016
Hospital Revenue Code	278
Min. Negotiated Rate	$297.00
Max. Negotiated Rate	$479.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$396.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$479.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$435.60
Rate for Payer: Qualcare PPO/HMO/WC	$297.00

BOLT FOR FEMORAL NECK SYSTEM 8

Facility

$1,980.00

Service Code	HCPCS C1713
Hospital Charge Code	270687016
Hospital Revenue Code	278
Min. Negotiated Rate	$47.72
Max. Negotiated Rate	$990.00
Rate for Payer: Aetna Commercial	$752.40
Rate for Payer: Aetna Medicare Advantage	$594.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$504.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$504.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$396.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$504.90
Rate for Payer: Cigna Commercial	$990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$479.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$435.60
Rate for Payer: Qualcare PPO/HMO/WC	$297.00
Rate for Payer: UnitedHealthcare Community & State	$47.72
Rate for Payer: Wellpoint Medicaid Managed Care	$52.47

BOLT FOR FEMORAL NK 110MM

Facility

$3,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270699631
Hospital Revenue Code	278
Min. Negotiated Rate	$79.53
Max. Negotiated Rate	$1,650.00
Rate for Payer: Aetna Commercial	$1,254.00
Rate for Payer: Aetna Medicare Advantage	$990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$841.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$841.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$660.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$841.50
Rate for Payer: Cigna Commercial	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$798.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$495.00
Rate for Payer: UnitedHealthcare Community & State	$79.53
Rate for Payer: Wellpoint Medicaid Managed Care	$87.45

BOLT FOR FEMORAL NK 110MM

Facility

$3,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270699631
Hospital Revenue Code	278
Min. Negotiated Rate	$495.00
Max. Negotiated Rate	$798.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$660.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$798.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$495.00

Know your out-of-pocket cost for care.

All Charges