Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BONE CEMENT SAT MIXING SYS

Facility

$3,318.00

Hospital Charge Code	270670685
Hospital Revenue Code	272
Min. Negotiated Rate	$497.70
Max. Negotiated Rate	$497.70
Rate for Payer: Qualcare PPO/HMO/WC	$497.70

BONE CEMENT SAT MIXING SYS

Facility

$3,318.00

Hospital Charge Code	270670685
Hospital Revenue Code	272
Min. Negotiated Rate	$79.96
Max. Negotiated Rate	$1,659.00
Rate for Payer: Aetna Commercial	$1,260.84
Rate for Payer: Aetna Medicare Advantage	$995.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$846.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$846.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$846.09
Rate for Payer: Cigna Commercial	$1,659.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$995.40
Rate for Payer: Oxford Commercial	$663.60
Rate for Payer: Qualcare PPO/HMO/WC	$497.70
Rate for Payer: UnitedHealthcare Commercial	$663.60
Rate for Payer: UnitedHealthcare Community & State	$79.96
Rate for Payer: Wellpoint Medicaid Managed Care	$87.93

BONE CEMENT SAT MIXING SYS 7CC

Facility

$3,505.00

Hospital Charge Code	270670688
Hospital Revenue Code	272
Min. Negotiated Rate	$84.47
Max. Negotiated Rate	$1,752.50
Rate for Payer: Aetna Commercial	$1,331.90
Rate for Payer: Aetna Medicare Advantage	$1,051.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$893.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$893.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$893.77
Rate for Payer: Cigna Commercial	$1,752.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,051.50
Rate for Payer: Oxford Commercial	$701.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.75
Rate for Payer: UnitedHealthcare Commercial	$701.00
Rate for Payer: UnitedHealthcare Community & State	$84.47
Rate for Payer: Wellpoint Medicaid Managed Care	$92.88

BONE CEMENT SAT MIXING SYS 7CC

Facility

$3,505.00

Hospital Charge Code	270670688
Hospital Revenue Code	272
Min. Negotiated Rate	$525.75
Max. Negotiated Rate	$525.75
Rate for Payer: Qualcare PPO/HMO/WC	$525.75

BONE CEMENT SIMPLEX FULL DOSE

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	270651646
Hospital Revenue Code	278
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$177.50
Rate for Payer: Aetna Commercial	$134.90
Rate for Payer: Aetna Medicare Advantage	$106.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.53
Rate for Payer: Cigna Commercial	$177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$78.10
Rate for Payer: Qualcare PPO/HMO/WC	$53.25
Rate for Payer: UnitedHealthcare Community & State	$8.56
Rate for Payer: Wellpoint Medicaid Managed Care	$9.41

BONE CEMENT SIMPLEX FULL DOSE

Facility

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	270672934
Hospital Revenue Code	278
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$85.80
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

BONE CEMENT SIMPLEX FULL DOSE

Facility

$390.00

Service Code	HCPCS C1713
Hospital Charge Code	270672934
Hospital Revenue Code	278
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$94.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$85.80
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BONE CEMENT SIMPLEX FULL DOSE

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	270651646
Hospital Revenue Code	278
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$85.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$78.10
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

BONE CEMENT SIMPLEX HALF DOSE

Facility

$250.00

Hospital Charge Code	270673756
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

BONE CEMENT SIMPLEX HALF DOSE

Facility

$249.50

Hospital Charge Code	270673759
Hospital Revenue Code	278
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$124.75
Rate for Payer: Aetna Commercial	$94.81
Rate for Payer: Aetna Medicare Advantage	$74.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.62
Rate for Payer: Cigna Commercial	$124.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.89
Rate for Payer: Qualcare PPO/HMO/WC	$37.42
Rate for Payer: UnitedHealthcare Community & State	$6.01
Rate for Payer: Wellpoint Medicaid Managed Care	$6.61

BONE CEMENT SIMPLEX HALF DOSE

Facility

$250.00

Hospital Charge Code	270673756
Hospital Revenue Code	278
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

BONE CEMENT SIMPLEX HALF DOSE

Facility

$249.50

Hospital Charge Code	270673759
Hospital Revenue Code	278
Min. Negotiated Rate	$37.42
Max. Negotiated Rate	$60.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.89
Rate for Payer: Qualcare PPO/HMO/WC	$37.42

BONE CEMENT SIMPLEX HV

Facility

$355.00

Hospital Charge Code	270673762
Hospital Revenue Code	278
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$85.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$78.10
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

BONE CEMENT SIMPLEX HV

Facility

$355.00

Hospital Charge Code	270673762
Hospital Revenue Code	278
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$177.50
Rate for Payer: Aetna Commercial	$134.90
Rate for Payer: Aetna Medicare Advantage	$106.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.53
Rate for Payer: Cigna Commercial	$177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$78.10
Rate for Payer: Qualcare PPO/HMO/WC	$53.25
Rate for Payer: UnitedHealthcare Community & State	$8.56
Rate for Payer: Wellpoint Medicaid Managed Care	$9.41

BONE CEMENT SIMPLEX HV

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	270669204
Hospital Revenue Code	278
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$85.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$78.10
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

BONE CEMENT SIMPLEX HV

Facility

$355.00

Service Code	HCPCS C1713
Hospital Charge Code	270669204
Hospital Revenue Code	278
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$177.50
Rate for Payer: Aetna Commercial	$134.90
Rate for Payer: Aetna Medicare Advantage	$106.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.53
Rate for Payer: Cigna Commercial	$177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$78.10
Rate for Payer: Qualcare PPO/HMO/WC	$53.25
Rate for Payer: UnitedHealthcare Community & State	$8.56
Rate for Payer: Wellpoint Medicaid Managed Care	$9.41

BONE CEMENT SIMPLEX HV GENT

Facility

$1,006.75

Service Code	HCPCS C1713
Hospital Charge Code	270669205
Hospital Revenue Code	278
Min. Negotiated Rate	$24.26
Max. Negotiated Rate	$503.38
Rate for Payer: Aetna Commercial	$382.56
Rate for Payer: Aetna Medicare Advantage	$302.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.72
Rate for Payer: Cigna Commercial	$503.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$221.49
Rate for Payer: Qualcare PPO/HMO/WC	$151.01
Rate for Payer: UnitedHealthcare Community & State	$24.26
Rate for Payer: Wellpoint Medicaid Managed Care	$26.68

BONE CEMENT SIMPLEX HV GENT

Facility

$1,006.77

Hospital Charge Code	270673387
Hospital Revenue Code	278
Min. Negotiated Rate	$151.02
Max. Negotiated Rate	$243.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$221.49
Rate for Payer: Qualcare PPO/HMO/WC	$151.02

BONE CEMENT SIMPLEX HV GENT

Facility

$1,006.75

Service Code	HCPCS C1713
Hospital Charge Code	270669205
Hospital Revenue Code	278
Min. Negotiated Rate	$151.01
Max. Negotiated Rate	$243.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$221.49
Rate for Payer: Qualcare PPO/HMO/WC	$151.01

BONE CEMENT SIMPLEX HV GENT

Facility

$1,006.77

Hospital Charge Code	270673387
Hospital Revenue Code	278
Min. Negotiated Rate	$24.26
Max. Negotiated Rate	$503.38
Rate for Payer: Aetna Commercial	$382.57
Rate for Payer: Aetna Medicare Advantage	$302.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.73
Rate for Payer: Cigna Commercial	$503.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$221.49
Rate for Payer: Qualcare PPO/HMO/WC	$151.02
Rate for Payer: UnitedHealthcare Community & State	$24.26
Rate for Payer: Wellpoint Medicaid Managed Care	$26.68

BONE CEMENT TOB FULL DOSE

Facility

$1,565.00

Service Code	HCPCS C1713
Hospital Charge Code	270660302
Hospital Revenue Code	278
Min. Negotiated Rate	$234.75
Max. Negotiated Rate	$378.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$313.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$344.30
Rate for Payer: Qualcare PPO/HMO/WC	$234.75

BONE CEMENT TOB FULL DOSE

Facility

$1,490.00

Hospital Charge Code	270673763
Hospital Revenue Code	278
Min. Negotiated Rate	$223.50
Max. Negotiated Rate	$360.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$298.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$360.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$327.80
Rate for Payer: Qualcare PPO/HMO/WC	$223.50

BONE CEMENT TOB FULL DOSE

Facility

$1,565.00

Service Code	HCPCS C1713
Hospital Charge Code	270660302
Hospital Revenue Code	278
Min. Negotiated Rate	$37.72
Max. Negotiated Rate	$782.50
Rate for Payer: Aetna Commercial	$594.70
Rate for Payer: Aetna Medicare Advantage	$469.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$399.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$399.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$313.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$399.07
Rate for Payer: Cigna Commercial	$782.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$344.30
Rate for Payer: Qualcare PPO/HMO/WC	$234.75
Rate for Payer: UnitedHealthcare Community & State	$37.72
Rate for Payer: Wellpoint Medicaid Managed Care	$41.47

BONE CEMENT TOB FULL DOSE

Facility

$1,490.00

Hospital Charge Code	270673763
Hospital Revenue Code	278
Min. Negotiated Rate	$35.91
Max. Negotiated Rate	$745.00
Rate for Payer: Aetna Commercial	$566.20
Rate for Payer: Aetna Medicare Advantage	$447.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$379.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$379.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$298.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$379.95
Rate for Payer: Cigna Commercial	$745.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$360.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$327.80
Rate for Payer: Qualcare PPO/HMO/WC	$223.50
Rate for Payer: UnitedHealthcare Community & State	$35.91
Rate for Payer: Wellpoint Medicaid Managed Care	$39.48

BONE CERAMENT BONE FILLER 5CC

Facility

$9,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270651533
Hospital Revenue Code	278
Min. Negotiated Rate	$1,362.00
Max. Negotiated Rate	$2,197.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,816.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,197.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,997.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,362.00

Know your out-of-pocket cost for care.

All Charges