Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

9 HOLE NARROW PLATE

Facility

$17,705.00

Service Code	HCPCS C1713
Hospital Charge Code	270705135
Hospital Revenue Code	278
Min. Negotiated Rate	$2,655.75
Max. Negotiated Rate	$4,284.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,541.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,284.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,895.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,655.75

9 HOLE NARROW PLATE

Facility

$17,705.00

Service Code	HCPCS C1713
Hospital Charge Code	270705135
Hospital Revenue Code	278
Min. Negotiated Rate	$426.69
Max. Negotiated Rate	$8,852.50
Rate for Payer: Aetna Commercial	$6,727.90
Rate for Payer: Aetna Medicare Advantage	$5,311.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,514.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,514.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,514.77
Rate for Payer: Cigna Commercial	$8,852.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,284.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,895.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,655.75
Rate for Payer: UnitedHealthcare Community & State	$426.69
Rate for Payer: Wellpoint Medicaid Managed Care	$469.18

9MM 6DEG ZAVATION CAGE

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	2707055356
Hospital Revenue Code	278
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

9MM 6DEG ZAVATION CAGE

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	2707055356
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

9MM CHONDROFIX ALLOGRAFT

Facility

$16,350.00

Hospital Charge Code	270656944
Hospital Revenue Code	278
Min. Negotiated Rate	$394.04
Max. Negotiated Rate	$8,175.00
Rate for Payer: Aetna Commercial	$6,213.00
Rate for Payer: Aetna Medicare Advantage	$4,905.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,169.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,169.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,169.25
Rate for Payer: Cigna Commercial	$8,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,956.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,597.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,452.50
Rate for Payer: UnitedHealthcare Community & State	$394.04
Rate for Payer: Wellpoint Medicaid Managed Care	$433.27

9MM CHONDROFIX ALLOGRAFT

Facility

$16,350.00

Hospital Charge Code	270656944
Hospital Revenue Code	278
Min. Negotiated Rate	$2,452.50
Max. Negotiated Rate	$3,956.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,956.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,597.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,452.50

9MM FIXATION PLATE, 2-HOLES

Facility

$9,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270705958
Hospital Revenue Code	278
Min. Negotiated Rate	$227.75
Max. Negotiated Rate	$4,725.00
Rate for Payer: Aetna Commercial	$3,591.00
Rate for Payer: Aetna Medicare Advantage	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,409.75
Rate for Payer: Cigna Commercial	$4,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,079.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50
Rate for Payer: UnitedHealthcare Community & State	$227.75
Rate for Payer: Wellpoint Medicaid Managed Care	$250.43

9MM FIXATION PLATE, 2-HOLES

Facility

$9,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270705958
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$2,286.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,079.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50

9MM TITANIUM ACIF CAGE

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705957
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

9MM TITANIUM ACIF CAGE

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705957
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

9X38X28MM ALIF SPACER, 10DEG

Facility

$33,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270703760
Hospital Revenue Code	278
Min. Negotiated Rate	$4,968.75
Max. Negotiated Rate	$8,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,016.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,287.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,968.75

9X38X28MM ALIF SPACER, 10DEG

Facility

$33,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270703760
Hospital Revenue Code	278
Min. Negotiated Rate	$798.31
Max. Negotiated Rate	$16,562.50
Rate for Payer: Aetna Commercial	$12,587.50
Rate for Payer: Aetna Medicare Advantage	$9,937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,446.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,446.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,446.88
Rate for Payer: Cigna Commercial	$16,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,016.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,287.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,968.75
Rate for Payer: UnitedHealthcare Community & State	$798.31
Rate for Payer: Wellpoint Medicaid Managed Care	$877.81

A001HELX LOCKING TOOL

Facility

$250.00

Hospital Charge Code	270702509
Hospital Revenue Code	279
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

A001HELX LOCKING TOOL

Facility

$250.00

Hospital Charge Code	270702509
Hospital Revenue Code	279
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) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$50.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$50.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

A2 HEMOGLOBIN

Facility

$218.45

Service Code	HCPCS 83021
Hospital Charge Code	3000130
Hospital Revenue Code	301
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$32.77
Rate for Payer: Qualcare PPO/HMO/WC	$32.77

A2 HEMOGLOBIN

Facility

$218.45

Service Code	HCPCS 83021
Hospital Charge Code	3000130
Hospital Revenue Code	301
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$49.12
Rate for Payer: Aetna Medicare Advantage	$58.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.19
Rate for Payer: Cigna Commercial	$109.22
Rate for Payer: Cigna Medicare Advantage	$18.06
Rate for Payer: Clover Medicare Advantage	$17.16
Rate for Payer: EmblemHealth Commercial	$54.18
Rate for Payer: Humana Medicare Advantage	$18.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.53
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.77
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.06
Rate for Payer: Wellcare Medicare Advantage	$18.06
Rate for Payer: Wellpoint Medicaid Managed Care	$5.79

A2 HEMOGLOBIN***

Facility

$40.00

Hospital Charge Code	3010139
Hospital Revenue Code	309
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

A2 HEMOGLOBIN***

Facility

$40.00

Hospital Charge Code	3010139
Hospital Revenue Code	309
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$124.00
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	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

A5 CONNECTOR

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270659852
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

A5 CONNECTOR

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270659852
Hospital Revenue Code	278
Min. Negotiated Rate	$153.64
Max. Negotiated Rate	$3,187.50
Rate for Payer: Aetna Commercial	$2,422.50
Rate for Payer: Aetna Medicare Advantage	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,625.62
Rate for Payer: Cigna Commercial	$3,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25
Rate for Payer: UnitedHealthcare Community & State	$153.64
Rate for Payer: Wellpoint Medicaid Managed Care	$168.94

A5 CROSSLINK

Facility

$11,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270665831
Hospital Revenue Code	278
Min. Negotiated Rate	$279.56
Max. Negotiated Rate	$5,800.00
Rate for Payer: Aetna Commercial	$4,408.00
Rate for Payer: Aetna Medicare Advantage	$3,480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,958.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,958.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,958.00
Rate for Payer: Cigna Commercial	$5,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,807.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,552.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,740.00
Rate for Payer: UnitedHealthcare Community & State	$279.56
Rate for Payer: Wellpoint Medicaid Managed Care	$307.40

A5 CROSSLINK

Facility

$11,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270665831
Hospital Revenue Code	278
Min. Negotiated Rate	$1,740.00
Max. Negotiated Rate	$2,807.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,807.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,552.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,740.00

A6 CONNECTOR

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270661529
Hospital Revenue Code	278
Min. Negotiated Rate	$153.64
Max. Negotiated Rate	$3,187.50
Rate for Payer: Aetna Commercial	$2,422.50
Rate for Payer: Aetna Medicare Advantage	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,625.62
Rate for Payer: Cigna Commercial	$3,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25
Rate for Payer: UnitedHealthcare Community & State	$153.64
Rate for Payer: Wellpoint Medicaid Managed Care	$168.94

A6 CONNECTOR

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270661529
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

ABACAVIR 300 MG TAB

Facility

$74.84

Service Code	NDC 49702022144
Hospital Charge Code	60629217
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$37.42
Rate for Payer: Aetna Commercial	$28.44
Rate for Payer: Aetna Medicare Advantage	$22.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.08
Rate for Payer: Cigna Commercial	$37.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.45
Rate for Payer: Oxford Commercial	$14.97
Rate for Payer: Qualcare PPO/HMO/WC	$11.23
Rate for Payer: UnitedHealthcare Commercial	$14.97
Rate for Payer: UnitedHealthcare Community & State	$1.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1.98

Know your out-of-pocket cost for care.

All Charges