Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CEMELESS EXT STEM 14MM/ 150 MM

Facility

$8,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270687682
Hospital Revenue Code	278
Min. Negotiated Rate	$216.66
Max. Negotiated Rate	$4,495.00
Rate for Payer: Aetna Commercial	$3,416.20
Rate for Payer: Aetna Medicare Advantage	$2,697.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,292.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,292.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,798.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,292.45
Rate for Payer: Cigna Commercial	$4,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,175.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,977.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,348.50
Rate for Payer: UnitedHealthcare Community & State	$216.66
Rate for Payer: Wellpoint Medicaid Managed Care	$238.24

CEMENT BC R 1 X 40 GM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	270682311
Hospital Revenue Code	278
Min. Negotiated Rate	$7.47
Max. Negotiated Rate	$155.00
Rate for Payer: Aetna Commercial	$117.80
Rate for Payer: Aetna Medicare Advantage	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.05
Rate for Payer: Cigna Commercial	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.20
Rate for Payer: Qualcare PPO/HMO/WC	$46.50
Rate for Payer: UnitedHealthcare Community & State	$7.47
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

CEMENT BC R 1 X 40 GM

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	270682311
Hospital Revenue Code	278
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$75.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.20
Rate for Payer: Qualcare PPO/HMO/WC	$46.50

CEMENT BMT BONE PK 402401

Facility

$1,816.00

Hospital Charge Code	270628842
Hospital Revenue Code	278
Min. Negotiated Rate	$272.40
Max. Negotiated Rate	$439.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$399.52
Rate for Payer: Qualcare PPO/HMO/WC	$272.40

CEMENT BMT BONE PK 402401

Facility

$1,816.00

Hospital Charge Code	270628842
Hospital Revenue Code	278
Min. Negotiated Rate	$43.77
Max. Negotiated Rate	$908.00
Rate for Payer: Aetna Commercial	$690.08
Rate for Payer: Aetna Medicare Advantage	$544.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$463.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$463.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$463.08
Rate for Payer: Cigna Commercial	$908.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$399.52
Rate for Payer: Qualcare PPO/HMO/WC	$272.40
Rate for Payer: UnitedHealthcare Community & State	$43.77
Rate for Payer: Wellpoint Medicaid Managed Care	$48.12

CEMENT BMT OPTIVAC HIP 2006-12

Facility

$729.20

Hospital Charge Code	270417000
Hospital Revenue Code	278
Min. Negotiated Rate	$109.38
Max. Negotiated Rate	$176.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$160.42
Rate for Payer: Qualcare PPO/HMO/WC	$109.38

CEMENT BMT OPTIVAC HIP 2006-12

Facility

$729.20

Hospital Charge Code	270417000
Hospital Revenue Code	278
Min. Negotiated Rate	$17.57
Max. Negotiated Rate	$364.60
Rate for Payer: Aetna Commercial	$277.10
Rate for Payer: Aetna Medicare Advantage	$218.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$185.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$185.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$185.95
Rate for Payer: Cigna Commercial	$364.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$160.42
Rate for Payer: Qualcare PPO/HMO/WC	$109.38
Rate for Payer: UnitedHealthcare Community & State	$17.57
Rate for Payer: Wellpoint Medicaid Managed Care	$19.32

CEMENT BONE 40/20

Facility

$4,405.00

Service Code	HCPCS C1776
Hospital Charge Code	270656673
Hospital Revenue Code	278
Min. Negotiated Rate	$660.75
Max. Negotiated Rate	$1,066.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$969.10
Rate for Payer: Qualcare PPO/HMO/WC	$660.75

CEMENT BONE 40/20

Facility

$4,405.00

Service Code	HCPCS C1776
Hospital Charge Code	270656673
Hospital Revenue Code	278
Min. Negotiated Rate	$106.16
Max. Negotiated Rate	$2,202.50
Rate for Payer: Aetna Commercial	$1,673.90
Rate for Payer: Aetna Medicare Advantage	$1,321.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,123.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,123.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,123.28
Rate for Payer: Cigna Commercial	$2,202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$969.10
Rate for Payer: Qualcare PPO/HMO/WC	$660.75
Rate for Payer: UnitedHealthcare Community & State	$106.16
Rate for Payer: Wellpoint Medicaid Managed Care	$116.73

CEMENT BONE ACTIVOS

Facility

$1,342.00

Service Code	HCPCS C1713
Hospital Charge Code	270657326O
Hospital Revenue Code	278
Min. Negotiated Rate	$201.30
Max. Negotiated Rate	$324.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$268.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$295.24
Rate for Payer: Qualcare PPO/HMO/WC	$201.30

CEMENT BONE ACTIVOS

Facility

$1,342.00

Service Code	HCPCS C1713
Hospital Charge Code	270657326
Hospital Revenue Code	278
Min. Negotiated Rate	$32.34
Max. Negotiated Rate	$671.00
Rate for Payer: Aetna Commercial	$509.96
Rate for Payer: Aetna Medicare Advantage	$402.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$268.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.21
Rate for Payer: Cigna Commercial	$671.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$295.24
Rate for Payer: Qualcare PPO/HMO/WC	$201.30
Rate for Payer: UnitedHealthcare Community & State	$32.34
Rate for Payer: Wellpoint Medicaid Managed Care	$35.56

CEMENT BONE ACTIVOS

Facility

$1,342.00

Service Code	HCPCS C1713
Hospital Charge Code	270657326S
Hospital Revenue Code	278
Min. Negotiated Rate	$32.34
Max. Negotiated Rate	$671.00
Rate for Payer: Aetna Commercial	$509.96
Rate for Payer: Aetna Medicare Advantage	$402.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$268.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.21
Rate for Payer: Cigna Commercial	$671.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$295.24
Rate for Payer: Qualcare PPO/HMO/WC	$201.30
Rate for Payer: UnitedHealthcare Community & State	$32.34
Rate for Payer: Wellpoint Medicaid Managed Care	$35.56

CEMENT BONE ACTIVOS

Facility

$1,342.00

Service Code	HCPCS C1713
Hospital Charge Code	270657326O
Hospital Revenue Code	278
Min. Negotiated Rate	$32.34
Max. Negotiated Rate	$671.00
Rate for Payer: Aetna Commercial	$509.96
Rate for Payer: Aetna Medicare Advantage	$402.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$268.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.21
Rate for Payer: Cigna Commercial	$671.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$295.24
Rate for Payer: Qualcare PPO/HMO/WC	$201.30
Rate for Payer: UnitedHealthcare Community & State	$32.34
Rate for Payer: Wellpoint Medicaid Managed Care	$35.56

CEMENT BONE ACTIVOS

Facility

$1,342.00

Service Code	HCPCS C1713
Hospital Charge Code	270657326S
Hospital Revenue Code	278
Min. Negotiated Rate	$201.30
Max. Negotiated Rate	$324.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$268.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$295.24
Rate for Payer: Qualcare PPO/HMO/WC	$201.30

CEMENT BONE ACTIVOS

Facility

$1,342.00

Service Code	HCPCS C1713
Hospital Charge Code	270657326
Hospital Revenue Code	278
Min. Negotiated Rate	$201.30
Max. Negotiated Rate	$324.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$268.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$295.24
Rate for Payer: Qualcare PPO/HMO/WC	$201.30

CEMENT BONE COBALT40/20 W/GENT

Facility

$2,200.00

Hospital Charge Code	270643861
Hospital Revenue Code	278
Min. Negotiated Rate	$53.02
Max. Negotiated Rate	$1,100.00
Rate for Payer: Aetna Commercial	$836.00
Rate for Payer: Aetna Medicare Advantage	$660.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$561.00
Rate for Payer: Cigna Commercial	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$532.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$330.00
Rate for Payer: UnitedHealthcare Community & State	$53.02
Rate for Payer: Wellpoint Medicaid Managed Care	$58.30

CEMENT BONE COBALT40/20 W/GENT

Facility

$2,200.00

Hospital Charge Code	270643861
Hospital Revenue Code	278
Min. Negotiated Rate	$330.00
Max. Negotiated Rate	$532.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$532.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$330.00

CEMENT BONE COBALT G-HV

Facility

$3,810.00

Service Code	HCPCS C1713
Hospital Charge Code	270692264
Hospital Revenue Code	278
Min. Negotiated Rate	$91.82
Max. Negotiated Rate	$1,905.00
Rate for Payer: Aetna Commercial	$1,447.80
Rate for Payer: Aetna Medicare Advantage	$1,143.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$971.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$971.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$762.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$971.55
Rate for Payer: Cigna Commercial	$1,905.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$922.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$838.20
Rate for Payer: Qualcare PPO/HMO/WC	$571.50
Rate for Payer: UnitedHealthcare Community & State	$91.82
Rate for Payer: Wellpoint Medicaid Managed Care	$100.97

CEMENT BONE COBALT G-HV

Facility

$3,810.00

Service Code	HCPCS C1713
Hospital Charge Code	270692264
Hospital Revenue Code	278
Min. Negotiated Rate	$571.50
Max. Negotiated Rate	$922.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$762.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$922.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$838.20
Rate for Payer: Qualcare PPO/HMO/WC	$571.50

CEMENT BONE COBALT HV

Facility

$790.00

Service Code	HCPCS C1713
Hospital Charge Code	270642312
Hospital Revenue Code	278
Min. Negotiated Rate	$118.50
Max. Negotiated Rate	$191.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$158.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$173.80
Rate for Payer: Qualcare PPO/HMO/WC	$118.50

CEMENT BONE COBALT HV

Facility

$790.00

Service Code	HCPCS C1713
Hospital Charge Code	270642312
Hospital Revenue Code	278
Min. Negotiated Rate	$19.04
Max. Negotiated Rate	$395.00
Rate for Payer: Aetna Commercial	$300.20
Rate for Payer: Aetna Medicare Advantage	$237.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.45
Rate for Payer: Cigna Commercial	$395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$173.80
Rate for Payer: Qualcare PPO/HMO/WC	$118.50
Rate for Payer: UnitedHealthcare Community & State	$19.04
Rate for Payer: Wellpoint Medicaid Managed Care	$20.93

CEMENT BONE COBALT HV W/GENT

Facility

$1,830.00

Service Code	HCPCS C1713
Hospital Charge Code	270645007
Hospital Revenue Code	278
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$915.00
Rate for Payer: Aetna Commercial	$695.40
Rate for Payer: Aetna Medicare Advantage	$549.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$466.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$466.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$366.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$466.65
Rate for Payer: Cigna Commercial	$915.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$402.60
Rate for Payer: Qualcare PPO/HMO/WC	$274.50
Rate for Payer: UnitedHealthcare Community & State	$44.10
Rate for Payer: Wellpoint Medicaid Managed Care	$48.49

CEMENT BONE COBALT HV W/GENT

Facility

$1,830.00

Service Code	HCPCS C1713
Hospital Charge Code	270645007
Hospital Revenue Code	278
Min. Negotiated Rate	$274.50
Max. Negotiated Rate	$442.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$366.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$402.60
Rate for Payer: Qualcare PPO/HMO/WC	$274.50

CEMENT BONE CONFLOW

Facility

$414.45

Service Code	HCPCS C1713
Hospital Charge Code	270695534
Hospital Revenue Code	278
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$100.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$91.18
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

CEMENT BONE CONFLOW

Facility

$414.45

Service Code	HCPCS C1713
Hospital Charge Code	270695534
Hospital Revenue Code	278
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$207.22
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$91.18
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

Know your out-of-pocket cost for care.

All Charges