Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CEMENT COBALT W/ANTIB 402433

Facility

$1,975.00

Hospital Charge Code	270638571
Hospital Revenue Code	278
Min. Negotiated Rate	$296.25
Max. Negotiated Rate	$477.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$477.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$434.50
Rate for Payer: Qualcare PPO/HMO/WC	$296.25

CEMENT DELIVERY SYSTEM 605-685

Facility

$5,000.00

Hospital Charge Code	270644262
Hospital Revenue Code	272
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.00
Rate for Payer: Oxford Commercial	$1,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$1,000.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

CEMENT DELIVERY SYSTEM 605-685

Facility

$5,000.00

Hospital Charge Code	270644262
Hospital Revenue Code	272
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

CEMENTED HIP STEM SZ.3

Facility

$23,085.00

Hospital Charge Code	270656397
Hospital Revenue Code	278
Min. Negotiated Rate	$556.35
Max. Negotiated Rate	$11,542.50
Rate for Payer: Aetna Commercial	$8,772.30
Rate for Payer: Aetna Medicare Advantage	$6,925.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,886.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,886.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,617.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,886.68
Rate for Payer: Cigna Commercial	$11,542.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,586.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,078.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,462.75
Rate for Payer: UnitedHealthcare Community & State	$556.35
Rate for Payer: Wellpoint Medicaid Managed Care	$611.75

CEMENTED HIP STEM SZ.3

Facility

$23,085.00

Hospital Charge Code	270656397
Hospital Revenue Code	278
Min. Negotiated Rate	$3,462.75
Max. Negotiated Rate	$5,586.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,617.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,586.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,078.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,462.75

CEMENT FEMORAL RESTRICTOR SZ2

Facility

$397.50

Service Code	HCPCS C1713
Hospital Charge Code	270655655
Hospital Revenue Code	278
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$198.75
Rate for Payer: Aetna Commercial	$151.05
Rate for Payer: Aetna Medicare Advantage	$119.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.36
Rate for Payer: Cigna Commercial	$198.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$87.45
Rate for Payer: Qualcare PPO/HMO/WC	$59.62
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: Wellpoint Medicaid Managed Care	$10.53

CEMENT FEMORAL RESTRICTOR SZ2

Facility

$397.50

Service Code	HCPCS C1713
Hospital Charge Code	270655655
Hospital Revenue Code	278
Min. Negotiated Rate	$59.62
Max. Negotiated Rate	$96.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$87.45
Rate for Payer: Qualcare PPO/HMO/WC	$59.62

CEMENT FEMORAL RESTRICTOR SZ3

Facility

$397.50

Service Code	HCPCS C1713
Hospital Charge Code	270655657
Hospital Revenue Code	278
Min. Negotiated Rate	$59.62
Max. Negotiated Rate	$96.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$87.45
Rate for Payer: Qualcare PPO/HMO/WC	$59.62

CEMENT FEMORAL RESTRICTOR SZ3

Facility

$397.50

Service Code	HCPCS C1713
Hospital Charge Code	270655657
Hospital Revenue Code	278
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$198.75
Rate for Payer: Aetna Commercial	$151.05
Rate for Payer: Aetna Medicare Advantage	$119.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.36
Rate for Payer: Cigna Commercial	$198.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$87.45
Rate for Payer: Qualcare PPO/HMO/WC	$59.62
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: Wellpoint Medicaid Managed Care	$10.53

CEMENT FEMORAL RESTRICTOR SZ4

Facility

$397.50

Hospital Charge Code	270655658
Hospital Revenue Code	278
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$198.75
Rate for Payer: Aetna Commercial	$151.05
Rate for Payer: Aetna Medicare Advantage	$119.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.36
Rate for Payer: Cigna Commercial	$198.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$87.45
Rate for Payer: Qualcare PPO/HMO/WC	$59.62
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: Wellpoint Medicaid Managed Care	$10.53

CEMENT FEMORAL RESTRICTOR SZ4

Facility

$397.50

Hospital Charge Code	270655658
Hospital Revenue Code	278
Min. Negotiated Rate	$59.62
Max. Negotiated Rate	$96.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$87.45
Rate for Payer: Qualcare PPO/HMO/WC	$59.62

CEMENT FEMORAL RESTRICTOR SZ5

Facility

$397.50

Hospital Charge Code	270655660
Hospital Revenue Code	278
Min. Negotiated Rate	$59.62
Max. Negotiated Rate	$96.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$87.45
Rate for Payer: Qualcare PPO/HMO/WC	$59.62

CEMENT FEMORAL RESTRICTOR SZ5

Facility

$397.50

Hospital Charge Code	270655660
Hospital Revenue Code	278
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$198.75
Rate for Payer: Aetna Commercial	$151.05
Rate for Payer: Aetna Medicare Advantage	$119.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.36
Rate for Payer: Cigna Commercial	$198.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$87.45
Rate for Payer: Qualcare PPO/HMO/WC	$59.62
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: Wellpoint Medicaid Managed Care	$10.53

CEMENT FEMORAL RESTRICTOR SZ6

Facility

$397.50

Hospital Charge Code	270655663
Hospital Revenue Code	278
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$198.75
Rate for Payer: Aetna Commercial	$151.05
Rate for Payer: Aetna Medicare Advantage	$119.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.36
Rate for Payer: Cigna Commercial	$198.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$87.45
Rate for Payer: Qualcare PPO/HMO/WC	$59.62
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: Wellpoint Medicaid Managed Care	$10.53

CEMENT FEMORAL RESTRICTOR SZ6

Facility

$397.50

Hospital Charge Code	270655663
Hospital Revenue Code	278
Min. Negotiated Rate	$59.62
Max. Negotiated Rate	$96.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$87.45
Rate for Payer: Qualcare PPO/HMO/WC	$59.62

CEMENT FEMORAL RESTRICTOR SZ7

Facility

$397.50

Hospital Charge Code	270655665
Hospital Revenue Code	278
Min. Negotiated Rate	$59.62
Max. Negotiated Rate	$96.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$87.45
Rate for Payer: Qualcare PPO/HMO/WC	$59.62

CEMENT FEMORAL RESTRICTOR SZ7

Facility

$397.50

Hospital Charge Code	270655665
Hospital Revenue Code	278
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$198.75
Rate for Payer: Aetna Commercial	$151.05
Rate for Payer: Aetna Medicare Advantage	$119.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.36
Rate for Payer: Cigna Commercial	$198.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$87.45
Rate for Payer: Qualcare PPO/HMO/WC	$59.62
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: Wellpoint Medicaid Managed Care	$10.53

CEMENT HMD BONE RDPQ 6191010

Facility

$544.85

Hospital Charge Code	270629334
Hospital Revenue Code	278
Min. Negotiated Rate	$81.73
Max. Negotiated Rate	$131.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$119.87
Rate for Payer: Qualcare PPO/HMO/WC	$81.73

CEMENT HMD BONE RDPQ 6191010

Facility

$544.85

Hospital Charge Code	270629334
Hospital Revenue Code	278
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$272.43
Rate for Payer: Aetna Commercial	$207.04
Rate for Payer: Aetna Medicare Advantage	$163.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.94
Rate for Payer: Cigna Commercial	$272.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$119.87
Rate for Payer: Qualcare PPO/HMO/WC	$81.73
Rate for Payer: UnitedHealthcare Community & State	$13.13
Rate for Payer: Wellpoint Medicaid Managed Care	$14.44

CEMENT HMD BONE RDPQ 61911001

Facility

$839.25

Hospital Charge Code	270609404
Hospital Revenue Code	278
Min. Negotiated Rate	$20.23
Max. Negotiated Rate	$419.62
Rate for Payer: Aetna Commercial	$318.92
Rate for Payer: Aetna Medicare Advantage	$251.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$167.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.01
Rate for Payer: Cigna Commercial	$419.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$184.63
Rate for Payer: Qualcare PPO/HMO/WC	$125.89
Rate for Payer: UnitedHealthcare Community & State	$20.23
Rate for Payer: Wellpoint Medicaid Managed Care	$22.24

CEMENT HMD BONE RDPQ 61911001

Facility

$839.25

Hospital Charge Code	270609404
Hospital Revenue Code	278
Min. Negotiated Rate	$125.89
Max. Negotiated Rate	$203.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$167.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$184.63
Rate for Payer: Qualcare PPO/HMO/WC	$125.89

CEMENTLESS ACETAB SHELL 56MM.

Facility

$9,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270703600
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,090.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CEMENTLESS ACETAB SHELL 56MM.

Facility

$9,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270703600
Hospital Revenue Code	278
Min. Negotiated Rate	$228.95
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,090.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Community & State	$228.95
Rate for Payer: Wellpoint Medicaid Managed Care	$251.75

CEMENTLESS EXTENSION STEM 15M

Facility

$8,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270687677
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.50
Max. Negotiated Rate	$2,175.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,798.00
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

CEMENTLESS EXTENSION STEM 15M

Facility

$8,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270687677
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

Know your out-of-pocket cost for care.

All Charges