Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL COMP LAT 14x150MM

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270673645
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,695.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

FEMORAL COMPOMENT LEFT SZ 2

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679712
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

FEMORAL COMPOMENT LEFT SZ 2

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679712
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

FEMORAL COMPONANT SIZE 4

Facility

$7,500.00

Hospital Charge Code	270678341
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

FEMORAL COMPONANT SIZE 4

Facility

$7,500.00

Hospital Charge Code	270678341
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

FEMORAL COMPONANT SZ 5 LEFT

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678755
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

FEMORAL COMPONANT SZ 5 LEFT

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678755
Hospital Revenue Code	278
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

FEMORAL COMPONENT

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683039
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

FEMORAL COMPONENT

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683039
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

FEMORAL COMPONENT

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270667709
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

FEMORAL COMPONENT

Facility

$17,435.00

Hospital Charge Code	270666803
Hospital Revenue Code	278
Min. Negotiated Rate	$2,615.25
Max. Negotiated Rate	$4,219.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,487.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,219.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,835.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,615.25

FEMORAL COMPONENT

Facility

$17,435.00

Hospital Charge Code	270666803
Hospital Revenue Code	278
Min. Negotiated Rate	$420.18
Max. Negotiated Rate	$8,717.50
Rate for Payer: Aetna Commercial	$6,625.30
Rate for Payer: Aetna Medicare Advantage	$5,230.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,445.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,445.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,487.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,445.93
Rate for Payer: Cigna Commercial	$8,717.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,219.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,835.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,615.25
Rate for Payer: UnitedHealthcare Community & State	$420.18
Rate for Payer: Wellpoint Medicaid Managed Care	$462.03

FEMORAL COMPONENT

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270667709
Hospital Revenue Code	278
Min. Negotiated Rate	$289.20
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

FEMORAL COMPONENT

Facility

$7,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270685544
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

FEMORAL COMPONENT

Facility

$7,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270685544
Hospital Revenue Code	278
Min. Negotiated Rate	$186.78
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$186.78
Rate for Payer: Wellpoint Medicaid Managed Care	$205.38

FEMORAL COMPONENT 18MM

Facility

$20,376.00

Service Code	HCPCS C1776
Hospital Charge Code	270672590
Hospital Revenue Code	278
Min. Negotiated Rate	$491.06
Max. Negotiated Rate	$10,188.00
Rate for Payer: Aetna Commercial	$7,742.88
Rate for Payer: Aetna Medicare Advantage	$6,112.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,195.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,195.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,075.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,195.88
Rate for Payer: Cigna Commercial	$10,188.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,930.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,482.72
Rate for Payer: Qualcare PPO/HMO/WC	$3,056.40
Rate for Payer: UnitedHealthcare Community & State	$491.06
Rate for Payer: Wellpoint Medicaid Managed Care	$539.96

FEMORAL COMPONENT 18MM

Facility

$20,376.00

Service Code	HCPCS C1776
Hospital Charge Code	270672590
Hospital Revenue Code	278
Min. Negotiated Rate	$3,056.40
Max. Negotiated Rate	$4,930.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,075.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,930.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,482.72
Rate for Payer: Qualcare PPO/HMO/WC	$3,056.40

FEMORAL COMPONENT 54mm 102121

Facility

$9,042.45

Hospital Charge Code	270631519
Hospital Revenue Code	278
Min. Negotiated Rate	$217.92
Max. Negotiated Rate	$4,521.23
Rate for Payer: Aetna Commercial	$3,436.13
Rate for Payer: Aetna Medicare Advantage	$2,712.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,305.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,305.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,808.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,305.82
Rate for Payer: Cigna Commercial	$4,521.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,188.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,989.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,356.37
Rate for Payer: UnitedHealthcare Community & State	$217.92
Rate for Payer: Wellpoint Medicaid Managed Care	$239.62

FEMORAL COMPONENT 54mm 102121

Facility

$9,042.45

Hospital Charge Code	270631519
Hospital Revenue Code	278
Min. Negotiated Rate	$1,356.37
Max. Negotiated Rate	$2,188.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,808.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,188.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,989.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,356.37

FEMORAL COMPONENT 74MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676065
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

FEMORAL COMPONENT 74MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676065
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

FEMORAL COMPONENT CEMENTED SZ

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687756
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

FEMORAL COMPONENT CEMENTED SZ

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687756
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

FEMORAL COMPONENT CEMENT TRI

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270692000
Hospital Revenue Code	278
Min. Negotiated Rate	$174.43
Max. Negotiated Rate	$3,618.95
Rate for Payer: Aetna Commercial	$2,750.40
Rate for Payer: Aetna Medicare Advantage	$2,171.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,845.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,845.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,845.66
Rate for Payer: Cigna Commercial	$3,618.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,592.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.68
Rate for Payer: UnitedHealthcare Community & State	$174.43
Rate for Payer: Wellpoint Medicaid Managed Care	$191.80

FEMORAL COMPONENT CEMENT TRI

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270692000
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.68
Max. Negotiated Rate	$1,751.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,592.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.68

Know your out-of-pocket cost for care.

All Charges