Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL CRUCIATE #4 LFL

Facility

$7,097.05

Service Code	HCPCS C1776
Hospital Charge Code	270691042
Hospital Revenue Code	278
Min. Negotiated Rate	$1,064.56
Max. Negotiated Rate	$1,717.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,419.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,717.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,561.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,064.56

FEMORAL CRUCIATE #4 LFL

Facility

$7,097.05

Service Code	HCPCS C1776
Hospital Charge Code	270691042
Hospital Revenue Code	278
Min. Negotiated Rate	$171.04
Max. Negotiated Rate	$3,548.53
Rate for Payer: Aetna Commercial	$2,696.88
Rate for Payer: Aetna Medicare Advantage	$2,129.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,809.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,809.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,419.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,809.75
Rate for Payer: Cigna Commercial	$3,548.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,717.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,561.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,064.56
Rate for Payer: UnitedHealthcare Community & State	$171.04
Rate for Payer: Wellpoint Medicaid Managed Care	$188.07

FEMORAL CRUCIATE RT CR SZ3

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	693337
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

FEMORAL CRUCIATE RT CR SZ3

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	693337
Hospital Revenue Code	278
Min. Negotiated Rate	$253.76
Max. Negotiated Rate	$5,264.73
Rate for Payer: Aetna Commercial	$4,001.19
Rate for Payer: Aetna Medicare Advantage	$3,158.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.01
Rate for Payer: Cigna Commercial	$5,264.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42
Rate for Payer: UnitedHealthcare Community & State	$253.76
Rate for Payer: Wellpoint Medicaid Managed Care	$279.03

FEMORAL CRUCIATE SZ 5

Facility

$7,846.70

Service Code	HCPCS C1776
Hospital Charge Code	270691406
Hospital Revenue Code	278
Min. Negotiated Rate	$189.11
Max. Negotiated Rate	$3,923.35
Rate for Payer: Aetna Commercial	$2,981.75
Rate for Payer: Aetna Medicare Advantage	$2,354.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,000.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,000.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,000.91
Rate for Payer: Cigna Commercial	$3,923.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,726.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,177.01
Rate for Payer: UnitedHealthcare Community & State	$189.11
Rate for Payer: Wellpoint Medicaid Managed Care	$207.94

FEMORAL CRUCIATE SZ 5

Facility

$7,846.70

Service Code	HCPCS C1776
Hospital Charge Code	270691406
Hospital Revenue Code	278
Min. Negotiated Rate	$1,177.01
Max. Negotiated Rate	$1,898.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,726.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,177.01

FEMORAL DISTAL AUG #3 12MM

Facility

$6,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270687696
Hospital Revenue Code	278
Min. Negotiated Rate	$910.50
Max. Negotiated Rate	$1,468.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,214.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,468.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,335.40
Rate for Payer: Qualcare PPO/HMO/WC	$910.50

FEMORAL DISTAL AUG #3 12MM

Facility

$6,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270687696
Hospital Revenue Code	278
Min. Negotiated Rate	$146.29
Max. Negotiated Rate	$3,035.00
Rate for Payer: Aetna Commercial	$2,306.60
Rate for Payer: Aetna Medicare Advantage	$1,821.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,214.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,547.85
Rate for Payer: Cigna Commercial	$3,035.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,468.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,335.40
Rate for Payer: Qualcare PPO/HMO/WC	$910.50
Rate for Payer: UnitedHealthcare Community & State	$146.29
Rate for Payer: Wellpoint Medicaid Managed Care	$160.85

FEMORAL DISTAL BLK SCW SZ4 5MM

Facility

$3,861.00

Service Code	HCPCS C1776
Hospital Charge Code	270670654
Hospital Revenue Code	278
Min. Negotiated Rate	$93.05
Max. Negotiated Rate	$1,930.50
Rate for Payer: Aetna Commercial	$1,467.18
Rate for Payer: Aetna Medicare Advantage	$1,158.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.55
Rate for Payer: Cigna Commercial	$1,930.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$849.42
Rate for Payer: Qualcare PPO/HMO/WC	$579.15
Rate for Payer: UnitedHealthcare Community & State	$93.05
Rate for Payer: Wellpoint Medicaid Managed Care	$102.32

FEMORAL DISTAL BLK SCW SZ4 5MM

Facility

$3,861.00

Service Code	HCPCS C1776
Hospital Charge Code	270670654
Hospital Revenue Code	278
Min. Negotiated Rate	$579.15
Max. Negotiated Rate	$934.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$849.42
Rate for Payer: Qualcare PPO/HMO/WC	$579.15

FEMORAL DISTAL SZ3 5MM SRW BLK

Facility

$5,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668742
Hospital Revenue Code	278
Min. Negotiated Rate	$131.22
Max. Negotiated Rate	$2,722.50
Rate for Payer: Aetna Commercial	$2,069.10
Rate for Payer: Aetna Medicare Advantage	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,388.47
Rate for Payer: Cigna Commercial	$2,722.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,317.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,197.90
Rate for Payer: Qualcare PPO/HMO/WC	$816.75
Rate for Payer: UnitedHealthcare Community & State	$131.22
Rate for Payer: Wellpoint Medicaid Managed Care	$144.29

FEMORAL DISTAL SZ3 5MM SRW BLK

Facility

$5,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668742
Hospital Revenue Code	278
Min. Negotiated Rate	$816.75
Max. Negotiated Rate	$1,317.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,089.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,317.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,197.90
Rate for Payer: Qualcare PPO/HMO/WC	$816.75

FEMORAL DIS TRAY CONTOUR LOCK

Facility

$2,475.00

Hospital Charge Code	270675926
Hospital Revenue Code	272
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$371.25
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

FEMORAL DIS TRAY CONTOUR LOCK

Facility

$2,475.00

Hospital Charge Code	270675926
Hospital Revenue Code	272
Min. Negotiated Rate	$59.65
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$742.50
Rate for Payer: Oxford Commercial	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Commercial	$495.00
Rate for Payer: UnitedHealthcare Community & State	$59.65
Rate for Payer: Wellpoint Medicaid Managed Care	$65.59

FEMORAL ECHO POR RPP

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690589
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

FEMORAL ECHO POR RPP

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690589
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

FEMORAL GMK CEMENTED SZ5 RIGH

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678629
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 GMK CEMENTED SZ5 RIGH

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678629
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 HD BIPOLAR UNI 26X41MM

Facility

$2,743.55

Service Code	HCPCS C1776
Hospital Charge Code	270695308
Hospital Revenue Code	278
Min. Negotiated Rate	$411.53
Max. Negotiated Rate	$663.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$548.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$603.58
Rate for Payer: Qualcare PPO/HMO/WC	$411.53

FEMORAL HD BIPOLAR UNI 26X41MM

Facility

$2,743.55

Service Code	HCPCS C1776
Hospital Charge Code	270695308
Hospital Revenue Code	278
Min. Negotiated Rate	$66.12
Max. Negotiated Rate	$1,371.78
Rate for Payer: Aetna Commercial	$1,042.55
Rate for Payer: Aetna Medicare Advantage	$823.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$699.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$699.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$548.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$699.61
Rate for Payer: Cigna Commercial	$1,371.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$663.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$603.58
Rate for Payer: Qualcare PPO/HMO/WC	$411.53
Rate for Payer: UnitedHealthcare Community & State	$66.12
Rate for Payer: Wellpoint Medicaid Managed Care	$72.70

FEMORAL HEAD

Facility

$2,721.90

Hospital Charge Code	270657014
Hospital Revenue Code	278
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$1,360.95
Rate for Payer: Aetna Commercial	$1,034.32
Rate for Payer: Aetna Medicare Advantage	$816.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$694.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$694.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$544.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$694.08
Rate for Payer: Cigna Commercial	$1,360.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$658.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$598.82
Rate for Payer: Qualcare PPO/HMO/WC	$408.29
Rate for Payer: UnitedHealthcare Community & State	$65.60
Rate for Payer: Wellpoint Medicaid Managed Care	$72.13

FEMORAL HEAD

Facility

$2,721.90

Hospital Charge Code	270657012
Hospital Revenue Code	278
Min. Negotiated Rate	$408.29
Max. Negotiated Rate	$658.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$544.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$658.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$598.82
Rate for Payer: Qualcare PPO/HMO/WC	$408.29

FEMORAL HEAD

Facility

$2,721.90

Hospital Charge Code	270657014
Hospital Revenue Code	278
Min. Negotiated Rate	$408.29
Max. Negotiated Rate	$658.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$544.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$658.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$598.82
Rate for Payer: Qualcare PPO/HMO/WC	$408.29

FEMORAL HEAD

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686378
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

FEMORAL HEAD

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686378
Hospital Revenue Code	278
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

Know your out-of-pocket cost for care.

All Charges