Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL HEAD CERAM 32MM +7MM

Facility

$6,000.00

Hospital Charge Code	270672490
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL HEAD CERAM 36MM +0MM

Facility

$6,000.00

Hospital Charge Code	270672492
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

FEMORAL HEAD CERAM 36MM +0MM

Facility

$6,000.00

Hospital Charge Code	270672492
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL HEAD CERAM 36MM 16/18

Facility

$10,500.00

Hospital Charge Code	270672499
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 HEAD CERAM 36MM 16/18

Facility

$10,500.00

Hospital Charge Code	270672499
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 HEAD CERAM 36MM +3.5MM

Facility

$6,000.00

Hospital Charge Code	270672493
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

FEMORAL HEAD CERAM 36MM +3.5MM

Facility

$6,000.00

Hospital Charge Code	270672493
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL HEAD CERAM 36MM -3.5MM

Facility

$6,000.00

Hospital Charge Code	270672491
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

FEMORAL HEAD CERAM 36MM -3.5MM

Facility

$6,000.00

Hospital Charge Code	270672491
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL HEAD CERAM 36MM +7MM

Facility

$6,000.00

Hospital Charge Code	270672494
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FEMORAL HEAD CERAM 36MM +7MM

Facility

$6,000.00

Hospital Charge Code	270672494
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

FEMORAL HEAD CERAMIC 28MM/0

Facility

$4,605.00

Hospital Charge Code	270669125
Hospital Revenue Code	278
Min. Negotiated Rate	$110.98
Max. Negotiated Rate	$2,302.50
Rate for Payer: Aetna Commercial	$1,749.90
Rate for Payer: Aetna Medicare Advantage	$1,381.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,174.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,174.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$921.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,174.28
Rate for Payer: Cigna Commercial	$2,302.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,114.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,013.10
Rate for Payer: Qualcare PPO/HMO/WC	$690.75
Rate for Payer: UnitedHealthcare Community & State	$110.98
Rate for Payer: Wellpoint Medicaid Managed Care	$122.03

FEMORAL HEAD CERAMIC 28MM/0

Facility

$4,605.00

Hospital Charge Code	270669125
Hospital Revenue Code	278
Min. Negotiated Rate	$690.75
Max. Negotiated Rate	$1,114.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$921.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,114.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,013.10
Rate for Payer: Qualcare PPO/HMO/WC	$690.75

FEMORAL HEAD CERAMIC 28MM/+3.5

Facility

$4,605.00

Service Code	HCPCS C1776
Hospital Charge Code	270669126
Hospital Revenue Code	278
Min. Negotiated Rate	$110.98
Max. Negotiated Rate	$2,302.50
Rate for Payer: Aetna Commercial	$1,749.90
Rate for Payer: Aetna Medicare Advantage	$1,381.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,174.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,174.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$921.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,174.28
Rate for Payer: Cigna Commercial	$2,302.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,114.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,013.10
Rate for Payer: Qualcare PPO/HMO/WC	$690.75
Rate for Payer: UnitedHealthcare Community & State	$110.98
Rate for Payer: Wellpoint Medicaid Managed Care	$122.03

FEMORAL HEAD CERAMIC 28MM/+3.5

Facility

$4,605.00

Service Code	HCPCS C1776
Hospital Charge Code	270669126
Hospital Revenue Code	278
Min. Negotiated Rate	$690.75
Max. Negotiated Rate	$1,114.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$921.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,114.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,013.10
Rate for Payer: Qualcare PPO/HMO/WC	$690.75

FEMORAL HEAD CERAMIC 28MM/-3.5

Facility

$4,605.00

Hospital Charge Code	270669127
Hospital Revenue Code	278
Min. Negotiated Rate	$690.75
Max. Negotiated Rate	$1,114.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$921.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,114.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,013.10
Rate for Payer: Qualcare PPO/HMO/WC	$690.75

FEMORAL HEAD CERAMIC 28MM/-3.5

Facility

$4,605.00

Hospital Charge Code	270669127
Hospital Revenue Code	278
Min. Negotiated Rate	$110.98
Max. Negotiated Rate	$2,302.50
Rate for Payer: Aetna Commercial	$1,749.90
Rate for Payer: Aetna Medicare Advantage	$1,381.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,174.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,174.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$921.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,174.28
Rate for Payer: Cigna Commercial	$2,302.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,114.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,013.10
Rate for Payer: Qualcare PPO/HMO/WC	$690.75
Rate for Payer: UnitedHealthcare Community & State	$110.98
Rate for Payer: Wellpoint Medicaid Managed Care	$122.03

FEMORAL HEAD CERAMIC 32MM/0

Facility

$4,605.00

Service Code	HCPCS C1776
Hospital Charge Code	270669128
Hospital Revenue Code	278
Min. Negotiated Rate	$690.75
Max. Negotiated Rate	$1,114.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$921.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,114.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,013.10
Rate for Payer: Qualcare PPO/HMO/WC	$690.75

FEMORAL HEAD CERAMIC 32MM/0

Facility

$4,605.00

Service Code	HCPCS C1776
Hospital Charge Code	270669128
Hospital Revenue Code	278
Min. Negotiated Rate	$110.98
Max. Negotiated Rate	$2,302.50
Rate for Payer: Aetna Commercial	$1,749.90
Rate for Payer: Aetna Medicare Advantage	$1,381.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,174.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,174.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$921.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,174.28
Rate for Payer: Cigna Commercial	$2,302.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,114.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,013.10
Rate for Payer: Qualcare PPO/HMO/WC	$690.75
Rate for Payer: UnitedHealthcare Community & State	$110.98
Rate for Payer: Wellpoint Medicaid Managed Care	$122.03

FEMORAL HEAD CERAMIC 32MM/+3.5

Facility

$4,605.00

Service Code	HCPCS C1776
Hospital Charge Code	270669129
Hospital Revenue Code	278
Min. Negotiated Rate	$690.75
Max. Negotiated Rate	$1,114.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$921.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,114.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,013.10
Rate for Payer: Qualcare PPO/HMO/WC	$690.75

FEMORAL HEAD CERAMIC 32MM/+3.5

Facility

$4,605.00

Service Code	HCPCS C1776
Hospital Charge Code	270669129
Hospital Revenue Code	278
Min. Negotiated Rate	$110.98
Max. Negotiated Rate	$2,302.50
Rate for Payer: Aetna Commercial	$1,749.90
Rate for Payer: Aetna Medicare Advantage	$1,381.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,174.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,174.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$921.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,174.28
Rate for Payer: Cigna Commercial	$2,302.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,114.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,013.10
Rate for Payer: Qualcare PPO/HMO/WC	$690.75
Rate for Payer: UnitedHealthcare Community & State	$110.98
Rate for Payer: Wellpoint Medicaid Managed Care	$122.03

FEMORAL HEAD CERAMIC 32MM/-3.5

Facility

$4,605.00

Hospital Charge Code	270669131
Hospital Revenue Code	278
Min. Negotiated Rate	$690.75
Max. Negotiated Rate	$1,114.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$921.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,114.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,013.10
Rate for Payer: Qualcare PPO/HMO/WC	$690.75

FEMORAL HEAD CERAMIC 32MM/-3.5

Facility

$4,605.00

Hospital Charge Code	270669131
Hospital Revenue Code	278
Min. Negotiated Rate	$110.98
Max. Negotiated Rate	$2,302.50
Rate for Payer: Aetna Commercial	$1,749.90
Rate for Payer: Aetna Medicare Advantage	$1,381.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,174.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,174.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$921.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,174.28
Rate for Payer: Cigna Commercial	$2,302.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,114.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,013.10
Rate for Payer: Qualcare PPO/HMO/WC	$690.75
Rate for Payer: UnitedHealthcare Community & State	$110.98
Rate for Payer: Wellpoint Medicaid Managed Care	$122.03

FEMORAL HEAD CERAMIC 32MM/+7

Facility

$4,605.00

Hospital Charge Code	270669130
Hospital Revenue Code	278
Min. Negotiated Rate	$690.75
Max. Negotiated Rate	$1,114.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$921.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,114.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,013.10
Rate for Payer: Qualcare PPO/HMO/WC	$690.75

FEMORAL HEAD CERAMIC 32MM/+7

Facility

$4,605.00

Hospital Charge Code	270669130
Hospital Revenue Code	278
Min. Negotiated Rate	$110.98
Max. Negotiated Rate	$2,302.50
Rate for Payer: Aetna Commercial	$1,749.90
Rate for Payer: Aetna Medicare Advantage	$1,381.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,174.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,174.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$921.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,174.28
Rate for Payer: Cigna Commercial	$2,302.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,114.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,013.10
Rate for Payer: Qualcare PPO/HMO/WC	$690.75
Rate for Payer: UnitedHealthcare Community & State	$110.98
Rate for Payer: Wellpoint Medicaid Managed Care	$122.03

Know your out-of-pocket cost for care.

All Charges