Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL HEAD CERAMIC 36M/+3.5

Facility

$4,605.00

Service Code	HCPCS C1776
Hospital Charge Code	270669133
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 36M/+3.5

Facility

$4,605.00

Service Code	HCPCS C1776
Hospital Charge Code	270669133
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 36MM/0

Facility

$4,605.00

Service Code	HCPCS C1776
Hospital Charge Code	270669132
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 36MM/0

Facility

$4,605.00

Service Code	HCPCS C1776
Hospital Charge Code	270669132
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 36MM/-3.5

Facility

$4,605.00

Hospital Charge Code	270669135
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 36MM/-3.5

Facility

$4,605.00

Hospital Charge Code	270669135
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 36MM/+7

Facility

$4,605.00

Service Code	HCPCS C1776
Hospital Charge Code	270669134
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 36MM/+7

Facility

$4,605.00

Service Code	HCPCS C1776
Hospital Charge Code	270669134
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 V40 36 MM

Facility

$4,154.40

Service Code	HCPCS C1776
Hospital Charge Code	270691026
Hospital Revenue Code	278
Min. Negotiated Rate	$623.16
Max. Negotiated Rate	$1,005.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$830.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,005.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$913.97
Rate for Payer: Qualcare PPO/HMO/WC	$623.16

FEMORAL HEAD CERAMIC V40 36 MM

Facility

$4,154.40

Service Code	HCPCS C1776
Hospital Charge Code	270691026
Hospital Revenue Code	278
Min. Negotiated Rate	$100.12
Max. Negotiated Rate	$2,077.20
Rate for Payer: Aetna Commercial	$1,578.67
Rate for Payer: Aetna Medicare Advantage	$1,246.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,059.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,059.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$830.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,059.37
Rate for Payer: Cigna Commercial	$2,077.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,005.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$913.97
Rate for Payer: Qualcare PPO/HMO/WC	$623.16
Rate for Payer: UnitedHealthcare Community & State	$100.12
Rate for Payer: Wellpoint Medicaid Managed Care	$110.09

FEMORAL HEAD COCR 28M/-3.5

Facility

$1,795.00

Hospital Charge Code	270669108
Hospital Revenue Code	278
Min. Negotiated Rate	$43.26
Max. Negotiated Rate	$897.50
Rate for Payer: Aetna Commercial	$682.10
Rate for Payer: Aetna Medicare Advantage	$538.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$457.73
Rate for Payer: Cigna Commercial	$897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$394.90
Rate for Payer: Qualcare PPO/HMO/WC	$269.25
Rate for Payer: UnitedHealthcare Community & State	$43.26
Rate for Payer: Wellpoint Medicaid Managed Care	$47.57

FEMORAL HEAD COCR 28M/-3.5

Facility

$1,795.00

Hospital Charge Code	270669108
Hospital Revenue Code	278
Min. Negotiated Rate	$269.25
Max. Negotiated Rate	$434.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$394.90
Rate for Payer: Qualcare PPO/HMO/WC	$269.25

FEMORAL HEAD COCR 28MM/0

Facility

$1,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270669104
Hospital Revenue Code	278
Min. Negotiated Rate	$43.26
Max. Negotiated Rate	$897.50
Rate for Payer: Aetna Commercial	$682.10
Rate for Payer: Aetna Medicare Advantage	$538.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$457.73
Rate for Payer: Cigna Commercial	$897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$394.90
Rate for Payer: Qualcare PPO/HMO/WC	$269.25
Rate for Payer: UnitedHealthcare Community & State	$43.26
Rate for Payer: Wellpoint Medicaid Managed Care	$47.57

FEMORAL HEAD COCR 28MM/0

Facility

$1,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270669104
Hospital Revenue Code	278
Min. Negotiated Rate	$269.25
Max. Negotiated Rate	$434.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$394.90
Rate for Payer: Qualcare PPO/HMO/WC	$269.25

FEMORAL HEAD COCR 28MM/+10.5

Facility

$1,795.00

Hospital Charge Code	270669107
Hospital Revenue Code	278
Min. Negotiated Rate	$269.25
Max. Negotiated Rate	$434.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$394.90
Rate for Payer: Qualcare PPO/HMO/WC	$269.25

FEMORAL HEAD COCR 28MM/+10.5

Facility

$1,795.00

Hospital Charge Code	270669107
Hospital Revenue Code	278
Min. Negotiated Rate	$43.26
Max. Negotiated Rate	$897.50
Rate for Payer: Aetna Commercial	$682.10
Rate for Payer: Aetna Medicare Advantage	$538.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$457.73
Rate for Payer: Cigna Commercial	$897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$394.90
Rate for Payer: Qualcare PPO/HMO/WC	$269.25
Rate for Payer: UnitedHealthcare Community & State	$43.26
Rate for Payer: Wellpoint Medicaid Managed Care	$47.57

FEMORAL HEAD COCR 28MM/+3.5

Facility

$1,795.00

Hospital Charge Code	270669105
Hospital Revenue Code	278
Min. Negotiated Rate	$43.26
Max. Negotiated Rate	$897.50
Rate for Payer: Aetna Commercial	$682.10
Rate for Payer: Aetna Medicare Advantage	$538.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$457.73
Rate for Payer: Cigna Commercial	$897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$394.90
Rate for Payer: Qualcare PPO/HMO/WC	$269.25
Rate for Payer: UnitedHealthcare Community & State	$43.26
Rate for Payer: Wellpoint Medicaid Managed Care	$47.57

FEMORAL HEAD COCR 28MM/+3.5

Facility

$1,795.00

Hospital Charge Code	270669105
Hospital Revenue Code	278
Min. Negotiated Rate	$269.25
Max. Negotiated Rate	$434.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$394.90
Rate for Payer: Qualcare PPO/HMO/WC	$269.25

FEMORAL HEAD COCR 28MM/+7

Facility

$1,795.00

Hospital Charge Code	270669106
Hospital Revenue Code	278
Min. Negotiated Rate	$43.26
Max. Negotiated Rate	$897.50
Rate for Payer: Aetna Commercial	$682.10
Rate for Payer: Aetna Medicare Advantage	$538.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$457.73
Rate for Payer: Cigna Commercial	$897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$394.90
Rate for Payer: Qualcare PPO/HMO/WC	$269.25
Rate for Payer: UnitedHealthcare Community & State	$43.26
Rate for Payer: Wellpoint Medicaid Managed Care	$47.57

FEMORAL HEAD COCR 28MM/+7

Facility

$1,795.00

Hospital Charge Code	270669106
Hospital Revenue Code	278
Min. Negotiated Rate	$269.25
Max. Negotiated Rate	$434.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$394.90
Rate for Payer: Qualcare PPO/HMO/WC	$269.25

FEMORAL HEAD COCR 32MM/0

Facility

$1,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270669109
Hospital Revenue Code	278
Min. Negotiated Rate	$43.26
Max. Negotiated Rate	$897.50
Rate for Payer: Aetna Commercial	$682.10
Rate for Payer: Aetna Medicare Advantage	$538.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$457.73
Rate for Payer: Cigna Commercial	$897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$394.90
Rate for Payer: Qualcare PPO/HMO/WC	$269.25
Rate for Payer: UnitedHealthcare Community & State	$43.26
Rate for Payer: Wellpoint Medicaid Managed Care	$47.57

FEMORAL HEAD COCR 32MM/0

Facility

$1,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270669109
Hospital Revenue Code	278
Min. Negotiated Rate	$269.25
Max. Negotiated Rate	$434.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$394.90
Rate for Payer: Qualcare PPO/HMO/WC	$269.25

FEMORAL HEAD COCR 32MM/+10.5

Facility

$1,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270669112
Hospital Revenue Code	278
Min. Negotiated Rate	$269.25
Max. Negotiated Rate	$434.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$394.90
Rate for Payer: Qualcare PPO/HMO/WC	$269.25

FEMORAL HEAD COCR 32MM/+10.5

Facility

$1,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270669112
Hospital Revenue Code	278
Min. Negotiated Rate	$43.26
Max. Negotiated Rate	$897.50
Rate for Payer: Aetna Commercial	$682.10
Rate for Payer: Aetna Medicare Advantage	$538.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$457.73
Rate for Payer: Cigna Commercial	$897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$394.90
Rate for Payer: Qualcare PPO/HMO/WC	$269.25
Rate for Payer: UnitedHealthcare Community & State	$43.26
Rate for Payer: Wellpoint Medicaid Managed Care	$47.57

FEMORAL HEAD COCR 32MM/+3.5

Facility

$1,795.00

Service Code	HCPCS C1776
Hospital Charge Code	270669110
Hospital Revenue Code	278
Min. Negotiated Rate	$43.26
Max. Negotiated Rate	$897.50
Rate for Payer: Aetna Commercial	$682.10
Rate for Payer: Aetna Medicare Advantage	$538.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$457.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$359.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$457.73
Rate for Payer: Cigna Commercial	$897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$434.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$394.90
Rate for Payer: Qualcare PPO/HMO/WC	$269.25
Rate for Payer: UnitedHealthcare Community & State	$43.26
Rate for Payer: Wellpoint Medicaid Managed Care	$47.57

Know your out-of-pocket cost for care.

All Charges