Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL HEAD COCR 40MM/-3.5

Facility

$2,255.00

Hospital Charge Code	270669124
Hospital Revenue Code	278
Min. Negotiated Rate	$338.25
Max. Negotiated Rate	$545.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$545.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$496.10
Rate for Payer: Qualcare PPO/HMO/WC	$338.25

FEMORAL HEAD COCR 40MM/-3.5

Facility

$2,255.00

Hospital Charge Code	270669124
Hospital Revenue Code	278
Min. Negotiated Rate	$54.35
Max. Negotiated Rate	$1,127.50
Rate for Payer: Aetna Commercial	$856.90
Rate for Payer: Aetna Medicare Advantage	$676.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$575.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$575.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$575.02
Rate for Payer: Cigna Commercial	$1,127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$545.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$496.10
Rate for Payer: Qualcare PPO/HMO/WC	$338.25
Rate for Payer: UnitedHealthcare Community & State	$54.35
Rate for Payer: Wellpoint Medicaid Managed Care	$59.76

FEMORAL HEAD COCR 40MM/+7

Facility

$2,255.00

Hospital Charge Code	270669122
Hospital Revenue Code	278
Min. Negotiated Rate	$54.35
Max. Negotiated Rate	$1,127.50
Rate for Payer: Aetna Commercial	$856.90
Rate for Payer: Aetna Medicare Advantage	$676.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$575.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$575.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$575.02
Rate for Payer: Cigna Commercial	$1,127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$545.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$496.10
Rate for Payer: Qualcare PPO/HMO/WC	$338.25
Rate for Payer: UnitedHealthcare Community & State	$54.35
Rate for Payer: Wellpoint Medicaid Managed Care	$59.76

FEMORAL HEAD COCR 40MM/+7

Facility

$2,255.00

Hospital Charge Code	270669122
Hospital Revenue Code	278
Min. Negotiated Rate	$338.25
Max. Negotiated Rate	$545.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$451.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$545.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$496.10
Rate for Payer: Qualcare PPO/HMO/WC	$338.25

FEMORAL HEAD C-TPR 36MM +10

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270672947
Hospital Revenue Code	278
Min. Negotiated Rate	$536.25
Max. Negotiated Rate	$865.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$865.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$786.50
Rate for Payer: Qualcare PPO/HMO/WC	$536.25

FEMORAL HEAD C-TPR 36MM +10

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270672947
Hospital Revenue Code	278
Min. Negotiated Rate	$86.16
Max. Negotiated Rate	$1,787.50
Rate for Payer: Aetna Commercial	$1,358.50
Rate for Payer: Aetna Medicare Advantage	$1,072.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$911.62
Rate for Payer: Cigna Commercial	$1,787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$865.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$786.50
Rate for Payer: Qualcare PPO/HMO/WC	$536.25
Rate for Payer: UnitedHealthcare Community & State	$86.16
Rate for Payer: Wellpoint Medicaid Managed Care	$94.74

FEMORAL HEAD C-TPR 36MM -5

Facility

$4,128.25

Hospital Charge Code	270676935
Hospital Revenue Code	278
Min. Negotiated Rate	$619.24
Max. Negotiated Rate	$999.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$999.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$908.22
Rate for Payer: Qualcare PPO/HMO/WC	$619.24

FEMORAL HEAD C-TPR 36MM -5

Facility

$4,128.25

Hospital Charge Code	270676935
Hospital Revenue Code	278
Min. Negotiated Rate	$99.49
Max. Negotiated Rate	$2,064.12
Rate for Payer: Aetna Commercial	$1,568.73
Rate for Payer: Aetna Medicare Advantage	$1,238.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,052.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,052.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,052.70
Rate for Payer: Cigna Commercial	$2,064.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$999.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$908.22
Rate for Payer: Qualcare PPO/HMO/WC	$619.24
Rate for Payer: UnitedHealthcare Community & State	$99.49
Rate for Payer: Wellpoint Medicaid Managed Care	$109.40

FEMORAL HEAD DELTA 28MM/M

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270669779
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 DELTA 28MM/M

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270669779
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

FEMORAL HEAD DELTA 28MM/S/-3.5

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270667470
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

FEMORAL HEAD DELTA 28MM/S/-3.5

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270667470
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 DELTA 32MM +0MM

Facility

$16,325.00

Hospital Charge Code	270670946
Hospital Revenue Code	278
Min. Negotiated Rate	$393.43
Max. Negotiated Rate	$8,162.50
Rate for Payer: Aetna Commercial	$6,203.50
Rate for Payer: Aetna Medicare Advantage	$4,897.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,162.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,162.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,162.88
Rate for Payer: Cigna Commercial	$8,162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,950.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,591.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,448.75
Rate for Payer: UnitedHealthcare Community & State	$393.43
Rate for Payer: Wellpoint Medicaid Managed Care	$432.61

FEMORAL HEAD DELTA 32MM +0MM

Facility

$16,325.00

Hospital Charge Code	270670947
Hospital Revenue Code	278
Min. Negotiated Rate	$2,448.75
Max. Negotiated Rate	$3,950.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,950.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,591.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,448.75

FEMORAL HEAD DELTA 32MM +0MM

Facility

$16,325.00

Hospital Charge Code	270670946
Hospital Revenue Code	278
Min. Negotiated Rate	$2,448.75
Max. Negotiated Rate	$3,950.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,950.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,591.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,448.75

FEMORAL HEAD DELTA 32MM +0MM

Facility

$16,325.00

Hospital Charge Code	270670947
Hospital Revenue Code	278
Min. Negotiated Rate	$393.43
Max. Negotiated Rate	$8,162.50
Rate for Payer: Aetna Commercial	$6,203.50
Rate for Payer: Aetna Medicare Advantage	$4,897.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,162.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,162.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,162.88
Rate for Payer: Cigna Commercial	$8,162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,950.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,591.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,448.75
Rate for Payer: UnitedHealthcare Community & State	$393.43
Rate for Payer: Wellpoint Medicaid Managed Care	$432.61

FEMORAL HEAD DELTA 32MM L

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683439
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

FEMORAL HEAD DELTA 32MM L

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683439
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 FREETI 36MMX3MM

Facility

$7,920.00

Service Code	HCPCS C1776
Hospital Charge Code	270698166
Hospital Revenue Code	278
Min. Negotiated Rate	$1,188.00
Max. Negotiated Rate	$1,916.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,584.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,742.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,188.00

FEMORAL HEAD FREETI 36MMX3MM

Facility

$7,920.00

Service Code	HCPCS C1776
Hospital Charge Code	270698166
Hospital Revenue Code	278
Min. Negotiated Rate	$190.87
Max. Negotiated Rate	$3,960.00
Rate for Payer: Aetna Commercial	$3,009.60
Rate for Payer: Aetna Medicare Advantage	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,019.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,584.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,019.60
Rate for Payer: Cigna Commercial	$3,960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,742.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,188.00
Rate for Payer: UnitedHealthcare Community & State	$190.87
Rate for Payer: Wellpoint Medicaid Managed Care	$209.88

FEMORAL HEAD FROZEN

Facility

$6,740.00

Service Code	HCPCS C1776
Hospital Charge Code	270655601
Hospital Revenue Code	278
Min. Negotiated Rate	$162.43
Max. Negotiated Rate	$3,370.00
Rate for Payer: Aetna Commercial	$2,561.20
Rate for Payer: Aetna Medicare Advantage	$2,022.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,718.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,718.70
Rate for Payer: Cigna Commercial	$3,370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,482.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00
Rate for Payer: UnitedHealthcare Community & State	$162.43
Rate for Payer: Wellpoint Medicaid Managed Care	$178.61

FEMORAL HEAD FROZEN

Facility

$6,740.00

Service Code	HCPCS C1776
Hospital Charge Code	270655601
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.00
Max. Negotiated Rate	$1,631.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,482.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.00

FEMORAL HEAD LFIT

Facility

$5,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270660306
Hospital Revenue Code	278
Min. Negotiated Rate	$141.71
Max. Negotiated Rate	$2,940.00
Rate for Payer: Aetna Commercial	$2,234.40
Rate for Payer: Aetna Medicare Advantage	$1,764.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,499.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,499.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,176.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,499.40
Rate for Payer: Cigna Commercial	$2,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,422.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,293.60
Rate for Payer: Qualcare PPO/HMO/WC	$882.00
Rate for Payer: UnitedHealthcare Community & State	$141.71
Rate for Payer: Wellpoint Medicaid Managed Care	$155.82

FEMORAL HEAD LFIT

Facility

$5,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270660306
Hospital Revenue Code	278
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$1,422.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,176.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,422.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,293.60
Rate for Payer: Qualcare PPO/HMO/WC	$882.00

FEMORAL HEAD LFIT V40 28MM +4

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270671838
Hospital Revenue Code	278
Min. Negotiated Rate	$86.16
Max. Negotiated Rate	$1,787.50
Rate for Payer: Aetna Commercial	$1,358.50
Rate for Payer: Aetna Medicare Advantage	$1,072.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$911.62
Rate for Payer: Cigna Commercial	$1,787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$865.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$786.50
Rate for Payer: Qualcare PPO/HMO/WC	$536.25
Rate for Payer: UnitedHealthcare Community & State	$86.16
Rate for Payer: Wellpoint Medicaid Managed Care	$94.74

Know your out-of-pocket cost for care.

All Charges