Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 LIFT V40 28MM +0

Facility

$2,792.25

Service Code	HCPCS C1776
Hospital Charge Code	270656524
Hospital Revenue Code	278
Min. Negotiated Rate	$418.84
Max. Negotiated Rate	$675.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$558.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$675.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$614.29
Rate for Payer: Qualcare PPO/HMO/WC	$418.84

FEMORAL HEAD LIFT V40 28MM +0

Facility

$2,792.25

Service Code	HCPCS C1776
Hospital Charge Code	270656524
Hospital Revenue Code	278
Min. Negotiated Rate	$67.29
Max. Negotiated Rate	$1,396.12
Rate for Payer: Aetna Commercial	$1,061.06
Rate for Payer: Aetna Medicare Advantage	$837.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$712.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$712.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$558.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$712.02
Rate for Payer: Cigna Commercial	$1,396.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$675.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$614.29
Rate for Payer: Qualcare PPO/HMO/WC	$418.84
Rate for Payer: UnitedHealthcare Community & State	$67.29
Rate for Payer: Wellpoint Medicaid Managed Care	$73.99

FEMORAL HEAD MSPEC 36 MM 12/14

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689593
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 MSPEC 36 MM 12/14

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689573
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 MSPEC 36 MM 12/14

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689573
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 MSPEC 36 MM 12/14

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689593
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 OD 28MM OFFST 8MM

Facility

$2,792.25

Service Code	HCPCS C1776
Hospital Charge Code	270695124
Hospital Revenue Code	278
Min. Negotiated Rate	$67.29
Max. Negotiated Rate	$1,396.12
Rate for Payer: Aetna Commercial	$1,061.06
Rate for Payer: Aetna Medicare Advantage	$837.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$712.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$712.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$558.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$712.02
Rate for Payer: Cigna Commercial	$1,396.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$675.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$614.29
Rate for Payer: Qualcare PPO/HMO/WC	$418.84
Rate for Payer: UnitedHealthcare Community & State	$67.29
Rate for Payer: Wellpoint Medicaid Managed Care	$73.99

FEMORAL HEAD OD 28MM OFFST 8MM

Facility

$2,792.25

Service Code	HCPCS C1776
Hospital Charge Code	270695124
Hospital Revenue Code	278
Min. Negotiated Rate	$418.84
Max. Negotiated Rate	$675.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$558.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$675.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$614.29
Rate for Payer: Qualcare PPO/HMO/WC	$418.84

FEMORAL HEAD SMALL 28MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270673193
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

FEMORAL HEAD SMALL 28MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270673193
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

FEMORAL HEAD SZ 22MM +3.5MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675407
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

FEMORAL HEAD SZ 22MM +3.5MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675407
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

FEMORAL HEAD SZ28 +7 12/14 TAP

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675840
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

FEMORAL HEAD SZ28 +7 12/14 TAP

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270675840
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

FEMORAL HEAD SZ 28MM +0MM

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270672697
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 SZ 28MM +0MM

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270672697
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 SZ D EXPLANT 38MM

Facility

$2,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270696896
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

FEMORAL HEAD SZ D EXPLANT 38MM

Facility

$2,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270696896
Hospital Revenue Code	278
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$54.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.62

FEMORAL HEAD SZ M SZ 22.2MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688350
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

FEMORAL HEAD SZ M SZ 22.2MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688350
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

FEMORAL HEAD V40 -5MM 36MM

Facility

$3,575.00

Hospital Charge Code	270671314
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 V40 -5MM 36MM

Facility

$3,575.00

Hospital Charge Code	270671314
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 V40 COCR 28MM +12

Facility

$6,205.00

Service Code	HCPCS C1776
Hospital Charge Code	270676121
Hospital Revenue Code	278
Min. Negotiated Rate	$149.54
Max. Negotiated Rate	$3,102.50
Rate for Payer: Aetna Commercial	$2,357.90
Rate for Payer: Aetna Medicare Advantage	$1,861.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,582.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,582.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,241.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,582.28
Rate for Payer: Cigna Commercial	$3,102.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,501.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,365.10
Rate for Payer: Qualcare PPO/HMO/WC	$930.75
Rate for Payer: UnitedHealthcare Community & State	$149.54
Rate for Payer: Wellpoint Medicaid Managed Care	$164.43

FEMORAL HEAD V40 COCR 28MM +12

Facility

$6,205.00

Service Code	HCPCS C1776
Hospital Charge Code	270676121
Hospital Revenue Code	278
Min. Negotiated Rate	$930.75
Max. Negotiated Rate	$1,501.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,241.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,501.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,365.10
Rate for Payer: Qualcare PPO/HMO/WC	$930.75

Know your out-of-pocket cost for care.

All Charges