Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEMORALHEMI CONDYLE RT LAT

Facility

$60,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672847
Hospital Revenue Code	278
Min. Negotiated Rate	$9,000.00
Max. Negotiated Rate	$14,520.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,520.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,000.00

FEMORALHEMI CONDYLE RT LAT

Facility

$60,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672847
Hospital Revenue Code	278
Min. Negotiated Rate	$1,446.00
Max. Negotiated Rate	$30,000.00
Rate for Payer: Aetna Commercial	$22,800.00
Rate for Payer: Aetna Medicare Advantage	$18,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,300.00
Rate for Payer: Cigna Commercial	$30,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,520.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,000.00
Rate for Payer: UnitedHealthcare Community & State	$1,446.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,590.00

FEMORAL HIP ST R-NECK SZ10

Facility

$17,062.50

Service Code	HCPCS C1776
Hospital Charge Code	270692221
Hospital Revenue Code	278
Min. Negotiated Rate	$411.21
Max. Negotiated Rate	$8,531.25
Rate for Payer: Aetna Commercial	$6,483.75
Rate for Payer: Aetna Medicare Advantage	$5,118.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,350.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,350.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,350.94
Rate for Payer: Cigna Commercial	$8,531.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,129.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,753.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,559.38
Rate for Payer: UnitedHealthcare Community & State	$411.21
Rate for Payer: Wellpoint Medicaid Managed Care	$452.16

FEMORAL HIP ST R-NECK SZ10

Facility

$17,062.50

Service Code	HCPCS C1776
Hospital Charge Code	270692221
Hospital Revenue Code	278
Min. Negotiated Rate	$2,559.38
Max. Negotiated Rate	$4,129.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,129.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,753.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,559.38

FEMORAL HIP SYS SZ 1 30x110MM

Facility

$14,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270673999
Hospital Revenue Code	278
Min. Negotiated Rate	$357.88
Max. Negotiated Rate	$7,425.00
Rate for Payer: Aetna Commercial	$5,643.00
Rate for Payer: Aetna Medicare Advantage	$4,455.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,786.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,786.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,786.75
Rate for Payer: Cigna Commercial	$7,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,593.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.50
Rate for Payer: UnitedHealthcare Community & State	$357.88
Rate for Payer: Wellpoint Medicaid Managed Care	$393.52

FEMORAL HIP SYS SZ 1 30x110MM

Facility

$14,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270673999
Hospital Revenue Code	278
Min. Negotiated Rate	$2,227.50
Max. Negotiated Rate	$3,593.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,970.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,593.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,227.50

FEMORAL HIP SYSTEM SZ 3

Facility

$4,750.00

Hospital Charge Code	270703306
Hospital Revenue Code	278
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

FEMORAL HIP SYSTEM SZ 3

Facility

$4,750.00

Hospital Charge Code	270703306
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

FEMORAL HIP TAPERFILL SZ 7

Facility

$17,062.50

Service Code	HCPCS C1776
Hospital Charge Code	270692215
Hospital Revenue Code	278
Min. Negotiated Rate	$2,559.38
Max. Negotiated Rate	$4,129.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,129.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,753.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,559.38

FEMORAL HIP TAPERFILL SZ 7

Facility

$17,062.50

Service Code	HCPCS C1776
Hospital Charge Code	270692215
Hospital Revenue Code	278
Min. Negotiated Rate	$411.21
Max. Negotiated Rate	$8,531.25
Rate for Payer: Aetna Commercial	$6,483.75
Rate for Payer: Aetna Medicare Advantage	$5,118.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,350.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,350.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,350.94
Rate for Payer: Cigna Commercial	$8,531.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,129.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,753.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,559.38
Rate for Payer: UnitedHealthcare Community & State	$411.21
Rate for Payer: Wellpoint Medicaid Managed Care	$452.16

FEMORAL INTERLOK LT 60MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270639169
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

FEMORAL INTERLOK LT 60MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270639169
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

FEMORAL KNEE 60MM CEMENTED

Facility

$14,800.00

Service Code	HCPCS C1776
Hospital Charge Code	270682049
Hospital Revenue Code	278
Min. Negotiated Rate	$2,220.00
Max. Negotiated Rate	$3,581.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,581.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,256.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,220.00

FEMORAL KNEE 60MM CEMENTED

Facility

$14,800.00

Service Code	HCPCS C1776
Hospital Charge Code	270682049
Hospital Revenue Code	278
Min. Negotiated Rate	$356.68
Max. Negotiated Rate	$7,400.00
Rate for Payer: Aetna Commercial	$5,624.00
Rate for Payer: Aetna Medicare Advantage	$4,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,774.00
Rate for Payer: Cigna Commercial	$7,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,581.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,256.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$356.68
Rate for Payer: Wellpoint Medicaid Managed Care	$392.20

FEMORAL KNEE SZ7 LEFT

Facility

$19,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270693993
Hospital Revenue Code	278
Min. Negotiated Rate	$457.90
Max. Negotiated Rate	$9,500.00
Rate for Payer: Aetna Commercial	$7,220.00
Rate for Payer: Aetna Medicare Advantage	$5,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,845.00
Rate for Payer: Cigna Commercial	$9,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,598.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,180.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,850.00
Rate for Payer: UnitedHealthcare Community & State	$457.90
Rate for Payer: Wellpoint Medicaid Managed Care	$503.50

FEMORAL KNEE SZ7 LEFT

Facility

$19,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270693993
Hospital Revenue Code	278
Min. Negotiated Rate	$2,850.00
Max. Negotiated Rate	$4,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,598.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,180.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,850.00

FEMORAL LCCK SZ G -RT NEXGEN

Facility

$36,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270686835
Hospital Revenue Code	278
Min. Negotiated Rate	$889.29
Max. Negotiated Rate	$18,450.00
Rate for Payer: Aetna Commercial	$14,022.00
Rate for Payer: Aetna Medicare Advantage	$11,070.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,409.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,409.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,380.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,409.50
Rate for Payer: Cigna Commercial	$18,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,929.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,118.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,535.00
Rate for Payer: UnitedHealthcare Community & State	$889.29
Rate for Payer: Wellpoint Medicaid Managed Care	$977.85

FEMORAL LCCK SZ G -RT NEXGEN

Facility

$36,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270686835
Hospital Revenue Code	278
Min. Negotiated Rate	$5,535.00
Max. Negotiated Rate	$8,929.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,929.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,118.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,535.00

FEMORAL LPS-FLEX GSF OPTION

Facility

$12,165.00

Hospital Charge Code	270660823
Hospital Revenue Code	278
Min. Negotiated Rate	$293.18
Max. Negotiated Rate	$6,082.50
Rate for Payer: Aetna Commercial	$4,622.70
Rate for Payer: Aetna Medicare Advantage	$3,649.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,102.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,102.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,433.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,102.07
Rate for Payer: Cigna Commercial	$6,082.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,943.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,676.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,824.75
Rate for Payer: UnitedHealthcare Community & State	$293.18
Rate for Payer: Wellpoint Medicaid Managed Care	$322.37

FEMORAL LPS-FLEX GSF OPTION

Facility

$12,165.00

Hospital Charge Code	270660823
Hospital Revenue Code	278
Min. Negotiated Rate	$1,824.75
Max. Negotiated Rate	$2,943.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,433.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,943.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,676.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,824.75

FEMORAL MOLD CEMENT 75 MM

Facility

$10,460.00

Service Code	HCPCS C1713
Hospital Charge Code	270684834
Hospital Revenue Code	278
Min. Negotiated Rate	$252.09
Max. Negotiated Rate	$5,230.00
Rate for Payer: Aetna Commercial	$3,974.80
Rate for Payer: Aetna Medicare Advantage	$3,138.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,667.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,667.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,092.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,667.30
Rate for Payer: Cigna Commercial	$5,230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,531.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,301.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,569.00
Rate for Payer: UnitedHealthcare Community & State	$252.09
Rate for Payer: Wellpoint Medicaid Managed Care	$277.19

FEMORAL MOLD CEMENT 75 MM

Facility

$10,460.00

Service Code	HCPCS C1713
Hospital Charge Code	270684834
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.00
Max. Negotiated Rate	$2,531.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,092.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,531.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,301.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,569.00

FEMORAL NAIL EX SPIRAL 70 MM B

Facility

$2,563.85

Service Code	HCPCS C1713
Hospital Charge Code	270688215
Hospital Revenue Code	278
Min. Negotiated Rate	$384.58
Max. Negotiated Rate	$620.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$512.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$620.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$564.05
Rate for Payer: Qualcare PPO/HMO/WC	$384.58

FEMORAL NAIL EX SPIRAL 70 MM B

Facility

$2,563.85

Service Code	HCPCS C1713
Hospital Charge Code	270688215
Hospital Revenue Code	278
Min. Negotiated Rate	$61.79
Max. Negotiated Rate	$1,281.92
Rate for Payer: Aetna Commercial	$974.26
Rate for Payer: Aetna Medicare Advantage	$769.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$653.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$653.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$512.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$653.78
Rate for Payer: Cigna Commercial	$1,281.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$620.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$564.05
Rate for Payer: Qualcare PPO/HMO/WC	$384.58
Rate for Payer: UnitedHealthcare Community & State	$61.79
Rate for Payer: Wellpoint Medicaid Managed Care	$67.94

FEMORAL NAIL LEFT

Facility

$13,910.00

Hospital Charge Code	27065601
Hospital Revenue Code	278
Min. Negotiated Rate	$335.23
Max. Negotiated Rate	$6,955.00
Rate for Payer: Aetna Commercial	$5,285.80
Rate for Payer: Aetna Medicare Advantage	$4,173.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,547.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,547.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,782.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,547.05
Rate for Payer: Cigna Commercial	$6,955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,366.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,060.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,086.50
Rate for Payer: UnitedHealthcare Community & State	$335.23
Rate for Payer: Wellpoint Medicaid Managed Care	$368.62

Know your out-of-pocket cost for care.

All Charges