Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL RM 45 102100

Facility

$9,042.45

Hospital Charge Code	270632446
Hospital Revenue Code	278
Min. Negotiated Rate	$217.92
Max. Negotiated Rate	$4,521.23
Rate for Payer: Aetna Commercial	$3,436.13
Rate for Payer: Aetna Medicare Advantage	$2,712.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,305.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,305.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,808.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,305.82
Rate for Payer: Cigna Commercial	$4,521.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,188.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,989.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,356.37
Rate for Payer: UnitedHealthcare Community & State	$217.92
Rate for Payer: Wellpoint Medicaid Managed Care	$239.62

FEMORAL RM 48 102110

Facility

$10,396.25

Hospital Charge Code	270630492
Hospital Revenue Code	278
Min. Negotiated Rate	$1,559.44
Max. Negotiated Rate	$2,515.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,079.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,515.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,287.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,559.44

FEMORAL RM 48 102110

Facility

$10,396.25

Hospital Charge Code	270630492
Hospital Revenue Code	278
Min. Negotiated Rate	$250.55
Max. Negotiated Rate	$5,198.12
Rate for Payer: Aetna Commercial	$3,950.57
Rate for Payer: Aetna Medicare Advantage	$3,118.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,651.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,651.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,079.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,651.04
Rate for Payer: Cigna Commercial	$5,198.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,515.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,287.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,559.44
Rate for Payer: UnitedHealthcare Community & State	$250.55
Rate for Payer: Wellpoint Medicaid Managed Care	$275.50

FEMORAL RPP NC ECHO POR

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692413
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 RPP NC ECHO POR

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692413
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 SOFT TISSUE FASTENER

Facility

$6,355.00

Service Code	HCPCS C1776
Hospital Charge Code	270679464
Hospital Revenue Code	278
Min. Negotiated Rate	$153.16
Max. Negotiated Rate	$3,177.50
Rate for Payer: Aetna Commercial	$2,414.90
Rate for Payer: Aetna Medicare Advantage	$1,906.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,620.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,620.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,271.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,620.53
Rate for Payer: Cigna Commercial	$3,177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,537.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,398.10
Rate for Payer: Qualcare PPO/HMO/WC	$953.25
Rate for Payer: UnitedHealthcare Community & State	$153.16
Rate for Payer: Wellpoint Medicaid Managed Care	$168.41

FEMORAL SOFT TISSUE FASTENER

Facility

$6,355.00

Service Code	HCPCS C1776
Hospital Charge Code	270679464
Hospital Revenue Code	278
Min. Negotiated Rate	$953.25
Max. Negotiated Rate	$1,537.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,271.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,537.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,398.10
Rate for Payer: Qualcare PPO/HMO/WC	$953.25

FEMORAL SPACER MOLD 60x42MM

Facility

$7,980.00

Service Code	HCPCS C1713
Hospital Charge Code	270672077
Hospital Revenue Code	278
Min. Negotiated Rate	$1,197.00
Max. Negotiated Rate	$1,931.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,596.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,931.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,755.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,197.00

FEMORAL SPACER MOLD 60x42MM

Facility

$7,980.00

Service Code	HCPCS C1713
Hospital Charge Code	270672077
Hospital Revenue Code	278
Min. Negotiated Rate	$192.32
Max. Negotiated Rate	$3,990.00
Rate for Payer: Aetna Commercial	$3,032.40
Rate for Payer: Aetna Medicare Advantage	$2,394.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,034.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,034.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,596.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,034.90
Rate for Payer: Cigna Commercial	$3,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,931.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,755.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,197.00
Rate for Payer: UnitedHealthcare Community & State	$192.32
Rate for Payer: Wellpoint Medicaid Managed Care	$211.47

FEMORAL SPHERE S3 INSTR SET

Facility

$625.00

Service Code	HCPCS C1776
Hospital Charge Code	270684551
Hospital Revenue Code	278
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

FEMORAL SPHERE S3 INSTR SET

Facility

$625.00

Service Code	HCPCS C1776
Hospital Charge Code	270684551
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

FEMORAL SSK 65 LEFT

Facility

$28,175.00

Service Code	HCPCS C1776
Hospital Charge Code	270638755
Hospital Revenue Code	278
Min. Negotiated Rate	$4,226.25
Max. Negotiated Rate	$6,818.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,635.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,818.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,198.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,226.25

FEMORAL SSK 65 LEFT

Facility

$28,175.00

Service Code	HCPCS C1776
Hospital Charge Code	270638755
Hospital Revenue Code	278
Min. Negotiated Rate	$679.02
Max. Negotiated Rate	$14,087.50
Rate for Payer: Aetna Commercial	$10,706.50
Rate for Payer: Aetna Medicare Advantage	$8,452.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,184.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,184.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,635.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,184.62
Rate for Payer: Cigna Commercial	$14,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,818.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,198.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,226.25
Rate for Payer: UnitedHealthcare Community & State	$679.02
Rate for Payer: Wellpoint Medicaid Managed Care	$746.64

FEMORAL SSK 65 RIGHT 183304

Facility

$34,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270647559
Hospital Revenue Code	278
Min. Negotiated Rate	$835.91
Max. Negotiated Rate	$17,342.50
Rate for Payer: Aetna Commercial	$13,180.30
Rate for Payer: Aetna Medicare Advantage	$10,405.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,844.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,844.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,937.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,844.67
Rate for Payer: Cigna Commercial	$17,342.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,393.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,630.70
Rate for Payer: Qualcare PPO/HMO/WC	$5,202.75
Rate for Payer: UnitedHealthcare Community & State	$835.91
Rate for Payer: Wellpoint Medicaid Managed Care	$919.15

FEMORAL SSK 65 RIGHT 183304

Facility

$34,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270647559
Hospital Revenue Code	278
Min. Negotiated Rate	$5,202.75
Max. Negotiated Rate	$8,393.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,937.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,393.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,630.70
Rate for Payer: Qualcare PPO/HMO/WC	$5,202.75

FEMORAL SSK 70MM LEFT INTERLOK

Facility

$40,345.00

Hospital Charge Code	270671341
Hospital Revenue Code	278
Min. Negotiated Rate	$6,051.75
Max. Negotiated Rate	$9,763.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,069.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,763.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,875.90
Rate for Payer: Qualcare PPO/HMO/WC	$6,051.75

FEMORAL SSK 70MM LEFT INTERLOK

Facility

$40,345.00

Hospital Charge Code	270671341
Hospital Revenue Code	278
Min. Negotiated Rate	$972.31
Max. Negotiated Rate	$20,172.50
Rate for Payer: Aetna Commercial	$15,331.10
Rate for Payer: Aetna Medicare Advantage	$12,103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,287.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,287.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,069.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,287.98
Rate for Payer: Cigna Commercial	$20,172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,763.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,875.90
Rate for Payer: Qualcare PPO/HMO/WC	$6,051.75
Rate for Payer: UnitedHealthcare Community & State	$972.31
Rate for Payer: Wellpoint Medicaid Managed Care	$1,069.14

FEMORAL SSK 75mm RIGHT

Facility

$40,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270669900
Hospital Revenue Code	278
Min. Negotiated Rate	$972.31
Max. Negotiated Rate	$20,172.50
Rate for Payer: Aetna Commercial	$15,331.10
Rate for Payer: Aetna Medicare Advantage	$12,103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,287.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,287.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,069.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,287.98
Rate for Payer: Cigna Commercial	$20,172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,763.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,875.90
Rate for Payer: Qualcare PPO/HMO/WC	$6,051.75
Rate for Payer: UnitedHealthcare Community & State	$972.31
Rate for Payer: Wellpoint Medicaid Managed Care	$1,069.14

FEMORAL SSK 75mm RIGHT

Facility

$40,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270669900
Hospital Revenue Code	278
Min. Negotiated Rate	$6,051.75
Max. Negotiated Rate	$9,763.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,069.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,763.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,875.90
Rate for Payer: Qualcare PPO/HMO/WC	$6,051.75

FEMORAL SSK 75MM RIGHT

Facility

$40,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270183308
Hospital Revenue Code	278
Min. Negotiated Rate	$6,051.75
Max. Negotiated Rate	$9,763.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,069.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,763.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,875.90
Rate for Payer: Qualcare PPO/HMO/WC	$6,051.75

FEMORAL SSK 75MM RIGHT

Facility

$40,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270183308
Hospital Revenue Code	278
Min. Negotiated Rate	$972.31
Max. Negotiated Rate	$20,172.50
Rate for Payer: Aetna Commercial	$15,331.10
Rate for Payer: Aetna Medicare Advantage	$12,103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,287.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,287.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,069.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,287.98
Rate for Payer: Cigna Commercial	$20,172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,763.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,875.90
Rate for Payer: Qualcare PPO/HMO/WC	$6,051.75
Rate for Payer: UnitedHealthcare Community & State	$972.31
Rate for Payer: Wellpoint Medicaid Managed Care	$1,069.14

FEMORAL SSK RIGHT 50mm

Facility

$39,540.00

Hospital Charge Code	270675556
Hospital Revenue Code	278
Min. Negotiated Rate	$952.91
Max. Negotiated Rate	$19,770.00
Rate for Payer: Aetna Commercial	$15,025.20
Rate for Payer: Aetna Medicare Advantage	$11,862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,082.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,082.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,908.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,082.70
Rate for Payer: Cigna Commercial	$19,770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,568.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,698.80
Rate for Payer: Qualcare PPO/HMO/WC	$5,931.00
Rate for Payer: UnitedHealthcare Community & State	$952.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1,047.81

FEMORAL SSK RIGHT 50mm

Facility

$39,540.00

Hospital Charge Code	270675556
Hospital Revenue Code	278
Min. Negotiated Rate	$5,931.00
Max. Negotiated Rate	$9,568.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,908.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,568.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,698.80
Rate for Payer: Qualcare PPO/HMO/WC	$5,931.00

FEMORAL STEM 12/14 SZ 13 155MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678420
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 STEM 12/14 SZ 13 155MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678420
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

Know your out-of-pocket cost for care.

All Charges