Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL STEM 12/14 TAP CEMENT

Facility

$9,025.00

Service Code	HCPCS C1776
Hospital Charge Code	270691682
Hospital Revenue Code	278
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$4,512.50
Rate for Payer: Aetna Commercial	$3,429.50
Rate for Payer: Aetna Medicare Advantage	$2,707.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,301.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,301.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,301.38
Rate for Payer: Cigna Commercial	$4,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,184.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,985.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,353.75
Rate for Payer: UnitedHealthcare Community & State	$217.50
Rate for Payer: Wellpoint Medicaid Managed Care	$239.16

FEMORAL STEM 12/14 TAP CEMENT

Facility

$9,025.00

Service Code	HCPCS C1776
Hospital Charge Code	270691682
Hospital Revenue Code	278
Min. Negotiated Rate	$1,353.75
Max. Negotiated Rate	$2,184.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,805.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,184.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,985.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,353.75

FEMORAL STEM 12/14 TAPER

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270690555
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$3,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,135.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

FEMORAL STEM 12/14 TAPER

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270690555
Hospital Revenue Code	278
Min. Negotiated Rate	$343.43
Max. Negotiated Rate	$7,125.00
Rate for Payer: Aetna Commercial	$5,415.00
Rate for Payer: Aetna Medicare Advantage	$4,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,633.75
Rate for Payer: Cigna Commercial	$7,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,135.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50
Rate for Payer: UnitedHealthcare Community & State	$343.43
Rate for Payer: Wellpoint Medicaid Managed Care	$377.62

FEMORAL STEM 12/14 TAPER ACTIS

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270688105
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$3,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,135.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

FEMORAL STEM 12/14 TAPER ACTIS

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270688892
Hospital Revenue Code	278
Min. Negotiated Rate	$343.43
Max. Negotiated Rate	$7,125.00
Rate for Payer: Aetna Commercial	$5,415.00
Rate for Payer: Aetna Medicare Advantage	$4,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,633.75
Rate for Payer: Cigna Commercial	$7,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,135.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50
Rate for Payer: UnitedHealthcare Community & State	$343.43
Rate for Payer: Wellpoint Medicaid Managed Care	$377.62

FEMORAL STEM 12/14 TAPER ACTIS

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270688892
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$3,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,135.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

FEMORAL STEM 12/14 TAPER ACTIS

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270688105
Hospital Revenue Code	278
Min. Negotiated Rate	$343.43
Max. Negotiated Rate	$7,125.00
Rate for Payer: Aetna Commercial	$5,415.00
Rate for Payer: Aetna Medicare Advantage	$4,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,633.75
Rate for Payer: Cigna Commercial	$7,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,135.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50
Rate for Payer: UnitedHealthcare Community & State	$343.43
Rate for Payer: Wellpoint Medicaid Managed Care	$377.62

FEMORAL STEM 12/14 TPR SZ11

Facility

$6,930.00

Service Code	HCPCS C1776
Hospital Charge Code	270700570
Hospital Revenue Code	278
Min. Negotiated Rate	$167.01
Max. Negotiated Rate	$3,465.00
Rate for Payer: Aetna Commercial	$2,633.40
Rate for Payer: Aetna Medicare Advantage	$2,079.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,767.15
Rate for Payer: Cigna Commercial	$3,465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50
Rate for Payer: UnitedHealthcare Community & State	$167.01
Rate for Payer: Wellpoint Medicaid Managed Care	$183.65

FEMORAL STEM 12/14 TPR SZ11

Facility

$6,930.00

Service Code	HCPCS C1776
Hospital Charge Code	270700570
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,677.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50

FEMORAL STEM (15)

Facility

$15,948.55

Hospital Charge Code	270657018
Hospital Revenue Code	278
Min. Negotiated Rate	$384.36
Max. Negotiated Rate	$7,974.27
Rate for Payer: Aetna Commercial	$6,060.45
Rate for Payer: Aetna Medicare Advantage	$4,784.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,066.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,066.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,066.88
Rate for Payer: Cigna Commercial	$7,974.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,859.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,508.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,392.28
Rate for Payer: UnitedHealthcare Community & State	$384.36
Rate for Payer: Wellpoint Medicaid Managed Care	$422.64

FEMORAL STEM (15)

Facility

$15,948.55

Hospital Charge Code	270657018
Hospital Revenue Code	278
Min. Negotiated Rate	$2,392.28
Max. Negotiated Rate	$3,859.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,859.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,508.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,392.28

FEMORAL STEM ECHO 11X135MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691269
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 STEM ECHO 11X135MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691269
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- STEM FIBER METAL SZ13

Facility

$15,948.55

Hospital Charge Code	270657019
Hospital Revenue Code	278
Min. Negotiated Rate	$2,392.28
Max. Negotiated Rate	$3,859.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,859.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,508.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,392.28

FEMORAL- STEM FIBER METAL SZ13

Facility

$15,948.55

Hospital Charge Code	270657019
Hospital Revenue Code	278
Min. Negotiated Rate	$384.36
Max. Negotiated Rate	$7,974.27
Rate for Payer: Aetna Commercial	$6,060.45
Rate for Payer: Aetna Medicare Advantage	$4,784.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,066.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,066.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,189.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,066.88
Rate for Payer: Cigna Commercial	$7,974.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,859.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,508.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,392.28
Rate for Payer: UnitedHealthcare Community & State	$384.36
Rate for Payer: Wellpoint Medicaid Managed Care	$422.64

FEMORAL STEM NOVA 12/14 SZ17

Facility

$12,998.00

Hospital Charge Code	270670574
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.70
Max. Negotiated Rate	$3,145.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,859.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.70

FEMORAL STEM NOVA 12/14 SZ17

Facility

$12,998.00

Hospital Charge Code	270670574
Hospital Revenue Code	278
Min. Negotiated Rate	$313.25
Max. Negotiated Rate	$6,499.00
Rate for Payer: Aetna Commercial	$4,939.24
Rate for Payer: Aetna Medicare Advantage	$3,899.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,314.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,314.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,314.49
Rate for Payer: Cigna Commercial	$6,499.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,859.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.70
Rate for Payer: UnitedHealthcare Community & State	$313.25
Rate for Payer: Wellpoint Medicaid Managed Care	$344.45

FEMORAL STEM OFF POROUS SZ 2

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672470
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

FEMORAL STEM OFF POROUS SZ 2

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672470
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

FEMORAL STEM OFF POROUS SZ 3

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672471
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

FEMORAL STEM OFF POROUS SZ 3

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672471
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

FEMORAL STEM OFF POROUS SZ 4

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672472
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

FEMORAL STEM OFF POROUS SZ 4

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672472
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

FEMORAL STEM OFF POROUS SZ 5

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672473
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

Know your out-of-pocket cost for care.

All Charges