Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEMUR CUTTING BLOCK RT SZ 3

Facility

$2,625.00

Hospital Charge Code	270672253
Hospital Revenue Code	278
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$635.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$577.50
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

FEMUR CUTTING BLOCK RT SZ 3

Facility

$2,625.00

Hospital Charge Code	270672253
Hospital Revenue Code	278
Min. Negotiated Rate	$63.26
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$577.50
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Community & State	$63.26
Rate for Payer: Wellpoint Medicaid Managed Care	$69.56

FEMUR CUTTING BLOCK RT SZ4

Facility

$2,625.00

Hospital Charge Code	270675308
Hospital Revenue Code	272
Min. Negotiated Rate	$63.26
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.50
Rate for Payer: Oxford Commercial	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Commercial	$525.00
Rate for Payer: UnitedHealthcare Community & State	$63.26
Rate for Payer: Wellpoint Medicaid Managed Care	$69.56

FEMUR CUTTING BLOCK RT SZ4

Facility

$2,625.00

Hospital Charge Code	270675308
Hospital Revenue Code	272
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$393.75
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

FEMUR CUTTING BLOCK SZ2 LEFT

Facility

$625.00

Hospital Charge Code	270677672
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

FEMUR CUTTING BLOCK SZ2 LEFT

Facility

$625.00

Hospital Charge Code	270677672
Hospital Revenue Code	272
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) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

FEMUR CUTTING BLOCK SZ 4 LEFT

Facility

$625.00

Hospital Charge Code	270671828
Hospital Revenue Code	272
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) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

FEMUR CUTTING BLOCK SZ 4 LEFT

Facility

$625.00

Hospital Charge Code	270671828
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

FEMUR CUTTING BLOCK SZ 5 RIGHT

Facility

$625.00

Hospital Charge Code	270678627
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

FEMUR CUTTING BLOCK SZ 5 RIGHT

Facility

$625.00

Hospital Charge Code	270678628
Hospital Revenue Code	272
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) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

FEMUR CUTTING BLOCK SZ 5 RIGHT

Facility

$625.00

Hospital Charge Code	270678627
Hospital Revenue Code	272
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) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

FEMUR CUTTING BLOCK SZ 5 RIGHT

Facility

$625.00

Hospital Charge Code	270678628
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

FEMUR DOME BEARING 28X50MM

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270698162
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

FEMUR DOME BEARING 28X50MM

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270698162
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

FEMUR GMK P.S RIGHT S5

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683812
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

FEMUR GMK P.S RIGHT S5

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683812
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

FEMUR HEAD BIOLOX 28X7MM XL

Facility

$9,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270695448
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.50
Max. Negotiated Rate	$2,417.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,998.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,417.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,197.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,498.50

FEMUR HEAD BIOLOX 28X7MM XL

Facility

$9,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270695448
Hospital Revenue Code	278
Min. Negotiated Rate	$240.76
Max. Negotiated Rate	$4,995.00
Rate for Payer: Aetna Commercial	$3,796.20
Rate for Payer: Aetna Medicare Advantage	$2,997.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,547.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,547.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,547.45
Rate for Payer: Cigna Commercial	$4,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,417.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,197.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,498.50
Rate for Payer: UnitedHealthcare Community & State	$240.76
Rate for Payer: Wellpoint Medicaid Managed Care	$264.74

FEMUR HEAD BIOLOX OPT 32 MM

Facility

$15,164.45

Service Code	HCPCS C1776
Hospital Charge Code	270698332
Hospital Revenue Code	278
Min. Negotiated Rate	$2,274.67
Max. Negotiated Rate	$3,669.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,032.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,669.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,336.18
Rate for Payer: Qualcare PPO/HMO/WC	$2,274.67

FEMUR HEAD BIOLOX OPT 32 MM

Facility

$15,164.45

Service Code	HCPCS C1776
Hospital Charge Code	270698332
Hospital Revenue Code	278
Min. Negotiated Rate	$365.46
Max. Negotiated Rate	$7,582.23
Rate for Payer: Aetna Commercial	$5,762.49
Rate for Payer: Aetna Medicare Advantage	$4,549.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,866.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,866.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,032.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,866.93
Rate for Payer: Cigna Commercial	$7,582.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,669.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,336.18
Rate for Payer: Qualcare PPO/HMO/WC	$2,274.67
Rate for Payer: UnitedHealthcare Community & State	$365.46
Rate for Payer: Wellpoint Medicaid Managed Care	$401.86

FEMUR HEAD DELTA BIOLOX 28MM

Facility

$6,412.50

Service Code	HCPCS C1776
Hospital Charge Code	270698149
Hospital Revenue Code	278
Min. Negotiated Rate	$154.54
Max. Negotiated Rate	$3,206.25
Rate for Payer: Aetna Commercial	$2,436.75
Rate for Payer: Aetna Medicare Advantage	$1,923.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,635.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,635.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,282.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,635.19
Rate for Payer: Cigna Commercial	$3,206.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,551.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,410.75
Rate for Payer: Qualcare PPO/HMO/WC	$961.88
Rate for Payer: UnitedHealthcare Community & State	$154.54
Rate for Payer: Wellpoint Medicaid Managed Care	$169.93

FEMUR HEAD DELTA BIOLOX 28MM

Facility

$6,412.50

Service Code	HCPCS C1776
Hospital Charge Code	270698149
Hospital Revenue Code	278
Min. Negotiated Rate	$961.88
Max. Negotiated Rate	$1,551.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,551.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,410.75
Rate for Payer: Qualcare PPO/HMO/WC	$961.88

FEMUR KNEE SAIPH 4 LEFT

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270680031
Hospital Revenue Code	278
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

FEMUR KNEE SAIPH 4 LEFT

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270680031
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

FEMUR KNEE SYSTEM SZ 11

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270690960
Hospital Revenue Code	278
Min. Negotiated Rate	$123.63
Max. Negotiated Rate	$2,565.00
Rate for Payer: Aetna Commercial	$1,949.40
Rate for Payer: Aetna Medicare Advantage	$1,539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,308.15
Rate for Payer: Cigna Commercial	$2,565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,128.60
Rate for Payer: Qualcare PPO/HMO/WC	$769.50
Rate for Payer: UnitedHealthcare Community & State	$123.63
Rate for Payer: Wellpoint Medicaid Managed Care	$135.94

Know your out-of-pocket cost for care.

All Charges