Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEMUR KNEE SYSTEM SZ 11

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270690960
Hospital Revenue Code	278
Min. Negotiated Rate	$769.50
Max. Negotiated Rate	$1,241.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
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

FEMUR L 62.5MM VNGD SSK 360

Facility

$36,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270687242
Hospital Revenue Code	278
Min. Negotiated Rate	$874.83
Max. Negotiated Rate	$18,150.00
Rate for Payer: Aetna Commercial	$13,794.00
Rate for Payer: Aetna Medicare Advantage	$10,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,256.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,256.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,256.50
Rate for Payer: Cigna Commercial	$18,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,784.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,986.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,445.00
Rate for Payer: UnitedHealthcare Community & State	$874.83
Rate for Payer: Wellpoint Medicaid Managed Care	$961.95

FEMUR L 62.5MM VNGD SSK 360

Facility

$36,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270687242
Hospital Revenue Code	278
Min. Negotiated Rate	$5,445.00
Max. Negotiated Rate	$8,784.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,784.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,986.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,445.00

FEMUR LEFT 65mm 145172

Facility

$13,312.70

Hospital Charge Code	270635345
Hospital Revenue Code	278
Min. Negotiated Rate	$1,996.90
Max. Negotiated Rate	$3,221.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,662.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,221.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,928.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,996.90

FEMUR LEFT 65mm 145172

Facility

$13,312.70

Hospital Charge Code	270635345
Hospital Revenue Code	278
Min. Negotiated Rate	$320.84
Max. Negotiated Rate	$6,656.35
Rate for Payer: Aetna Commercial	$5,058.83
Rate for Payer: Aetna Medicare Advantage	$3,993.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,662.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,394.74
Rate for Payer: Cigna Commercial	$6,656.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,221.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,928.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,996.90
Rate for Payer: UnitedHealthcare Community & State	$320.84
Rate for Payer: Wellpoint Medicaid Managed Care	$352.79

FEMUR LEFT 75mm 145174

Facility

$13,420.00

Hospital Charge Code	270637545
Hospital Revenue Code	278
Min. Negotiated Rate	$323.42
Max. Negotiated Rate	$6,710.00
Rate for Payer: Aetna Commercial	$5,099.60
Rate for Payer: Aetna Medicare Advantage	$4,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,422.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,422.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,684.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,422.10
Rate for Payer: Cigna Commercial	$6,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,247.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,952.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,013.00
Rate for Payer: UnitedHealthcare Community & State	$323.42
Rate for Payer: Wellpoint Medicaid Managed Care	$355.63

FEMUR LEFT 75mm 145174

Facility

$13,420.00

Hospital Charge Code	270637545
Hospital Revenue Code	278
Min. Negotiated Rate	$2,013.00
Max. Negotiated Rate	$3,247.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,684.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,247.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,952.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,013.00

FEMUR LINER G7 VITE FREE 36MM

Facility

$24,995.35

Service Code	HCPCS C1776
Hospital Charge Code	270698165
Hospital Revenue Code	278
Min. Negotiated Rate	$602.39
Max. Negotiated Rate	$12,497.67
Rate for Payer: Aetna Commercial	$9,498.23
Rate for Payer: Aetna Medicare Advantage	$7,498.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,373.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,373.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,373.81
Rate for Payer: Cigna Commercial	$12,497.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,498.98
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.30
Rate for Payer: UnitedHealthcare Community & State	$602.39
Rate for Payer: Wellpoint Medicaid Managed Care	$662.38

FEMUR LINER G7 VITE FREE 36MM

Facility

$24,995.35

Service Code	HCPCS C1776
Hospital Charge Code	270698165
Hospital Revenue Code	278
Min. Negotiated Rate	$3,749.30
Max. Negotiated Rate	$6,048.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,498.98
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.30

FEMUR LPS NEXGEN KNEE

Facility

$12,047.30

Hospital Charge Code	270639146
Hospital Revenue Code	278
Min. Negotiated Rate	$290.34
Max. Negotiated Rate	$6,023.65
Rate for Payer: Aetna Commercial	$4,577.97
Rate for Payer: Aetna Medicare Advantage	$3,614.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,072.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,072.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,409.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,072.06
Rate for Payer: Cigna Commercial	$6,023.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,915.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,650.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,807.10
Rate for Payer: UnitedHealthcare Community & State	$290.34
Rate for Payer: Wellpoint Medicaid Managed Care	$319.25

FEMUR LPS NEXGEN KNEE

Facility

$12,047.30

Hospital Charge Code	270639146
Hospital Revenue Code	278
Min. Negotiated Rate	$1,807.10
Max. Negotiated Rate	$2,915.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,409.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,915.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,650.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,807.10

FEMUR LPS RIGHT D

Facility

$11,583.95

Hospital Charge Code	270637618
Hospital Revenue Code	278
Min. Negotiated Rate	$279.17
Max. Negotiated Rate	$5,791.98
Rate for Payer: Aetna Commercial	$4,401.90
Rate for Payer: Aetna Medicare Advantage	$3,475.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,953.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,953.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,316.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,953.91
Rate for Payer: Cigna Commercial	$5,791.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,803.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,548.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,737.59
Rate for Payer: UnitedHealthcare Community & State	$279.17
Rate for Payer: Wellpoint Medicaid Managed Care	$306.97

FEMUR LPS RIGHT D

Facility

$11,583.95

Hospital Charge Code	270637618
Hospital Revenue Code	278
Min. Negotiated Rate	$1,737.59
Max. Negotiated Rate	$2,803.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,316.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,803.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,548.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,737.59

FEMUR MIN 2 VIEWS BILAT

Facility

$6,601.19

Service Code	HCPCS 7355250
Hospital Charge Code	94061484
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

FEMUR MIN 2 VIEWS BILAT

Facility

$6,601.19

Service Code	HCPCS 7355250
Hospital Charge Code	94061484
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,980.36
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$159.09
Rate for Payer: Wellpoint Medicaid Managed Care	$174.93

FEMUR MIN 2 VIEWS BILAT

Facility

$358.23

Service Code	HCPCS 7355250
Hospital Charge Code	75190638
Hospital Revenue Code	320
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$136.13
Rate for Payer: Aetna Medicare Advantage	$107.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.35
Rate for Payer: Cigna Commercial	$179.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.47
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.73
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$8.63
Rate for Payer: Wellpoint Medicaid Managed Care	$9.49

FEMUR MIN 2 VIEWS BILAT

Facility

$358.23

Service Code	HCPCS 7355250
Hospital Charge Code	75190638
Hospital Revenue Code	320
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$53.73
Rate for Payer: Qualcare PPO/HMO/WC	$53.73

FEMUR MIN 2 VIEWS BILAT

Facility

$6,601.19

Service Code	HCPCS 7355250
Hospital Charge Code	2011594
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,980.36
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$159.09
Rate for Payer: Wellpoint Medicaid Managed Care	$174.93

FEMUR MIN 2 VIEWS BILAT

Facility

$6,601.19

Service Code	HCPCS 7355250
Hospital Charge Code	2011594
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

FEMUR MIN 2 VIEWS BILAT

Facility

$358.23

Service Code	HCPCS 7355250
Hospital Charge Code	94270263
Hospital Revenue Code	320
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$53.73
Rate for Payer: Qualcare PPO/HMO/WC	$53.73

FEMUR MIN 2 VIEWS BILAT

Facility

$358.23

Service Code	HCPCS 7355250
Hospital Charge Code	94270263
Hospital Revenue Code	320
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$136.13
Rate for Payer: Aetna Medicare Advantage	$107.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.35
Rate for Payer: Cigna Commercial	$179.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.47
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.73
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$8.63
Rate for Payer: Wellpoint Medicaid Managed Care	$9.49

FEMUR MIN 2 VIEWS LT

Facility

$358.23

Service Code	HCPCS 73552LT
Hospital Charge Code	75190644
Hospital Revenue Code	320
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$136.13
Rate for Payer: Aetna Medicare Advantage	$107.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.35
Rate for Payer: Cigna Commercial	$179.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.47
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.73
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$8.63
Rate for Payer: Wellpoint Medicaid Managed Care	$9.49

FEMUR MIN 2 VIEWS LT

Facility

$358.23

Service Code	HCPCS 73552LT
Hospital Charge Code	94270271
Hospital Revenue Code	320
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$136.13
Rate for Payer: Aetna Medicare Advantage	$107.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.35
Rate for Payer: Cigna Commercial	$179.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.47
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.73
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$8.63
Rate for Payer: Wellpoint Medicaid Managed Care	$9.49

FEMUR MIN 2 VIEWS LT

Facility

$358.23

Service Code	HCPCS 73552LT
Hospital Charge Code	94270271
Hospital Revenue Code	320
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$53.73
Rate for Payer: Qualcare PPO/HMO/WC	$53.73

FEMUR MIN 2 VIEWS LT

Facility

$6,601.19

Service Code	HCPCS 73552LT
Hospital Charge Code	94061491
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

Know your out-of-pocket cost for care.

All Charges