Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HEAD BIPOLAR 56MM

Facility

$3,500.00

Hospital Charge Code	270676757
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

HEAD BIPOLAR 56MM

Facility

$3,500.00

Hospital Charge Code	270676757
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

HEAD BIPOLAR COMPONENT 47MM

Facility

$5,609.50

Service Code	HCPCS C1776
Hospital Charge Code	270670751
Hospital Revenue Code	278
Min. Negotiated Rate	$135.19
Max. Negotiated Rate	$2,804.75
Rate for Payer: Aetna Commercial	$2,131.61
Rate for Payer: Aetna Medicare Advantage	$1,682.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,430.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,430.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,121.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,430.42
Rate for Payer: Cigna Commercial	$2,804.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,357.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,234.09
Rate for Payer: Qualcare PPO/HMO/WC	$841.42
Rate for Payer: UnitedHealthcare Community & State	$135.19
Rate for Payer: Wellpoint Medicaid Managed Care	$148.65

HEAD BIPOLAR COMPONENT 47MM

Facility

$5,609.50

Service Code	HCPCS C1776
Hospital Charge Code	270670751
Hospital Revenue Code	278
Min. Negotiated Rate	$841.42
Max. Negotiated Rate	$1,357.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,121.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,357.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,234.09
Rate for Payer: Qualcare PPO/HMO/WC	$841.42

HEAD BIPOLAR SELF 28 MM 44 MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689575
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

HEAD BIPOLAR SELF 28 MM 44 MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689575
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

HEAD BIPOLAR SELF 28MMID41MMOD

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270657703
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

HEAD BIPOLAR SELF 28MMID41MMOD

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270657703
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

HEAD BIPOLAR SELFCTR 28X46MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270697314
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

HEAD BIPOLAR SELFCTR 28X46MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270697314
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

HEAD BIPOL SC 28MM ID/52MM OD

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699294
Hospital Revenue Code	278
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

HEAD BIPOL SC 28MM ID/52MM OD

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699294
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

HEAD BIP SELF CEM 28MM 40MM OD

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270691719
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

HEAD BIP SELF CEM 28MM 40MM OD

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270691719
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

HEAD BIXCUT MOD REAMER 10.5MM

Facility

$2,610.00

Hospital Charge Code	270670462
Hospital Revenue Code	272
Min. Negotiated Rate	$62.90
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$991.80
Rate for Payer: Aetna Medicare Advantage	$783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.55
Rate for Payer: Cigna Commercial	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$783.00
Rate for Payer: Oxford Commercial	$522.00
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Commercial	$522.00
Rate for Payer: UnitedHealthcare Community & State	$62.90
Rate for Payer: Wellpoint Medicaid Managed Care	$69.17

HEAD BIXCUT MOD REAMER 10.5MM

Facility

$2,610.00

Hospital Charge Code	270670462
Hospital Revenue Code	272
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD BIXCUT MOD REAMER 10MM

Facility

$2,610.00

Hospital Charge Code	270670461
Hospital Revenue Code	272
Min. Negotiated Rate	$62.90
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$991.80
Rate for Payer: Aetna Medicare Advantage	$783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.55
Rate for Payer: Cigna Commercial	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$783.00
Rate for Payer: Oxford Commercial	$522.00
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Commercial	$522.00
Rate for Payer: UnitedHealthcare Community & State	$62.90
Rate for Payer: Wellpoint Medicaid Managed Care	$69.17

HEAD BIXCUT MOD REAMER 10MM

Facility

$2,610.00

Hospital Charge Code	270670461
Hospital Revenue Code	272
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD BIXCUT MOD REAMER 11.5MM

Facility

$2,610.00

Hospital Charge Code	270670464
Hospital Revenue Code	272
Min. Negotiated Rate	$62.90
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$991.80
Rate for Payer: Aetna Medicare Advantage	$783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.55
Rate for Payer: Cigna Commercial	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$783.00
Rate for Payer: Oxford Commercial	$522.00
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Commercial	$522.00
Rate for Payer: UnitedHealthcare Community & State	$62.90
Rate for Payer: Wellpoint Medicaid Managed Care	$69.17

HEAD BIXCUT MOD REAMER 11.5MM

Facility

$2,610.00

Hospital Charge Code	270670464
Hospital Revenue Code	272
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD BIXCUT MOD REAMER 11MM

Facility

$2,610.00

Hospital Charge Code	270670463
Hospital Revenue Code	272
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD BIXCUT MOD REAMER 11MM

Facility

$2,610.00

Hospital Charge Code	270670463
Hospital Revenue Code	272
Min. Negotiated Rate	$62.90
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$991.80
Rate for Payer: Aetna Medicare Advantage	$783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.55
Rate for Payer: Cigna Commercial	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$783.00
Rate for Payer: Oxford Commercial	$522.00
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Commercial	$522.00
Rate for Payer: UnitedHealthcare Community & State	$62.90
Rate for Payer: Wellpoint Medicaid Managed Care	$69.17

HEAD BIXCUT MOD REAMER 9.5MM

Facility

$2,610.00

Hospital Charge Code	270670460
Hospital Revenue Code	272
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD BIXCUT MOD REAMER 9.5MM

Facility

$2,610.00

Hospital Charge Code	270670460
Hospital Revenue Code	272
Min. Negotiated Rate	$62.90
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$991.80
Rate for Payer: Aetna Medicare Advantage	$783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$665.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$665.55
Rate for Payer: Cigna Commercial	$1,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$783.00
Rate for Payer: Oxford Commercial	$522.00
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Commercial	$522.00
Rate for Payer: UnitedHealthcare Community & State	$62.90
Rate for Payer: Wellpoint Medicaid Managed Care	$69.17

HEAD BIXCUT MOD REAMER 9MM

Facility

$2,610.00

Hospital Charge Code	270670459
Hospital Revenue Code	272
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$391.50
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

Know your out-of-pocket cost for care.

All Charges