Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HEAD COMP ENDOPROSTHESIS 42MM

Facility

$4,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270674000
Hospital Revenue Code	278
Min. Negotiated Rate	$99.41
Max. Negotiated Rate	$2,062.50
Rate for Payer: Aetna Commercial	$1,567.50
Rate for Payer: Aetna Medicare Advantage	$1,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.88
Rate for Payer: Cigna Commercial	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$618.75
Rate for Payer: UnitedHealthcare Community & State	$99.41
Rate for Payer: Wellpoint Medicaid Managed Care	$109.31

HEAD COMP ENDOPROSTHESIS 42MM

Facility

$4,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270674000
Hospital Revenue Code	278
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$998.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$618.75

HEAD COMP ENDOPROSTHESIS 43MM

Facility

$4,252.25

Service Code	HCPCS C1776
Hospital Charge Code	270678036
Hospital Revenue Code	278
Min. Negotiated Rate	$637.84
Max. Negotiated Rate	$1,029.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,029.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.84

HEAD COMP ENDOPROSTHESIS 43MM

Facility

$4,252.25

Service Code	HCPCS C1776
Hospital Charge Code	270678036
Hospital Revenue Code	278
Min. Negotiated Rate	$102.48
Max. Negotiated Rate	$2,126.12
Rate for Payer: Aetna Commercial	$1,615.86
Rate for Payer: Aetna Medicare Advantage	$1,275.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,084.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,084.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,084.32
Rate for Payer: Cigna Commercial	$2,126.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,029.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.84
Rate for Payer: UnitedHealthcare Community & State	$102.48
Rate for Payer: Wellpoint Medicaid Managed Care	$112.68

HEAD COMP ENDOPROSTHESIS 48MM

Facility

$4,125.00

Hospital Charge Code	270669749
Hospital Revenue Code	278
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$998.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$618.75

HEAD COMP ENDOPROSTHESIS 48MM

Facility

$4,125.00

Hospital Charge Code	270669749
Hospital Revenue Code	278
Min. Negotiated Rate	$99.41
Max. Negotiated Rate	$2,062.50
Rate for Payer: Aetna Commercial	$1,567.50
Rate for Payer: Aetna Medicare Advantage	$1,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.88
Rate for Payer: Cigna Commercial	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$618.75
Rate for Payer: UnitedHealthcare Community & State	$99.41
Rate for Payer: Wellpoint Medicaid Managed Care	$109.31

HEAD COMP FEM ENDOPROSTH 47MM

Facility

$4,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270693839
Hospital Revenue Code	278
Min. Negotiated Rate	$99.41
Max. Negotiated Rate	$2,062.50
Rate for Payer: Aetna Commercial	$1,567.50
Rate for Payer: Aetna Medicare Advantage	$1,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.88
Rate for Payer: Cigna Commercial	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$618.75
Rate for Payer: UnitedHealthcare Community & State	$99.41
Rate for Payer: Wellpoint Medicaid Managed Care	$109.31

HEAD COMP FEM ENDOPROSTH 47MM

Facility

$4,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270693839
Hospital Revenue Code	278
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$998.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$618.75

HEADCONTENTRICHUMERAL40MMX21MM

Facility

$14,750.00

Hospital Charge Code	270663301
Hospital Revenue Code	278
Min. Negotiated Rate	$2,212.50
Max. Negotiated Rate	$3,569.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,569.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,245.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,212.50

HEADCONTENTRICHUMERAL40MMX21MM

Facility

$14,750.00

Hospital Charge Code	270663301
Hospital Revenue Code	278
Min. Negotiated Rate	$355.48
Max. Negotiated Rate	$7,375.00
Rate for Payer: Aetna Commercial	$5,605.00
Rate for Payer: Aetna Medicare Advantage	$4,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,761.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,761.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,761.25
Rate for Payer: Cigna Commercial	$7,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,569.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,245.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,212.50
Rate for Payer: UnitedHealthcare Community & State	$355.48
Rate for Payer: Wellpoint Medicaid Managed Care	$390.88

HEAD CRCO 46X18 HUMELOCK CEM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270692131
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 CRCO 46X18 HUMELOCK CEM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270692131
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 DELTA 40MM L BIOLOX

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684312
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 DELTA 40MM L BIOLOX

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684312
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 DELTA CERAMIC V40 28MM

Facility

$3,416.95

Service Code	HCPCS C1776
Hospital Charge Code	270699504
Hospital Revenue Code	278
Min. Negotiated Rate	$512.54
Max. Negotiated Rate	$826.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$683.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$826.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$751.73
Rate for Payer: Qualcare PPO/HMO/WC	$512.54

HEAD DELTA CERAMIC V40 28MM

Facility

$3,416.95

Service Code	HCPCS C1776
Hospital Charge Code	270699504
Hospital Revenue Code	278
Min. Negotiated Rate	$82.35
Max. Negotiated Rate	$1,708.47
Rate for Payer: Aetna Commercial	$1,298.44
Rate for Payer: Aetna Medicare Advantage	$1,025.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$871.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$871.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$683.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$871.32
Rate for Payer: Cigna Commercial	$1,708.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$826.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$751.73
Rate for Payer: Qualcare PPO/HMO/WC	$512.54
Rate for Payer: UnitedHealthcare Community & State	$82.35
Rate for Payer: Wellpoint Medicaid Managed Care	$90.55

HEAD DELTA C-TAPER 32MM -2.5MM

Facility

$4,255.50

Service Code	HCPCS C1776
Hospital Charge Code	270693032
Hospital Revenue Code	278
Min. Negotiated Rate	$638.33
Max. Negotiated Rate	$1,029.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$851.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,029.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$936.21
Rate for Payer: Qualcare PPO/HMO/WC	$638.33

HEAD DELTA C-TAPER 32MM -2.5MM

Facility

$4,255.50

Service Code	HCPCS C1776
Hospital Charge Code	270693032
Hospital Revenue Code	278
Min. Negotiated Rate	$102.56
Max. Negotiated Rate	$2,127.75
Rate for Payer: Aetna Commercial	$1,617.09
Rate for Payer: Aetna Medicare Advantage	$1,276.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,085.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,085.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$851.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,085.15
Rate for Payer: Cigna Commercial	$2,127.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,029.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$936.21
Rate for Payer: Qualcare PPO/HMO/WC	$638.33
Rate for Payer: UnitedHealthcare Community & State	$102.56
Rate for Payer: Wellpoint Medicaid Managed Care	$112.77

HEAD DELTA MED 36mm BIOLOX LT

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270682864
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 DELTA MED 36mm BIOLOX LT

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270682864
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 DONUT ADULT

Facility

$375.00

Hospital Charge Code	270651338
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

HEAD DONUT ADULT

Facility

$375.00

Hospital Charge Code	270651338
Hospital Revenue Code	278
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

HEADED DARCO 6.5x50MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270683636
Hospital Revenue Code	278
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

HEADED DARCO 6.5x50MM

Facility

$1,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270683636
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

HEAD EXPLOR 10x20M 11-210022

Facility

$6,310.00

Hospital Charge Code	270644773
Hospital Revenue Code	278
Min. Negotiated Rate	$946.50
Max. Negotiated Rate	$1,527.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,262.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,527.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,388.20
Rate for Payer: Qualcare PPO/HMO/WC	$946.50

Know your out-of-pocket cost for care.

All Charges