Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HEAD EXPLOR 10x20M 11-210022

Facility

$6,310.00

Hospital Charge Code	270644773
Hospital Revenue Code	278
Min. Negotiated Rate	$152.07
Max. Negotiated Rate	$3,155.00
Rate for Payer: Aetna Commercial	$2,397.80
Rate for Payer: Aetna Medicare Advantage	$1,893.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,609.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,609.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,262.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,609.05
Rate for Payer: Cigna Commercial	$3,155.00
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
Rate for Payer: UnitedHealthcare Community & State	$152.07
Rate for Payer: Wellpoint Medicaid Managed Care	$167.22

HEAD FEM 28MM +3.5MM BOPLOX

Facility

$9,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270695088
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

HEAD FEM 28MM +3.5MM BOPLOX

Facility

$9,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270695088
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

HEAD FEM BIOLOX DELTA CER 28MM

Facility

$9,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270694799
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

HEAD FEM BIOLOX DELTA CER 28MM

Facility

$9,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270694799
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

HEADFEMBIOLOXDLT12/14TAP36MM

Facility

$8,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270697655
Hospital Revenue Code	278
Min. Negotiated Rate	$1,265.25
Max. Negotiated Rate	$2,041.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,687.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,041.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,855.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.25

HEADFEMBIOLOXDLT12/14TAP36MM

Facility

$8,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270697655
Hospital Revenue Code	278
Min. Negotiated Rate	$203.28
Max. Negotiated Rate	$4,217.50
Rate for Payer: Aetna Commercial	$3,205.30
Rate for Payer: Aetna Medicare Advantage	$2,530.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,150.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,150.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,150.93
Rate for Payer: Cigna Commercial	$4,217.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,041.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,855.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.25
Rate for Payer: UnitedHealthcare Community & State	$203.28
Rate for Payer: Wellpoint Medicaid Managed Care	$223.53

HEAD FEM CER BIOLOX DELTA 36MM

Facility

$17,434.35

Service Code	HCPCS C1776
Hospital Charge Code	270698838
Hospital Revenue Code	278
Min. Negotiated Rate	$420.17
Max. Negotiated Rate	$8,717.17
Rate for Payer: Aetna Commercial	$6,625.05
Rate for Payer: Aetna Medicare Advantage	$5,230.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,445.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,445.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,445.76
Rate for Payer: Cigna Commercial	$8,717.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,219.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,835.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,615.15
Rate for Payer: UnitedHealthcare Community & State	$420.17
Rate for Payer: Wellpoint Medicaid Managed Care	$462.01

HEAD FEM CER BIOLOX DELTA 36MM

Facility

$17,434.35

Service Code	HCPCS C1776
Hospital Charge Code	270698838
Hospital Revenue Code	278
Min. Negotiated Rate	$2,615.15
Max. Negotiated Rate	$4,219.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,486.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,219.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,835.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,615.15

HEAD FEM DELTA BIOLOX 28MM

Facility

$6,410.00

Service Code	HCPCS C1776
Hospital Charge Code	270700045
Hospital Revenue Code	278
Min. Negotiated Rate	$154.48
Max. Negotiated Rate	$3,205.00
Rate for Payer: Aetna Commercial	$2,435.80
Rate for Payer: Aetna Medicare Advantage	$1,923.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,634.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,634.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,282.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,634.55
Rate for Payer: Cigna Commercial	$3,205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,551.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,410.20
Rate for Payer: Qualcare PPO/HMO/WC	$961.50
Rate for Payer: UnitedHealthcare Community & State	$154.48
Rate for Payer: Wellpoint Medicaid Managed Care	$169.87

HEAD FEM DELTA BIOLOX 28MM

Facility

$6,410.00

Service Code	HCPCS C1776
Hospital Charge Code	270700045
Hospital Revenue Code	278
Min. Negotiated Rate	$961.50
Max. Negotiated Rate	$1,551.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,282.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,551.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,410.20
Rate for Payer: Qualcare PPO/HMO/WC	$961.50

HEAD FEMORAL 26MM +8MM

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270673427
Hospital Revenue Code	278
Min. Negotiated Rate	$86.16
Max. Negotiated Rate	$1,787.50
Rate for Payer: Aetna Commercial	$1,358.50
Rate for Payer: Aetna Medicare Advantage	$1,072.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$911.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$911.62
Rate for Payer: Cigna Commercial	$1,787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$865.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$786.50
Rate for Payer: Qualcare PPO/HMO/WC	$536.25
Rate for Payer: UnitedHealthcare Community & State	$86.16
Rate for Payer: Wellpoint Medicaid Managed Care	$94.74

HEAD FEMORAL 26MM +8MM

Facility

$3,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270673427
Hospital Revenue Code	278
Min. Negotiated Rate	$536.25
Max. Negotiated Rate	$865.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$865.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$786.50
Rate for Payer: Qualcare PPO/HMO/WC	$536.25

HEAD FEMORAL 28mm +0mm

Facility

$4,271.30

Service Code	HCPCS C1776
Hospital Charge Code	270676689
Hospital Revenue Code	278
Min. Negotiated Rate	$102.94
Max. Negotiated Rate	$2,135.65
Rate for Payer: Aetna Commercial	$1,623.09
Rate for Payer: Aetna Medicare Advantage	$1,281.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,089.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,089.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$854.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,089.18
Rate for Payer: Cigna Commercial	$2,135.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,033.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$939.69
Rate for Payer: Qualcare PPO/HMO/WC	$640.70
Rate for Payer: UnitedHealthcare Community & State	$102.94
Rate for Payer: Wellpoint Medicaid Managed Care	$113.19

HEAD FEMORAL 28mm +0mm

Facility

$4,271.30

Service Code	HCPCS C1776
Hospital Charge Code	270676689
Hospital Revenue Code	278
Min. Negotiated Rate	$640.70
Max. Negotiated Rate	$1,033.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$854.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,033.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$939.69
Rate for Payer: Qualcare PPO/HMO/WC	$640.70

HEAD FEMORAL 28MM +5

Facility

$2,610.00

Hospital Charge Code	270677210
Hospital Revenue Code	278
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) NJ Health	$522.00
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	$631.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$574.20
Rate for Payer: Qualcare PPO/HMO/WC	$391.50
Rate for Payer: UnitedHealthcare Community & State	$62.90
Rate for Payer: Wellpoint Medicaid Managed Care	$69.17

HEAD FEMORAL 28MM +5

Facility

$2,610.00

Hospital Charge Code	270677210
Hospital Revenue Code	278
Min. Negotiated Rate	$391.50
Max. Negotiated Rate	$631.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$522.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$631.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$574.20
Rate for Payer: Qualcare PPO/HMO/WC	$391.50

HEAD FEMORAL 28MM LARGE

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677987
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

HEAD FEMORAL 28MM LARGE

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677987
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

HEAD FEMORAL 28MM LONG 9026-30

Facility

$2,120.85

Hospital Charge Code	270614531
Hospital Revenue Code	278
Min. Negotiated Rate	$51.11
Max. Negotiated Rate	$1,060.42
Rate for Payer: Aetna Commercial	$805.92
Rate for Payer: Aetna Medicare Advantage	$636.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$540.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$540.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$424.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$540.82
Rate for Payer: Cigna Commercial	$1,060.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$513.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$466.59
Rate for Payer: Qualcare PPO/HMO/WC	$318.13
Rate for Payer: UnitedHealthcare Community & State	$51.11
Rate for Payer: Wellpoint Medicaid Managed Care	$56.20

HEAD FEMORAL 28MM LONG 9026-30

Facility

$2,120.85

Hospital Charge Code	270614531
Hospital Revenue Code	278
Min. Negotiated Rate	$318.13
Max. Negotiated Rate	$513.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$424.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$513.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$466.59
Rate for Payer: Qualcare PPO/HMO/WC	$318.13

HEAD FEMORAL 28MMOD 4MM LNGTH

Facility

$8,662.50

Service Code	HCPCS C1776
Hospital Charge Code	270646339
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.38
Max. Negotiated Rate	$2,096.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,096.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,905.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.38

HEAD FEMORAL 28MMOD 4MM LNGTH

Facility

$8,662.50

Service Code	HCPCS C1776
Hospital Charge Code	270646339
Hospital Revenue Code	278
Min. Negotiated Rate	$208.77
Max. Negotiated Rate	$4,331.25
Rate for Payer: Aetna Commercial	$3,291.75
Rate for Payer: Aetna Medicare Advantage	$2,598.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,208.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,208.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,208.94
Rate for Payer: Cigna Commercial	$4,331.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,096.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,905.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.38
Rate for Payer: UnitedHealthcare Community & State	$208.77
Rate for Payer: Wellpoint Medicaid Managed Care	$229.56

HEAD FEMORAL 32MM +0MM

Facility

$4,143.00

Service Code	HCPCS C1776
Hospital Charge Code	270680957
Hospital Revenue Code	278
Min. Negotiated Rate	$621.45
Max. Negotiated Rate	$1,002.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$828.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,002.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$911.46
Rate for Payer: Qualcare PPO/HMO/WC	$621.45

HEAD FEMORAL 32MM +0MM

Facility

$4,143.00

Service Code	HCPCS C1776
Hospital Charge Code	270680957
Hospital Revenue Code	278
Min. Negotiated Rate	$99.85
Max. Negotiated Rate	$2,071.50
Rate for Payer: Aetna Commercial	$1,574.34
Rate for Payer: Aetna Medicare Advantage	$1,242.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,056.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,056.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$828.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,056.46
Rate for Payer: Cigna Commercial	$2,071.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,002.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$911.46
Rate for Payer: Qualcare PPO/HMO/WC	$621.45
Rate for Payer: UnitedHealthcare Community & State	$99.85
Rate for Payer: Wellpoint Medicaid Managed Care	$109.79

Know your out-of-pocket cost for care.

All Charges