Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HEAD FEMORAL 32mmDIA +3mm NECK

Facility

$4,065.00

Hospital Charge Code	270642681
Hospital Revenue Code	278
Min. Negotiated Rate	$609.75
Max. Negotiated Rate	$983.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$813.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$983.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$894.30
Rate for Payer: Qualcare PPO/HMO/WC	$609.75

HEAD FEMORAL 32mmDIA +3mm NECK

Facility

$4,065.00

Hospital Charge Code	270642681
Hospital Revenue Code	278
Min. Negotiated Rate	$97.97
Max. Negotiated Rate	$2,032.50
Rate for Payer: Aetna Commercial	$1,544.70
Rate for Payer: Aetna Medicare Advantage	$1,219.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,036.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,036.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$813.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,036.58
Rate for Payer: Cigna Commercial	$2,032.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$983.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$894.30
Rate for Payer: Qualcare PPO/HMO/WC	$609.75
Rate for Payer: UnitedHealthcare Community & State	$97.97
Rate for Payer: Wellpoint Medicaid Managed Care	$107.72

HEAD FEMORAL 36-50mm

Facility

$9,044.75

Service Code	HCPCS C1776
Hospital Charge Code	270678864
Hospital Revenue Code	278
Min. Negotiated Rate	$1,356.71
Max. Negotiated Rate	$2,188.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,808.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,188.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,989.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,356.71

HEAD FEMORAL 36-50mm

Facility

$9,044.75

Service Code	HCPCS C1776
Hospital Charge Code	270678864
Hospital Revenue Code	278
Min. Negotiated Rate	$217.98
Max. Negotiated Rate	$4,522.38
Rate for Payer: Aetna Commercial	$3,437.01
Rate for Payer: Aetna Medicare Advantage	$2,713.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,306.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,306.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,808.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,306.41
Rate for Payer: Cigna Commercial	$4,522.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,188.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,989.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,356.71
Rate for Payer: UnitedHealthcare Community & State	$217.98
Rate for Payer: Wellpoint Medicaid Managed Care	$239.69

HEAD FEMORAL 36MM

Facility

$8,498.00

Service Code	HCPCS C1776
Hospital Charge Code	270678672
Hospital Revenue Code	278
Min. Negotiated Rate	$204.80
Max. Negotiated Rate	$4,249.00
Rate for Payer: Aetna Commercial	$3,229.24
Rate for Payer: Aetna Medicare Advantage	$2,549.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,166.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,166.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,699.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,166.99
Rate for Payer: Cigna Commercial	$4,249.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,056.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,869.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,274.70
Rate for Payer: UnitedHealthcare Community & State	$204.80
Rate for Payer: Wellpoint Medicaid Managed Care	$225.20

HEAD FEMORAL 36MM

Facility

$4,250.00

Hospital Charge Code	270703305
Hospital Revenue Code	278
Min. Negotiated Rate	$102.42
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,615.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50
Rate for Payer: UnitedHealthcare Community & State	$102.42
Rate for Payer: Wellpoint Medicaid Managed Care	$112.62

HEAD FEMORAL 36MM

Facility

$8,498.00

Service Code	HCPCS C1776
Hospital Charge Code	270678672
Hospital Revenue Code	278
Min. Negotiated Rate	$1,274.70
Max. Negotiated Rate	$2,056.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,699.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,056.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,869.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,274.70

HEAD FEMORAL 36MM

Facility

$4,250.00

Hospital Charge Code	270703305
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

HEAD FEMORAL 36MM +0MM

Facility

$4,087.15

Service Code	HCPCS C1776
Hospital Charge Code	270679973
Hospital Revenue Code	278
Min. Negotiated Rate	$613.07
Max. Negotiated Rate	$989.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$817.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$989.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$899.17
Rate for Payer: Qualcare PPO/HMO/WC	$613.07

HEAD FEMORAL 36MM +0MM

Facility

$4,087.15

Service Code	HCPCS C1776
Hospital Charge Code	270679973
Hospital Revenue Code	278
Min. Negotiated Rate	$98.50
Max. Negotiated Rate	$2,043.58
Rate for Payer: Aetna Commercial	$1,553.12
Rate for Payer: Aetna Medicare Advantage	$1,226.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,042.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,042.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$817.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,042.22
Rate for Payer: Cigna Commercial	$2,043.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$989.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$899.17
Rate for Payer: Qualcare PPO/HMO/WC	$613.07
Rate for Payer: UnitedHealthcare Community & State	$98.50
Rate for Payer: Wellpoint Medicaid Managed Care	$108.31

HEAD FEMORAL 36MM -2.5MM

Facility

$4,728.50

Service Code	HCPCS C1776
Hospital Charge Code	270676583
Hospital Revenue Code	278
Min. Negotiated Rate	$709.27
Max. Negotiated Rate	$1,144.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$945.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,144.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,040.27
Rate for Payer: Qualcare PPO/HMO/WC	$709.27

HEAD FEMORAL 36MM -2.5MM

Facility

$4,728.50

Service Code	HCPCS C1776
Hospital Charge Code	270676583
Hospital Revenue Code	278
Min. Negotiated Rate	$113.96
Max. Negotiated Rate	$2,364.25
Rate for Payer: Aetna Commercial	$1,796.83
Rate for Payer: Aetna Medicare Advantage	$1,418.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,205.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,205.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$945.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,205.77
Rate for Payer: Cigna Commercial	$2,364.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,144.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,040.27
Rate for Payer: Qualcare PPO/HMO/WC	$709.27
Rate for Payer: UnitedHealthcare Community & State	$113.96
Rate for Payer: Wellpoint Medicaid Managed Care	$125.31

HEAD FEMORAL 36MM +5MM

Facility

$4,182.30

Service Code	HCPCS C1776
Hospital Charge Code	270677486
Hospital Revenue Code	278
Min. Negotiated Rate	$627.35
Max. Negotiated Rate	$1,012.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$836.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,012.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$920.11
Rate for Payer: Qualcare PPO/HMO/WC	$627.35

HEAD FEMORAL 36MM +5MM

Facility

$4,182.30

Service Code	HCPCS C1776
Hospital Charge Code	270677486
Hospital Revenue Code	278
Min. Negotiated Rate	$100.79
Max. Negotiated Rate	$2,091.15
Rate for Payer: Aetna Commercial	$1,589.27
Rate for Payer: Aetna Medicare Advantage	$1,254.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,066.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,066.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$836.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,066.49
Rate for Payer: Cigna Commercial	$2,091.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,012.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$920.11
Rate for Payer: Qualcare PPO/HMO/WC	$627.35
Rate for Payer: UnitedHealthcare Community & State	$100.79
Rate for Payer: Wellpoint Medicaid Managed Care	$110.83

HEAD FEMORAL 3x28MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677118
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

HEAD FEMORAL 3x28MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677118
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

HEAD FEMORAL 8018-28-14

Facility

$3,239.60

Hospital Charge Code	270638803
Hospital Revenue Code	278
Min. Negotiated Rate	$78.07
Max. Negotiated Rate	$1,619.80
Rate for Payer: Aetna Commercial	$1,231.05
Rate for Payer: Aetna Medicare Advantage	$971.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$826.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$826.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$647.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$826.10
Rate for Payer: Cigna Commercial	$1,619.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$783.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$712.71
Rate for Payer: Qualcare PPO/HMO/WC	$485.94
Rate for Payer: UnitedHealthcare Community & State	$78.07
Rate for Payer: Wellpoint Medicaid Managed Care	$85.85

HEAD FEMORAL 8018-28-14

Facility

$3,239.60

Hospital Charge Code	270638803
Hospital Revenue Code	278
Min. Negotiated Rate	$485.94
Max. Negotiated Rate	$783.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$647.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$783.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$712.71
Rate for Payer: Qualcare PPO/HMO/WC	$485.94

HEAD FEMORAL ALLOGRAFT 77-0038

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270627380
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

HEAD FEMORAL ALLOGRAFT 77-0038

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270627380
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

HEAD FEMORAL CERAM BIOLOX 36MM

Facility

$10,220.00

Service Code	HCPCS C1776
Hospital Charge Code	270692213
Hospital Revenue Code	278
Min. Negotiated Rate	$246.30
Max. Negotiated Rate	$5,110.00
Rate for Payer: Aetna Commercial	$3,883.60
Rate for Payer: Aetna Medicare Advantage	$3,066.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,606.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,606.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,044.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,606.10
Rate for Payer: Cigna Commercial	$5,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,473.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,248.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.00
Rate for Payer: UnitedHealthcare Community & State	$246.30
Rate for Payer: Wellpoint Medicaid Managed Care	$270.83

HEAD FEMORAL CERAM BIOLOX 36MM

Facility

$10,220.00

Service Code	HCPCS C1776
Hospital Charge Code	270692213
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.00
Max. Negotiated Rate	$2,473.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,044.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,473.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,248.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,533.00

HEAD FEMORAL COCR 32MM +0 12/1

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270679647
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

HEAD FEMORAL COCR 32MM +0 12/1

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270679647
Hospital Revenue Code	278
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

HEAD FEMORAL COCR 36MM +0

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270670573
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

Know your out-of-pocket cost for care.

All Charges