Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HEAD FEMORAL COCR 36MM +0

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270670573
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 LFIT 22.2MM +0MM

Facility

$1,948.70

Service Code	HCPCS C1776
Hospital Charge Code	270681296
Hospital Revenue Code	278
Min. Negotiated Rate	$292.31
Max. Negotiated Rate	$471.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$389.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$428.71
Rate for Payer: Qualcare PPO/HMO/WC	$292.31

HEAD FEMORAL LFIT 22.2MM +0MM

Facility

$1,948.70

Service Code	HCPCS C1776
Hospital Charge Code	270681296
Hospital Revenue Code	278
Min. Negotiated Rate	$46.96
Max. Negotiated Rate	$974.35
Rate for Payer: Aetna Commercial	$740.51
Rate for Payer: Aetna Medicare Advantage	$584.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$496.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$496.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$389.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$496.92
Rate for Payer: Cigna Commercial	$974.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$428.71
Rate for Payer: Qualcare PPO/HMO/WC	$292.31
Rate for Payer: UnitedHealthcare Community & State	$46.96
Rate for Payer: Wellpoint Medicaid Managed Care	$51.64

HEAD FEMORAL LFIT 26MM -3MM

Facility

$2,030.70

Service Code	HCPCS C1776
Hospital Charge Code	270671303
Hospital Revenue Code	278
Min. Negotiated Rate	$304.61
Max. Negotiated Rate	$491.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$406.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$491.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$446.75
Rate for Payer: Qualcare PPO/HMO/WC	$304.61

HEAD FEMORAL LFIT 26MM -3MM

Facility

$2,030.70

Service Code	HCPCS C1776
Hospital Charge Code	270671303
Hospital Revenue Code	278
Min. Negotiated Rate	$48.94
Max. Negotiated Rate	$1,015.35
Rate for Payer: Aetna Commercial	$771.67
Rate for Payer: Aetna Medicare Advantage	$609.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$517.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$517.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$406.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$517.83
Rate for Payer: Cigna Commercial	$1,015.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$491.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$446.75
Rate for Payer: Qualcare PPO/HMO/WC	$304.61
Rate for Payer: UnitedHealthcare Community & State	$48.94
Rate for Payer: Wellpoint Medicaid Managed Care	$53.81

HEAD FEMORAL LFIT 26MM +4MM

Facility

$4,277.00

Service Code	HCPCS C1776
Hospital Charge Code	270683500
Hospital Revenue Code	278
Min. Negotiated Rate	$641.55
Max. Negotiated Rate	$1,035.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$940.94
Rate for Payer: Qualcare PPO/HMO/WC	$641.55

HEAD FEMORAL LFIT 26MM +4MM

Facility

$4,277.00

Service Code	HCPCS C1776
Hospital Charge Code	270683500
Hospital Revenue Code	278
Min. Negotiated Rate	$103.08
Max. Negotiated Rate	$2,138.50
Rate for Payer: Aetna Commercial	$1,625.26
Rate for Payer: Aetna Medicare Advantage	$1,283.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,090.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,090.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,090.63
Rate for Payer: Cigna Commercial	$2,138.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$940.94
Rate for Payer: Qualcare PPO/HMO/WC	$641.55
Rate for Payer: UnitedHealthcare Community & State	$103.08
Rate for Payer: Wellpoint Medicaid Managed Care	$113.34

HEAD FEMORAL LFIT 32MM +4MM

Facility

$4,033.25

Service Code	HCPCS C1776
Hospital Charge Code	270680445
Hospital Revenue Code	278
Min. Negotiated Rate	$604.99
Max. Negotiated Rate	$976.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$806.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$976.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$887.32
Rate for Payer: Qualcare PPO/HMO/WC	$604.99

HEAD FEMORAL LFIT 32MM +4MM

Facility

$4,033.25

Service Code	HCPCS C1776
Hospital Charge Code	270680445
Hospital Revenue Code	278
Min. Negotiated Rate	$97.20
Max. Negotiated Rate	$2,016.62
Rate for Payer: Aetna Commercial	$1,532.63
Rate for Payer: Aetna Medicare Advantage	$1,209.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$806.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.48
Rate for Payer: Cigna Commercial	$2,016.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$976.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$887.32
Rate for Payer: Qualcare PPO/HMO/WC	$604.99
Rate for Payer: UnitedHealthcare Community & State	$97.20
Rate for Payer: Wellpoint Medicaid Managed Care	$106.88

HEAD FEMORAL LFIT 36MM +0MM

Facility

$11,753.70

Service Code	HCPCS C1776
Hospital Charge Code	270677351
Hospital Revenue Code	278
Min. Negotiated Rate	$283.26
Max. Negotiated Rate	$5,876.85
Rate for Payer: Aetna Commercial	$4,466.41
Rate for Payer: Aetna Medicare Advantage	$3,526.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,997.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,997.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,997.19
Rate for Payer: Cigna Commercial	$5,876.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,844.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,585.81
Rate for Payer: Qualcare PPO/HMO/WC	$1,763.06
Rate for Payer: UnitedHealthcare Community & State	$283.26
Rate for Payer: Wellpoint Medicaid Managed Care	$311.47

HEAD FEMORAL LFIT 36MM +0MM

Facility

$11,753.70

Service Code	HCPCS C1776
Hospital Charge Code	270677351
Hospital Revenue Code	278
Min. Negotiated Rate	$1,763.06
Max. Negotiated Rate	$2,844.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,844.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,585.81
Rate for Payer: Qualcare PPO/HMO/WC	$1,763.06

HEAD FEMORAL SZ 0 28MM XXL

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680970
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 SZ 0 28MM XXL

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680970
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 SZ 26MM +0

Facility

$2,786.40

Service Code	HCPCS C1776
Hospital Charge Code	270673479
Hospital Revenue Code	278
Min. Negotiated Rate	$67.15
Max. Negotiated Rate	$1,393.20
Rate for Payer: Aetna Commercial	$1,058.83
Rate for Payer: Aetna Medicare Advantage	$835.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$710.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$710.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$557.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$710.53
Rate for Payer: Cigna Commercial	$1,393.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$674.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$613.01
Rate for Payer: Qualcare PPO/HMO/WC	$417.96
Rate for Payer: UnitedHealthcare Community & State	$67.15
Rate for Payer: Wellpoint Medicaid Managed Care	$73.84

HEAD FEMORAL SZ 26MM +0

Facility

$2,786.40

Service Code	HCPCS C1776
Hospital Charge Code	270673479
Hospital Revenue Code	278
Min. Negotiated Rate	$417.96
Max. Negotiated Rate	$674.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$557.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$674.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$613.01
Rate for Payer: Qualcare PPO/HMO/WC	$417.96

HEAD FEMORAL SZ 28MM +10MM

Facility

$2,171.75

Service Code	HCPCS C1776
Hospital Charge Code	270676939
Hospital Revenue Code	278
Min. Negotiated Rate	$325.76
Max. Negotiated Rate	$525.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$434.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$525.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$477.79
Rate for Payer: Qualcare PPO/HMO/WC	$325.76

HEAD FEMORAL SZ 28MM +10MM

Facility

$2,171.75

Service Code	HCPCS C1776
Hospital Charge Code	270676939
Hospital Revenue Code	278
Min. Negotiated Rate	$52.34
Max. Negotiated Rate	$1,085.88
Rate for Payer: Aetna Commercial	$825.26
Rate for Payer: Aetna Medicare Advantage	$651.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$553.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$553.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$434.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$553.80
Rate for Payer: Cigna Commercial	$1,085.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$525.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$477.79
Rate for Payer: Qualcare PPO/HMO/WC	$325.76
Rate for Payer: UnitedHealthcare Community & State	$52.34
Rate for Payer: Wellpoint Medicaid Managed Care	$57.55

HEAD FEMORAL SZ M 22.2MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677710
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 SZ M 22.2MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677710
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 SZ M 28MM

Facility

$2,500.00

Hospital Charge Code	270677709
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 FEMORAL SZ M 28MM

Facility

$2,500.00

Hospital Charge Code	270677709
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 FEMORAL TAPER 32MM

Facility

$15,640.00

Service Code	HCPCS C1776
Hospital Charge Code	270696295
Hospital Revenue Code	278
Min. Negotiated Rate	$376.92
Max. Negotiated Rate	$7,820.00
Rate for Payer: Aetna Commercial	$5,943.20
Rate for Payer: Aetna Medicare Advantage	$4,692.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,988.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,988.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,128.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,988.20
Rate for Payer: Cigna Commercial	$7,820.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,784.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,440.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,346.00
Rate for Payer: UnitedHealthcare Community & State	$376.92
Rate for Payer: Wellpoint Medicaid Managed Care	$414.46

HEAD FEMORAL TAPER 32MM

Facility

$15,640.00

Service Code	HCPCS C1776
Hospital Charge Code	270696295
Hospital Revenue Code	278
Min. Negotiated Rate	$2,346.00
Max. Negotiated Rate	$3,784.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,128.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,784.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,440.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,346.00

HEAD FEMORAL V40 28mm +8mm

Facility

$2,132.95

Service Code	HCPCS C1776
Hospital Charge Code	270685585
Hospital Revenue Code	278
Min. Negotiated Rate	$51.40
Max. Negotiated Rate	$1,066.47
Rate for Payer: Aetna Commercial	$810.52
Rate for Payer: Aetna Medicare Advantage	$639.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$543.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$543.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$426.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$543.90
Rate for Payer: Cigna Commercial	$1,066.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$516.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$469.25
Rate for Payer: Qualcare PPO/HMO/WC	$319.94
Rate for Payer: UnitedHealthcare Community & State	$51.40
Rate for Payer: Wellpoint Medicaid Managed Care	$56.52

HEAD FEMORAL V40 28mm +8mm

Facility

$2,132.95

Service Code	HCPCS C1776
Hospital Charge Code	270685585
Hospital Revenue Code	278
Min. Negotiated Rate	$319.94
Max. Negotiated Rate	$516.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$426.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$516.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$469.25
Rate for Payer: Qualcare PPO/HMO/WC	$319.94

Know your out-of-pocket cost for care.

All Charges