Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LINER 42MM DUAL MOBILITY

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690602
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

LINER 67/63MM X 18 MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688247
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

LINER 67/63MM X 18 MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688247
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

LINER ACET 36MM

Facility

$7,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270692211
Hospital Revenue Code	278
Min. Negotiated Rate	$189.79
Max. Negotiated Rate	$3,937.50
Rate for Payer: Aetna Commercial	$2,992.50
Rate for Payer: Aetna Medicare Advantage	$2,362.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,008.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,008.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,008.12
Rate for Payer: Cigna Commercial	$3,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,732.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.25
Rate for Payer: UnitedHealthcare Community & State	$189.79
Rate for Payer: Wellpoint Medicaid Managed Care	$208.69

LINER ACET 36MM

Facility

$7,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270692211
Hospital Revenue Code	278
Min. Negotiated Rate	$1,181.25
Max. Negotiated Rate	$1,905.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,732.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.25

LINER ACETAB 40SZ 25 EP108525

Facility

$9,265.00

Hospital Charge Code	270644875
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.75
Max. Negotiated Rate	$2,242.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,038.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75

LINER ACETAB 40SZ 25 EP108525

Facility

$9,265.00

Hospital Charge Code	270644875
Hospital Revenue Code	278
Min. Negotiated Rate	$223.29
Max. Negotiated Rate	$4,632.50
Rate for Payer: Aetna Commercial	$3,520.70
Rate for Payer: Aetna Medicare Advantage	$2,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,362.57
Rate for Payer: Cigna Commercial	$4,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,038.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75
Rate for Payer: UnitedHealthcare Community & State	$223.29
Rate for Payer: Wellpoint Medicaid Managed Care	$245.52

LINER ACETABLR 40 RLC EP108524

Facility

$9,265.00

Hospital Charge Code	270644635
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.75
Max. Negotiated Rate	$2,242.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,038.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75

LINER ACETABLR 40 RLC EP108524

Facility

$9,265.00

Hospital Charge Code	270644635
Hospital Revenue Code	278
Min. Negotiated Rate	$223.29
Max. Negotiated Rate	$4,632.50
Rate for Payer: Aetna Commercial	$3,520.70
Rate for Payer: Aetna Medicare Advantage	$2,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,362.57
Rate for Payer: Cigna Commercial	$4,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,038.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75
Rate for Payer: UnitedHealthcare Community & State	$223.29
Rate for Payer: Wellpoint Medicaid Managed Care	$245.52

LINER ACETABULAR 15DEG. SZ G 3

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270679648
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

LINER ACETABULAR 15DEG. SZ G 3

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270679648
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

LINER ACETABULAR 22 32mm

Facility

$9,265.00

Hospital Charge Code	270644359
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.75
Max. Negotiated Rate	$2,242.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,038.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75

LINER ACETABULAR 22 32mm

Facility

$9,265.00

Hospital Charge Code	270644359
Hospital Revenue Code	278
Min. Negotiated Rate	$223.29
Max. Negotiated Rate	$4,632.50
Rate for Payer: Aetna Commercial	$3,520.70
Rate for Payer: Aetna Medicare Advantage	$2,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,362.57
Rate for Payer: Cigna Commercial	$4,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,038.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75
Rate for Payer: UnitedHealthcare Community & State	$223.29
Rate for Payer: Wellpoint Medicaid Managed Care	$245.52

LINER ACETABULAR 28 MM SIZE 22

Facility

$5,765.00

Hospital Charge Code	270667967
Hospital Revenue Code	278
Min. Negotiated Rate	$138.94
Max. Negotiated Rate	$2,882.50
Rate for Payer: Aetna Commercial	$2,190.70
Rate for Payer: Aetna Medicare Advantage	$1,729.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,470.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,470.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,470.08
Rate for Payer: Cigna Commercial	$2,882.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,395.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,268.30
Rate for Payer: Qualcare PPO/HMO/WC	$864.75
Rate for Payer: UnitedHealthcare Community & State	$138.94
Rate for Payer: Wellpoint Medicaid Managed Care	$152.77

LINER ACETABULAR 28 MM SIZE 22

Facility

$5,765.00

Hospital Charge Code	270667967
Hospital Revenue Code	278
Min. Negotiated Rate	$864.75
Max. Negotiated Rate	$1,395.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,153.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,395.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,268.30
Rate for Payer: Qualcare PPO/HMO/WC	$864.75

LINER ACETABULAR 36MM

Facility

$9,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270679048
Hospital Revenue Code	278
Min. Negotiated Rate	$1,443.75
Max. Negotiated Rate	$2,329.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,329.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,443.75

LINER ACETABULAR 36MM

Facility

$9,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270679048
Hospital Revenue Code	278
Min. Negotiated Rate	$231.96
Max. Negotiated Rate	$4,812.50
Rate for Payer: Aetna Commercial	$3,657.50
Rate for Payer: Aetna Medicare Advantage	$2,887.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,454.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,454.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,454.38
Rate for Payer: Cigna Commercial	$4,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,329.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,443.75
Rate for Payer: UnitedHealthcare Community & State	$231.96
Rate for Payer: Wellpoint Medicaid Managed Care	$255.06

LINER ACETABULAR 36mm SIZE 24

Facility

$9,265.00

Hospital Charge Code	270645774
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.75
Max. Negotiated Rate	$2,242.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,038.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75

LINER ACETABULAR 36mm SIZE 24

Facility

$9,265.00

Hospital Charge Code	270645774
Hospital Revenue Code	278
Min. Negotiated Rate	$223.29
Max. Negotiated Rate	$4,632.50
Rate for Payer: Aetna Commercial	$3,520.70
Rate for Payer: Aetna Medicare Advantage	$2,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,362.57
Rate for Payer: Cigna Commercial	$4,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,038.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75
Rate for Payer: UnitedHealthcare Community & State	$223.29
Rate for Payer: Wellpoint Medicaid Managed Care	$245.52

LINER ACETABULAR 36MM SZ 25

Facility

$9,265.00

Service Code	HCPCS C1776
Hospital Charge Code	270666901
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.75
Max. Negotiated Rate	$2,242.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,038.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75

LINER ACETABULAR 36MM SZ 25

Facility

$9,265.00

Service Code	HCPCS C1776
Hospital Charge Code	270666901
Hospital Revenue Code	278
Min. Negotiated Rate	$223.29
Max. Negotiated Rate	$4,632.50
Rate for Payer: Aetna Commercial	$3,520.70
Rate for Payer: Aetna Medicare Advantage	$2,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,362.57
Rate for Payer: Cigna Commercial	$4,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,038.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75
Rate for Payer: UnitedHealthcare Community & State	$223.29
Rate for Payer: Wellpoint Medicaid Managed Care	$245.52

LINER ACETABULAR 40MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688349
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

LINER ACETABULAR 40MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688349
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

LINER ACETABULAR 44MM SZ F

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677542
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

LINER ACETABULAR 44MM SZ F

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677542
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

Know your out-of-pocket cost for care.

All Charges