Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LINER ACETABULAR ALTEX 10 DEG

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270689570
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

LINER ACETABULAR ALTEX 10 DEG

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270689570
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

LINER ACETABULAR RINGLOC

Facility

$9,265.00

Service Code	HCPCS C1776
Hospital Charge Code	270659192
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 RINGLOC

Facility

$9,265.00

Service Code	HCPCS C1776
Hospital Charge Code	270659192
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 ACETB G7 VITE HWAL 32MM

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698333
Hospital Revenue Code	278
Min. Negotiated Rate	$289.20
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

LINER ACETB G7 VITE HWAL 32MM

Facility

$12,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698333
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

LINER ACETBULAR 36 MM

Facility

$6,000.00

Hospital Charge Code	270703304
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 ACETBULAR 36 MM

Facility

$6,000.00

Hospital Charge Code	270703304
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 ACETEBULAR SIZE 25 36mm

Facility

$5,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270639963
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 ACETEBULAR SIZE 25 36mm

Facility

$5,765.00

Service Code	HCPCS C1776
Hospital Charge Code	270639963
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

LINERACETTRIDENTTRX3PE0D40MM

Facility

$4,434.25

Service Code	HCPCS C1776
Hospital Charge Code	270697850
Hospital Revenue Code	278
Min. Negotiated Rate	$665.14
Max. Negotiated Rate	$1,073.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$886.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,073.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$975.53
Rate for Payer: Qualcare PPO/HMO/WC	$665.14

LINERACETTRIDENTTRX3PE0D40MM

Facility

$4,434.25

Service Code	HCPCS C1776
Hospital Charge Code	270697850
Hospital Revenue Code	278
Min. Negotiated Rate	$106.87
Max. Negotiated Rate	$2,217.12
Rate for Payer: Aetna Commercial	$1,685.02
Rate for Payer: Aetna Medicare Advantage	$1,330.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,130.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,130.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$886.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,130.73
Rate for Payer: Cigna Commercial	$2,217.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,073.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$975.53
Rate for Payer: Qualcare PPO/HMO/WC	$665.14
Rate for Payer: UnitedHealthcare Community & State	$106.87
Rate for Payer: Wellpoint Medicaid Managed Care	$117.51

LINER ACTBLR 36 SZ23 EP-108323

Facility

$9,265.00

Hospital Charge Code	270658421
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 ACTBLR 36 SZ23 EP-108323

Facility

$9,265.00

Hospital Charge Code	270658421
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 ARCOM 32mm RING LOC

Facility

$4,330.00

Hospital Charge Code	270638891
Hospital Revenue Code	278
Min. Negotiated Rate	$104.35
Max. Negotiated Rate	$2,165.00
Rate for Payer: Aetna Commercial	$1,645.40
Rate for Payer: Aetna Medicare Advantage	$1,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,104.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,104.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$866.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,104.15
Rate for Payer: Cigna Commercial	$2,165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,047.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$952.60
Rate for Payer: Qualcare PPO/HMO/WC	$649.50
Rate for Payer: UnitedHealthcare Community & State	$104.35
Rate for Payer: Wellpoint Medicaid Managed Care	$114.75

LINER ARCOM 32mm RING LOC

Facility

$4,330.00

Hospital Charge Code	270638891
Hospital Revenue Code	278
Min. Negotiated Rate	$649.50
Max. Negotiated Rate	$1,047.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$866.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,047.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$952.60
Rate for Payer: Qualcare PPO/HMO/WC	$649.50

LINER ARCOM XL 24mm RINGLOC

Facility

$5,728.85

Hospital Charge Code	270636664
Hospital Revenue Code	278
Min. Negotiated Rate	$138.07
Max. Negotiated Rate	$2,864.43
Rate for Payer: Aetna Commercial	$2,176.96
Rate for Payer: Aetna Medicare Advantage	$1,718.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,460.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,460.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,145.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,460.86
Rate for Payer: Cigna Commercial	$2,864.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,386.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,260.35
Rate for Payer: Qualcare PPO/HMO/WC	$859.33
Rate for Payer: UnitedHealthcare Community & State	$138.07
Rate for Payer: Wellpoint Medicaid Managed Care	$151.81

LINER ARCOM XL 24mm RINGLOC

Facility

$5,728.85

Hospital Charge Code	270636664
Hospital Revenue Code	278
Min. Negotiated Rate	$859.33
Max. Negotiated Rate	$1,386.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,145.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,386.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,260.35
Rate for Payer: Qualcare PPO/HMO/WC	$859.33

LINER ARCOM XL 28mm RINGLOC

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270634778
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

LINER ARCOM XL 28mm RINGLOC

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270634778
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

LINER ARC XL36mm RING XL105914

Facility

$5,775.00

Hospital Charge Code	270637576
Hospital Revenue Code	278
Min. Negotiated Rate	$139.18
Max. Negotiated Rate	$2,887.50
Rate for Payer: Aetna Commercial	$2,194.50
Rate for Payer: Aetna Medicare Advantage	$1,732.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,472.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,472.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,472.62
Rate for Payer: Cigna Commercial	$2,887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,397.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$866.25
Rate for Payer: UnitedHealthcare Community & State	$139.18
Rate for Payer: Wellpoint Medicaid Managed Care	$153.04

LINER ARC XL36mm RING XL105914

Facility

$5,775.00

Hospital Charge Code	270637576
Hospital Revenue Code	278
Min. Negotiated Rate	$866.25
Max. Negotiated Rate	$1,397.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,397.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$866.25

LINER ASF 16MM VE RIGHT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689751
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 ASF 16MM VE RIGHT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689751
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 ASSY 40/41x22ID 50014022

Facility

$1,528.50

Hospital Charge Code	270633291
Hospital Revenue Code	278
Min. Negotiated Rate	$229.28
Max. Negotiated Rate	$369.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$336.27
Rate for Payer: Qualcare PPO/HMO/WC	$229.28

Know your out-of-pocket cost for care.

All Charges