Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LINER ASSY 40/41x22ID 50014022

Facility

$1,528.50

Hospital Charge Code	270633291
Hospital Revenue Code	278
Min. Negotiated Rate	$36.84
Max. Negotiated Rate	$764.25
Rate for Payer: Aetna Commercial	$580.83
Rate for Payer: Aetna Medicare Advantage	$458.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$389.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$389.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$389.77
Rate for Payer: Cigna Commercial	$764.25
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
Rate for Payer: UnitedHealthcare Community & State	$36.84
Rate for Payer: Wellpoint Medicaid Managed Care	$40.51

LINER ASSY 42/43x22 50014222

Facility

$1,400.00

Hospital Charge Code	270633232
Hospital Revenue Code	278
Min. Negotiated Rate	$33.74
Max. Negotiated Rate	$700.00
Rate for Payer: Aetna Commercial	$532.00
Rate for Payer: Aetna Medicare Advantage	$420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$357.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$357.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$357.00
Rate for Payer: Cigna Commercial	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$338.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$308.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.00
Rate for Payer: UnitedHealthcare Community & State	$33.74
Rate for Payer: Wellpoint Medicaid Managed Care	$37.10

LINER ASSY 42/43x22 50014222

Facility

$1,400.00

Hospital Charge Code	270633232
Hospital Revenue Code	278
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$338.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$338.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$308.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.00

LINER BMT ACET 22 28 11-105902

Facility

$4,881.65

Hospital Charge Code	270615805
Hospital Revenue Code	278
Min. Negotiated Rate	$732.25
Max. Negotiated Rate	$1,181.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$976.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,181.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,073.96
Rate for Payer: Qualcare PPO/HMO/WC	$732.25

LINER BMT ACET 22 28 11-105902

Facility

$4,881.65

Hospital Charge Code	270615805
Hospital Revenue Code	278
Min. Negotiated Rate	$117.65
Max. Negotiated Rate	$2,440.82
Rate for Payer: Aetna Commercial	$1,855.03
Rate for Payer: Aetna Medicare Advantage	$1,464.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,244.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,244.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$976.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,244.82
Rate for Payer: Cigna Commercial	$2,440.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,181.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,073.96
Rate for Payer: Qualcare PPO/HMO/WC	$732.25
Rate for Payer: UnitedHealthcare Community & State	$117.65
Rate for Payer: Wellpoint Medicaid Managed Care	$129.36

LINER BMT ACET 23 11-105903

Facility

$4,520.85

Hospital Charge Code	270606919
Hospital Revenue Code	278
Min. Negotiated Rate	$678.13
Max. Negotiated Rate	$1,094.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$904.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,094.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$994.59
Rate for Payer: Qualcare PPO/HMO/WC	$678.13

LINER BMT ACET 23 11-105903

Facility

$4,520.85

Hospital Charge Code	270606919
Hospital Revenue Code	278
Min. Negotiated Rate	$108.95
Max. Negotiated Rate	$2,260.43
Rate for Payer: Aetna Commercial	$1,717.92
Rate for Payer: Aetna Medicare Advantage	$1,356.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,152.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,152.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$904.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,152.82
Rate for Payer: Cigna Commercial	$2,260.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,094.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$994.59
Rate for Payer: Qualcare PPO/HMO/WC	$678.13
Rate for Payer: UnitedHealthcare Community & State	$108.95
Rate for Payer: Wellpoint Medicaid Managed Care	$119.80

LINER BMT ACET 24 11-105904

Facility

$4,881.65

Hospital Charge Code	270607003
Hospital Revenue Code	278
Min. Negotiated Rate	$117.65
Max. Negotiated Rate	$2,440.82
Rate for Payer: Aetna Commercial	$1,855.03
Rate for Payer: Aetna Medicare Advantage	$1,464.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,244.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,244.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$976.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,244.82
Rate for Payer: Cigna Commercial	$2,440.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,181.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,073.96
Rate for Payer: Qualcare PPO/HMO/WC	$732.25
Rate for Payer: UnitedHealthcare Community & State	$117.65
Rate for Payer: Wellpoint Medicaid Managed Care	$129.36

LINER BMT ACET 24 11-105904

Facility

$4,881.65

Hospital Charge Code	270607003
Hospital Revenue Code	278
Min. Negotiated Rate	$732.25
Max. Negotiated Rate	$1,181.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$976.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,181.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,073.96
Rate for Payer: Qualcare PPO/HMO/WC	$732.25

LINER BMT ACET 25 11-105905

Facility

$4,520.85

Hospital Charge Code	270612163
Hospital Revenue Code	278
Min. Negotiated Rate	$108.95
Max. Negotiated Rate	$2,260.43
Rate for Payer: Aetna Commercial	$1,717.92
Rate for Payer: Aetna Medicare Advantage	$1,356.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,152.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,152.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$904.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,152.82
Rate for Payer: Cigna Commercial	$2,260.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,094.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$994.59
Rate for Payer: Qualcare PPO/HMO/WC	$678.13
Rate for Payer: UnitedHealthcare Community & State	$108.95
Rate for Payer: Wellpoint Medicaid Managed Care	$119.80

LINER BMT ACET 25 11-105905

Facility

$4,520.85

Hospital Charge Code	270612163
Hospital Revenue Code	278
Min. Negotiated Rate	$678.13
Max. Negotiated Rate	$1,094.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$904.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,094.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$994.59
Rate for Payer: Qualcare PPO/HMO/WC	$678.13

LINER BMT ACET 26 11-105906

Facility

$4,428.85

Hospital Charge Code	270609082
Hospital Revenue Code	278
Min. Negotiated Rate	$106.74
Max. Negotiated Rate	$2,214.43
Rate for Payer: Aetna Commercial	$1,682.96
Rate for Payer: Aetna Medicare Advantage	$1,328.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,129.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,129.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$885.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,129.36
Rate for Payer: Cigna Commercial	$2,214.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,071.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$974.35
Rate for Payer: Qualcare PPO/HMO/WC	$664.33
Rate for Payer: UnitedHealthcare Community & State	$106.74
Rate for Payer: Wellpoint Medicaid Managed Care	$117.36

LINER BMT ACET 26 11-105906

Facility

$4,428.85

Hospital Charge Code	270609082
Hospital Revenue Code	278
Min. Negotiated Rate	$664.33
Max. Negotiated Rate	$1,071.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$885.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,071.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$974.35
Rate for Payer: Qualcare PPO/HMO/WC	$664.33

LINER BMT MZA 28 37 15-105000

Facility

$3,916.00

Hospital Charge Code	270622514
Hospital Revenue Code	278
Min. Negotiated Rate	$587.40
Max. Negotiated Rate	$947.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$783.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$947.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$861.52
Rate for Payer: Qualcare PPO/HMO/WC	$587.40

LINER BMT MZA 28 37 15-105000

Facility

$3,916.00

Hospital Charge Code	270622514
Hospital Revenue Code	278
Min. Negotiated Rate	$94.38
Max. Negotiated Rate	$1,958.00
Rate for Payer: Aetna Commercial	$1,488.08
Rate for Payer: Aetna Medicare Advantage	$1,174.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$998.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$998.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$783.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$998.58
Rate for Payer: Cigna Commercial	$1,958.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$947.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$861.52
Rate for Payer: Qualcare PPO/HMO/WC	$587.40
Rate for Payer: UnitedHealthcare Community & State	$94.38
Rate for Payer: Wellpoint Medicaid Managed Care	$103.77

LINER CEMENTLESS MDM 36MM C

Facility

$5,667.00

Service Code	HCPCS C1776
Hospital Charge Code	270682912
Hospital Revenue Code	278
Min. Negotiated Rate	$136.57
Max. Negotiated Rate	$2,833.50
Rate for Payer: Aetna Commercial	$2,153.46
Rate for Payer: Aetna Medicare Advantage	$1,700.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,445.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,445.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,133.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,445.09
Rate for Payer: Cigna Commercial	$2,833.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,371.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,246.74
Rate for Payer: Qualcare PPO/HMO/WC	$850.05
Rate for Payer: UnitedHealthcare Community & State	$136.57
Rate for Payer: Wellpoint Medicaid Managed Care	$150.18

LINER CEMENTLESS MDM 36MM C

Facility

$5,667.00

Service Code	HCPCS C1776
Hospital Charge Code	270682912
Hospital Revenue Code	278
Min. Negotiated Rate	$850.05
Max. Negotiated Rate	$1,371.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,133.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,371.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,246.74
Rate for Payer: Qualcare PPO/HMO/WC	$850.05

LINER CEMENTLESS MDM 38MM D

Facility

$5,667.00

Service Code	HCPCS C1776
Hospital Charge Code	270681298
Hospital Revenue Code	278
Min. Negotiated Rate	$850.05
Max. Negotiated Rate	$1,371.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,133.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,371.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,246.74
Rate for Payer: Qualcare PPO/HMO/WC	$850.05

LINER CEMENTLESS MDM 38MM D

Facility

$5,667.00

Service Code	HCPCS C1776
Hospital Charge Code	270681298
Hospital Revenue Code	278
Min. Negotiated Rate	$136.57
Max. Negotiated Rate	$2,833.50
Rate for Payer: Aetna Commercial	$2,153.46
Rate for Payer: Aetna Medicare Advantage	$1,700.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,445.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,445.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,133.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,445.09
Rate for Payer: Cigna Commercial	$2,833.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,371.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,246.74
Rate for Payer: Qualcare PPO/HMO/WC	$850.05
Rate for Payer: UnitedHealthcare Community & State	$136.57
Rate for Payer: Wellpoint Medicaid Managed Care	$150.18

LINER CEMENTLESS MDM 38MM D

Facility

$5,147.65

Service Code	HCPCS C1776
Hospital Charge Code	270681378
Hospital Revenue Code	278
Min. Negotiated Rate	$124.06
Max. Negotiated Rate	$2,573.82
Rate for Payer: Aetna Commercial	$1,956.11
Rate for Payer: Aetna Medicare Advantage	$1,544.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,312.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,312.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,029.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,312.65
Rate for Payer: Cigna Commercial	$2,573.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,245.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,132.48
Rate for Payer: Qualcare PPO/HMO/WC	$772.15
Rate for Payer: UnitedHealthcare Community & State	$124.06
Rate for Payer: Wellpoint Medicaid Managed Care	$136.41

LINER CEMENTLESS MDM 38MM D

Facility

$5,147.65

Service Code	HCPCS C1776
Hospital Charge Code	270681378
Hospital Revenue Code	278
Min. Negotiated Rate	$772.15
Max. Negotiated Rate	$1,245.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,029.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,245.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,132.48
Rate for Payer: Qualcare PPO/HMO/WC	$772.15

LINER CEMENTLESS MDM 42 MM E

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270646338
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 CEMENTLESS MDM 42 MM E

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270646338
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 CEMENTLESS MDM 46MM F

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270684946
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

LINER CEMENTLESS MDM 46MM F

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270684946
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

Know your out-of-pocket cost for care.

All Charges