Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LINER CEMENTLESS MDM 48MM G

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671851
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

LINER CEMENTLESS MDM 48MM G

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270671851
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 CLUSTER CUP 52 F 52 MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692712
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

LINER CLUSTER CUP 52 F 52 MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692712
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

LINER CONNEXION ACETABULAR

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270678674
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 CONNEXION ACETABULAR

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270678674
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 CONSTRAINED GROUP 3 36MM

Facility

$7,848.00

Hospital Charge Code	270670931
Hospital Revenue Code	278
Min. Negotiated Rate	$189.14
Max. Negotiated Rate	$3,924.00
Rate for Payer: Aetna Commercial	$2,982.24
Rate for Payer: Aetna Medicare Advantage	$2,354.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,001.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,001.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,001.24
Rate for Payer: Cigna Commercial	$3,924.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,899.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,726.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,177.20
Rate for Payer: UnitedHealthcare Community & State	$189.14
Rate for Payer: Wellpoint Medicaid Managed Care	$207.97

LINER CONSTRAINED GROUP 3 36MM

Facility

$7,848.00

Hospital Charge Code	270670931
Hospital Revenue Code	278
Min. Negotiated Rate	$1,177.20
Max. Negotiated Rate	$1,899.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,899.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,726.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,177.20

LINER CONSTRAINED NEUTRAL 36MM

Facility

$26,745.00

Service Code	HCPCS C1713
Hospital Charge Code	270706022
Hospital Revenue Code	278
Min. Negotiated Rate	$644.55
Max. Negotiated Rate	$13,372.50
Rate for Payer: Aetna Commercial	$10,163.10
Rate for Payer: Aetna Medicare Advantage	$8,023.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,819.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,819.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,349.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,819.98
Rate for Payer: Cigna Commercial	$13,372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,472.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,883.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,011.75
Rate for Payer: UnitedHealthcare Community & State	$644.55
Rate for Payer: Wellpoint Medicaid Managed Care	$708.74

LINER CONSTRAINED NEUTRAL 36MM

Facility

$26,745.00

Service Code	HCPCS C1713
Hospital Charge Code	270706022
Hospital Revenue Code	278
Min. Negotiated Rate	$4,011.75
Max. Negotiated Rate	$6,472.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,349.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,472.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,883.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,011.75

LINER CONSTRAINED TRI 64x36MM

Facility

$17,943.50

Hospital Charge Code	270675768
Hospital Revenue Code	278
Min. Negotiated Rate	$2,691.53
Max. Negotiated Rate	$4,342.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,588.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,342.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,947.57
Rate for Payer: Qualcare PPO/HMO/WC	$2,691.53

LINER CONSTRAINED TRI 64x36MM

Facility

$17,943.50

Hospital Charge Code	270675768
Hospital Revenue Code	278
Min. Negotiated Rate	$432.44
Max. Negotiated Rate	$8,971.75
Rate for Payer: Aetna Commercial	$6,818.53
Rate for Payer: Aetna Medicare Advantage	$5,383.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,575.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,575.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,588.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,575.59
Rate for Payer: Cigna Commercial	$8,971.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,342.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,947.57
Rate for Payer: Qualcare PPO/HMO/WC	$2,691.53
Rate for Payer: UnitedHealthcare Community & State	$432.44
Rate for Payer: Wellpoint Medicaid Managed Care	$475.50

LINER DM

Facility

$9,825.00

Service Code	HCPCS C1776
Hospital Charge Code	270670740
Hospital Revenue Code	278
Min. Negotiated Rate	$236.78
Max. Negotiated Rate	$4,912.50
Rate for Payer: Aetna Commercial	$3,733.50
Rate for Payer: Aetna Medicare Advantage	$2,947.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,505.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,505.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,965.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,505.38
Rate for Payer: Cigna Commercial	$4,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,377.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,161.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,473.75
Rate for Payer: UnitedHealthcare Community & State	$236.78
Rate for Payer: Wellpoint Medicaid Managed Care	$260.36

LINER DM

Facility

$9,825.00

Service Code	HCPCS C1776
Hospital Charge Code	270670740
Hospital Revenue Code	278
Min. Negotiated Rate	$1,473.75
Max. Negotiated Rate	$2,377.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,965.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,377.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,161.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,473.75

LINER DME HEAD 26MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270676062
Hospital Revenue Code	278
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

LINER DME HEAD 26MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270676062
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

LINER DM HEAD 28MM

Facility

$9,825.00

Service Code	HCPCS C1776
Hospital Charge Code	270668030
Hospital Revenue Code	278
Min. Negotiated Rate	$1,473.75
Max. Negotiated Rate	$2,377.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,965.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,377.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,161.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,473.75

LINER DM HEAD 28MM

Facility

$9,825.00

Service Code	HCPCS C1776
Hospital Charge Code	270668030
Hospital Revenue Code	278
Min. Negotiated Rate	$236.78
Max. Negotiated Rate	$4,912.50
Rate for Payer: Aetna Commercial	$3,733.50
Rate for Payer: Aetna Medicare Advantage	$2,947.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,505.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,505.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,965.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,505.38
Rate for Payer: Cigna Commercial	$4,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,377.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,161.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,473.75
Rate for Payer: UnitedHealthcare Community & State	$236.78
Rate for Payer: Wellpoint Medicaid Managed Care	$260.36

LINER F/INSPIREASE DRUG DELI-

Facility

$29.93

Hospital Charge Code	270639105
Hospital Revenue Code	270
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$14.96
Rate for Payer: Aetna Commercial	$11.37
Rate for Payer: Aetna Medicare Advantage	$8.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.63
Rate for Payer: Cigna Commercial	$14.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.98
Rate for Payer: Oxford Commercial	$5.99
Rate for Payer: Qualcare PPO/HMO/WC	$4.49
Rate for Payer: UnitedHealthcare Commercial	$5.99
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

LINER F/INSPIREASE DRUG DELI-

Facility

$29.93

Hospital Charge Code	270639105
Hospital Revenue Code	270
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$4.49
Rate for Payer: Qualcare PPO/HMO/WC	$4.49

LINER FLAT HC 40 J MPACT

Facility

$10,465.00

Service Code	HCPCS C1776
Hospital Charge Code	270684311
Hospital Revenue Code	278
Min. Negotiated Rate	$252.21
Max. Negotiated Rate	$5,232.50
Rate for Payer: Aetna Commercial	$3,976.70
Rate for Payer: Aetna Medicare Advantage	$3,139.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,668.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,668.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,093.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,668.57
Rate for Payer: Cigna Commercial	$5,232.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,532.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,302.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,569.75
Rate for Payer: UnitedHealthcare Community & State	$252.21
Rate for Payer: Wellpoint Medicaid Managed Care	$277.32

LINER FLAT HC 40 J MPACT

Facility

$10,465.00

Service Code	HCPCS C1776
Hospital Charge Code	270684311
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.75
Max. Negotiated Rate	$2,532.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,093.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,532.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,302.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,569.75

LINER FLAT PE HC 36G

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270694024
Hospital Revenue Code	278
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

LINER FLAT PE HC 36G

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270694024
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

LINER FREEDOM CONS HD 36MM T1

Facility

$7,920.00

Service Code	HCPCS C1776
Hospital Charge Code	270697521
Hospital Revenue Code	278
Min. Negotiated Rate	$1,188.00
Max. Negotiated Rate	$1,916.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,584.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,916.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,742.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,188.00

Know your out-of-pocket cost for care.

All Charges