Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LINER HEAD DM 28x48MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270677707
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 HEAD DM 28x48MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270677707
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 HEAD DM 28x52MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270669780
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 HEAD DM 28x52MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270669780
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 HEAD DM 28x54MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270667468
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 HEAD DM 28x54MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270667468
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 HEAD DM 28x62MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270682088
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 HEAD DM 28x62MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270682088
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 HEAD DM 28x64MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270681948
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 HEAD DM 28x64MM

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270681948
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 HEAD SIZE EMPOWR 36MM

Facility

$7,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270692713
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 HEAD SIZE EMPOWR 36MM

Facility

$7,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270692713
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 HI WALL 24X36mm RING LOC

Facility

$14,610.00

Service Code	HCPCS C1776
Hospital Charge Code	270665220
Hospital Revenue Code	278
Min. Negotiated Rate	$352.10
Max. Negotiated Rate	$7,305.00
Rate for Payer: Aetna Commercial	$5,551.80
Rate for Payer: Aetna Medicare Advantage	$4,383.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,725.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,725.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,922.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,725.55
Rate for Payer: Cigna Commercial	$7,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,535.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,214.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,191.50
Rate for Payer: UnitedHealthcare Community & State	$352.10
Rate for Payer: Wellpoint Medicaid Managed Care	$387.17

LINER HI WALL 24X36mm RING LOC

Facility

$14,610.00

Service Code	HCPCS C1776
Hospital Charge Code	270665220
Hospital Revenue Code	278
Min. Negotiated Rate	$2,191.50
Max. Negotiated Rate	$3,535.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,922.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,535.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,214.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,191.50

LINER HOODED TRIO 32/F CC

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683288
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

LINER HOODED TRIO 32/F CC

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683288
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

LINER HUMER 6X36MM 12.5DREVERS

Facility

$13,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270697093
Hospital Revenue Code	278
Min. Negotiated Rate	$327.16
Max. Negotiated Rate	$6,787.50
Rate for Payer: Aetna Commercial	$5,158.50
Rate for Payer: Aetna Medicare Advantage	$4,072.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,461.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,461.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,461.62
Rate for Payer: Cigna Commercial	$6,787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,285.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,986.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,036.25
Rate for Payer: UnitedHealthcare Community & State	$327.16
Rate for Payer: Wellpoint Medicaid Managed Care	$359.74

LINER HUMER 6X36MM 12.5DREVERS

Facility

$13,575.00

Service Code	HCPCS C1776
Hospital Charge Code	270697093
Hospital Revenue Code	278
Min. Negotiated Rate	$2,036.25
Max. Negotiated Rate	$3,285.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,285.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,986.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,036.25

LINER HUMERAL 36 +3

Facility

$5,075.00

Service Code	HCPCS C1776
Hospital Charge Code	270672409
Hospital Revenue Code	278
Min. Negotiated Rate	$122.31
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$122.31
Rate for Payer: Wellpoint Medicaid Managed Care	$134.49

LINER HUMERAL 36 +3

Facility

$5,075.00

Service Code	HCPCS C1776
Hospital Charge Code	270672409
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 36 +3C

Facility

$5,075.00

Hospital Charge Code	270672410
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 36 +3C

Facility

$5,075.00

Hospital Charge Code	270672410
Hospital Revenue Code	278
Min. Negotiated Rate	$122.31
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$122.31
Rate for Payer: Wellpoint Medicaid Managed Care	$134.49

LINER HUMERAL 36 +6

Facility

$5,075.00

Hospital Charge Code	270672411
Hospital Revenue Code	278
Min. Negotiated Rate	$761.25
Max. Negotiated Rate	$1,228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25

LINER HUMERAL 36 +6

Facility

$5,075.00

Hospital Charge Code	270672411
Hospital Revenue Code	278
Min. Negotiated Rate	$122.31
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$122.31
Rate for Payer: Wellpoint Medicaid Managed Care	$134.49

LINER HUMERAL 36 +6C

Facility

$5,075.00

Hospital Charge Code	270672412
Hospital Revenue Code	278
Min. Negotiated Rate	$122.31
Max. Negotiated Rate	$2,537.50
Rate for Payer: Aetna Commercial	$1,928.50
Rate for Payer: Aetna Medicare Advantage	$1,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,015.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.12
Rate for Payer: Cigna Commercial	$2,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,228.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,116.50
Rate for Payer: Qualcare PPO/HMO/WC	$761.25
Rate for Payer: UnitedHealthcare Community & State	$122.31
Rate for Payer: Wellpoint Medicaid Managed Care	$134.49

Know your out-of-pocket cost for care.

All Charges