Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LINER HUMERAL REVERSE 36 6MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693859
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

LINER HUMERAL REVERSE 36 6MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693859
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

LINER HUMERAL REVERSE 36MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691233
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

LINER HUMERAL REVERSE 36MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691233
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

LINER INNER 36 MM +4 52 MM

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688140
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 INNER 36 MM +4 52 MM

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688140
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 INSERT MDM X3 36MM C

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270700713
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 INSERT MDM X3 36MM C

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270700713
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 LONGEV DM BEAR 28X42MM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270694354
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

LINER LONGEV DM BEAR 28X42MM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270694354
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

LINER METAL BACK LARGE

Facility

$2,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270680276
Hospital Revenue Code	278
Min. Negotiated Rate	$64.71
Max. Negotiated Rate	$1,342.50
Rate for Payer: Aetna Commercial	$1,020.30
Rate for Payer: Aetna Medicare Advantage	$805.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$684.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$684.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$537.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$684.67
Rate for Payer: Cigna Commercial	$1,342.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$590.70
Rate for Payer: Qualcare PPO/HMO/WC	$402.75
Rate for Payer: UnitedHealthcare Community & State	$64.71
Rate for Payer: Wellpoint Medicaid Managed Care	$71.15

LINER METAL BACK LARGE

Facility

$2,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270680276
Hospital Revenue Code	278
Min. Negotiated Rate	$402.75
Max. Negotiated Rate	$649.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$537.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$590.70
Rate for Payer: Qualcare PPO/HMO/WC	$402.75

LINER METAL BACK SMALL

Facility

$2,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270672312
Hospital Revenue Code	278
Min. Negotiated Rate	$402.75
Max. Negotiated Rate	$649.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$537.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$590.70
Rate for Payer: Qualcare PPO/HMO/WC	$402.75

LINER METAL BACK SMALL

Facility

$2,685.00

Service Code	HCPCS C1776
Hospital Charge Code	270672312
Hospital Revenue Code	278
Min. Negotiated Rate	$64.71
Max. Negotiated Rate	$1,342.50
Rate for Payer: Aetna Commercial	$1,020.30
Rate for Payer: Aetna Medicare Advantage	$805.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$684.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$684.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$537.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$684.67
Rate for Payer: Cigna Commercial	$1,342.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$590.70
Rate for Payer: Qualcare PPO/HMO/WC	$402.75
Rate for Payer: UnitedHealthcare Community & State	$64.71
Rate for Payer: Wellpoint Medicaid Managed Care	$71.15

LINER MOBILITY G7 DUAL 38MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688597
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 MOBILITY G7 DUAL 38MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688597
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 MULTIPOLAR PROV 50035028

Facility

$710.00

Hospital Charge Code	270637782
Hospital Revenue Code	278
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$171.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$142.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$156.20
Rate for Payer: Qualcare PPO/HMO/WC	$106.50

LINER MULTIPOLAR PROV 50035028

Facility

$710.00

Hospital Charge Code	270637782
Hospital Revenue Code	278
Min. Negotiated Rate	$17.11
Max. Negotiated Rate	$355.00
Rate for Payer: Aetna Commercial	$269.80
Rate for Payer: Aetna Medicare Advantage	$213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$181.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$181.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$142.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$181.05
Rate for Payer: Cigna Commercial	$355.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$156.20
Rate for Payer: Qualcare PPO/HMO/WC	$106.50
Rate for Payer: UnitedHealthcare Community & State	$17.11
Rate for Payer: Wellpoint Medicaid Managed Care	$18.82

LINER NEUTRAL 32 MM

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270689639
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 NEUTRAL 32 MM

Facility

$4,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270689639
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 PLY XLPE 10DG 6310-46-28

Facility

$5,889.65

Hospital Charge Code	270635649
Hospital Revenue Code	278
Min. Negotiated Rate	$141.94
Max. Negotiated Rate	$2,944.82
Rate for Payer: Aetna Commercial	$2,238.07
Rate for Payer: Aetna Medicare Advantage	$1,766.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,501.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,501.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,501.86
Rate for Payer: Cigna Commercial	$2,944.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,295.72
Rate for Payer: Qualcare PPO/HMO/WC	$883.45
Rate for Payer: UnitedHealthcare Community & State	$141.94
Rate for Payer: Wellpoint Medicaid Managed Care	$156.08

LINER PLY XLPE 10DG 6310-46-28

Facility

$5,889.65

Hospital Charge Code	270635649
Hospital Revenue Code	278
Min. Negotiated Rate	$883.45
Max. Negotiated Rate	$1,425.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,295.72
Rate for Payer: Qualcare PPO/HMO/WC	$883.45

LINER POLY 10DG 60x28 63106028

Facility

$5,654.60

Hospital Charge Code	270634430
Hospital Revenue Code	278
Min. Negotiated Rate	$848.19
Max. Negotiated Rate	$1,368.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,368.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,244.01
Rate for Payer: Qualcare PPO/HMO/WC	$848.19

LINER POLY 10DG 60x28 63106028

Facility

$5,654.60

Hospital Charge Code	270634430
Hospital Revenue Code	278
Min. Negotiated Rate	$136.28
Max. Negotiated Rate	$2,827.30
Rate for Payer: Aetna Commercial	$2,148.75
Rate for Payer: Aetna Medicare Advantage	$1,696.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,441.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,441.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,441.92
Rate for Payer: Cigna Commercial	$2,827.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,368.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,244.01
Rate for Payer: Qualcare PPO/HMO/WC	$848.19
Rate for Payer: UnitedHealthcare Community & State	$136.28
Rate for Payer: Wellpoint Medicaid Managed Care	$149.85

LINER POLY STANDARD 0 PLUS

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270689177
Hospital Revenue Code	278
Min. Negotiated Rate	$954.04
Max. Negotiated Rate	$1,539.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,399.26
Rate for Payer: Qualcare PPO/HMO/WC	$954.04

Know your out-of-pocket cost for care.

All Charges