Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

LINER STANDARD 9

Facility

$5,279.20

Service Code	HCPCS C1776
Hospital Charge Code	270689618
Hospital Revenue Code	278
Min. Negotiated Rate	$791.88
Max. Negotiated Rate	$1,277.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,055.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,161.42
Rate for Payer: Qualcare PPO/HMO/WC	$791.88

LINER STANDARD 9

Facility

$5,279.20

Service Code	HCPCS C1776
Hospital Charge Code	270689618
Hospital Revenue Code	278
Min. Negotiated Rate	$127.23
Max. Negotiated Rate	$2,639.60
Rate for Payer: Aetna Commercial	$2,006.10
Rate for Payer: Aetna Medicare Advantage	$1,583.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,346.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,346.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,055.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,346.20
Rate for Payer: Cigna Commercial	$2,639.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,277.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,161.42
Rate for Payer: Qualcare PPO/HMO/WC	$791.88
Rate for Payer: UnitedHealthcare Community & State	$127.23
Rate for Payer: Wellpoint Medicaid Managed Care	$139.90

LINER STD FACE 36x23mm

Facility

$14,045.00

Hospital Charge Code	270675922
Hospital Revenue Code	278
Min. Negotiated Rate	$338.48
Max. Negotiated Rate	$7,022.50
Rate for Payer: Aetna Commercial	$5,337.10
Rate for Payer: Aetna Medicare Advantage	$4,213.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,809.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,581.47
Rate for Payer: Cigna Commercial	$7,022.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,398.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,089.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,106.75
Rate for Payer: UnitedHealthcare Community & State	$338.48
Rate for Payer: Wellpoint Medicaid Managed Care	$372.19

LINER STD FACE 36x23mm

Facility

$14,045.00

Hospital Charge Code	270675922
Hospital Revenue Code	278
Min. Negotiated Rate	$2,106.75
Max. Negotiated Rate	$3,398.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,809.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,398.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,089.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,106.75

LINER STD F/METAL BACK GLENOID

Facility

$4,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270675411
Hospital Revenue Code	278
Min. Negotiated Rate	$117.49
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,852.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,072.50
Rate for Payer: Qualcare PPO/HMO/WC	$731.25
Rate for Payer: UnitedHealthcare Community & State	$117.49
Rate for Payer: Wellpoint Medicaid Managed Care	$129.19

LINER STD F/METAL BACK GLENOID

Facility

$4,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270675411
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$1,179.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,072.50
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

LINER STERRAD 10 X 17 TRAY

Facility

$10.50

Hospital Charge Code	270657523
Hospital Revenue Code	270
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

LINER STERRAD 10 X 17 TRAY

Facility

$10.50

Hospital Charge Code	270657523
Hospital Revenue Code	270
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Commercial	$3.99
Rate for Payer: Aetna Medicare Advantage	$3.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.68
Rate for Payer: Cigna Commercial	$5.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.15
Rate for Payer: Oxford Commercial	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$2.10
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

LINER SUCTION 1000 CC

Facility

$7.00

Hospital Charge Code	270301241
Hospital Revenue Code	270
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

LINER SUCTION 1000 CC

Facility

$7.00

Hospital Charge Code	270301241
Hospital Revenue Code	270
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LINER SUCTION 1500cc 65651515

Facility

$5.88

Hospital Charge Code	270301242
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.94
Rate for Payer: Aetna Commercial	$2.23
Rate for Payer: Aetna Medicare Advantage	$1.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.50
Rate for Payer: Cigna Commercial	$2.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.76
Rate for Payer: Oxford Commercial	$1.18
Rate for Payer: Qualcare PPO/HMO/WC	$0.88
Rate for Payer: UnitedHealthcare Commercial	$1.18
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

LINER SUCTION 1500cc 65651515

Facility

$5.88

Hospital Charge Code	270301242
Hospital Revenue Code	272
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.88

LINER TIBIA SZ11 10MM TK EMPOW

Facility

$5,775.00

Service Code	HCPCS C1776
Hospital Charge Code	270692717
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 TIBIA SZ11 10MM TK EMPOW

Facility

$5,775.00

Service Code	HCPCS C1776
Hospital Charge Code	270692717
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 TIB INSERT SZ4 12MM LT

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697440
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

LINER TIB INSERT SZ4 12MM LT

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697440
Hospital Revenue Code	278
Min. Negotiated Rate	$204.85
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Community & State	$204.85
Rate for Payer: Wellpoint Medicaid Managed Care	$225.25

LINER TRAY

Facility

$283.95

Hospital Charge Code	270650926
Hospital Revenue Code	272
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$141.97
Rate for Payer: Aetna Commercial	$107.90
Rate for Payer: Aetna Medicare Advantage	$85.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.41
Rate for Payer: Cigna Commercial	$141.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.19
Rate for Payer: Oxford Commercial	$56.79
Rate for Payer: Qualcare PPO/HMO/WC	$42.59
Rate for Payer: UnitedHealthcare Commercial	$56.79
Rate for Payer: UnitedHealthcare Community & State	$6.84
Rate for Payer: Wellpoint Medicaid Managed Care	$7.52

LINER TRAY

Facility

$283.95

Hospital Charge Code	270650926
Hospital Revenue Code	272
Min. Negotiated Rate	$42.59
Max. Negotiated Rate	$42.59
Rate for Payer: Qualcare PPO/HMO/WC	$42.59

LINER VERSAFITCUP CC TRIO FLAT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681267
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 VERSAFITCUP CC TRIO FLAT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681267
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 VERSAFIT CUP HC 52/28

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270682959
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 VERSAFIT CUP HC 52/28

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270682959
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 VIVACET-E BRNG 28X46MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693416
Hospital Revenue Code	278
Min. Negotiated Rate	$325.35
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Community & State	$325.35
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

LINER VIVACET-E BRNG 28X46MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693416
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

LINER ZIM ACETB 10 28 61205028

Facility

$4,137.65

Hospital Charge Code	270612225
Hospital Revenue Code	278
Min. Negotiated Rate	$99.72
Max. Negotiated Rate	$2,068.82
Rate for Payer: Aetna Commercial	$1,572.31
Rate for Payer: Aetna Medicare Advantage	$1,241.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,055.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,055.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$827.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,055.10
Rate for Payer: Cigna Commercial	$2,068.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,001.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$910.28
Rate for Payer: Qualcare PPO/HMO/WC	$620.65
Rate for Payer: UnitedHealthcare Community & State	$99.72
Rate for Payer: Wellpoint Medicaid Managed Care	$109.65

Know your out-of-pocket cost for care.

All Charges