Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MODULAR CUP 10 DEGREE 58X36

Facility

$6,220.00

Hospital Charge Code	270667173
Hospital Revenue Code	278
Min. Negotiated Rate	$933.00
Max. Negotiated Rate	$1,505.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,368.40
Rate for Payer: Qualcare PPO/HMO/WC	$933.00

MODULAR CUP 10 DEGREE 58X36

Facility

$6,220.00

Hospital Charge Code	270667173
Hospital Revenue Code	278
Min. Negotiated Rate	$149.90
Max. Negotiated Rate	$3,110.00
Rate for Payer: Aetna Commercial	$2,363.60
Rate for Payer: Aetna Medicare Advantage	$1,866.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,586.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,586.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,586.10
Rate for Payer: Cigna Commercial	$3,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,368.40
Rate for Payer: Qualcare PPO/HMO/WC	$933.00
Rate for Payer: UnitedHealthcare Community & State	$149.90
Rate for Payer: Wellpoint Medicaid Managed Care	$164.83

MODULAR CUP 62MM MULTI-HOLE

Facility

$8,660.00

Hospital Charge Code	270666712
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.00
Max. Negotiated Rate	$2,095.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,905.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.00

MODULAR CUP 62MM MULTI-HOLE

Facility

$8,660.00

Hospital Charge Code	270666712
Hospital Revenue Code	278
Min. Negotiated Rate	$208.71
Max. Negotiated Rate	$4,330.00
Rate for Payer: Aetna Commercial	$3,290.80
Rate for Payer: Aetna Medicare Advantage	$2,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,208.30
Rate for Payer: Cigna Commercial	$4,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,905.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.00
Rate for Payer: UnitedHealthcare Community & State	$208.71
Rate for Payer: Wellpoint Medicaid Managed Care	$229.49

MODULAR CUP NEU LINR LONG56X36

Facility

$6,221.55

Hospital Charge Code	270662349
Hospital Revenue Code	278
Min. Negotiated Rate	$149.94
Max. Negotiated Rate	$3,110.78
Rate for Payer: Aetna Commercial	$2,364.19
Rate for Payer: Aetna Medicare Advantage	$1,866.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,586.50
Rate for Payer: Cigna Commercial	$3,110.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,368.74
Rate for Payer: Qualcare PPO/HMO/WC	$933.23
Rate for Payer: UnitedHealthcare Community & State	$149.94
Rate for Payer: Wellpoint Medicaid Managed Care	$164.87

MODULAR CUP NEU LINR LONG56X36

Facility

$6,221.55

Hospital Charge Code	270662349
Hospital Revenue Code	278
Min. Negotiated Rate	$933.23
Max. Negotiated Rate	$1,505.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,368.74
Rate for Payer: Qualcare PPO/HMO/WC	$933.23

MODULAR CUP NEUTRAL 56X36

Facility

$6,220.00

Hospital Charge Code	270667176
Hospital Revenue Code	278
Min. Negotiated Rate	$933.00
Max. Negotiated Rate	$1,505.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,368.40
Rate for Payer: Qualcare PPO/HMO/WC	$933.00

MODULAR CUP NEUTRAL 56X36

Facility

$6,220.00

Hospital Charge Code	270667176
Hospital Revenue Code	278
Min. Negotiated Rate	$149.90
Max. Negotiated Rate	$3,110.00
Rate for Payer: Aetna Commercial	$2,363.60
Rate for Payer: Aetna Medicare Advantage	$1,866.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,586.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,586.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,586.10
Rate for Payer: Cigna Commercial	$3,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,368.40
Rate for Payer: Qualcare PPO/HMO/WC	$933.00
Rate for Payer: UnitedHealthcare Community & State	$149.90
Rate for Payer: Wellpoint Medicaid Managed Care	$164.83

MODULAR CUP TM 56MM MULTI H

Facility

$8,660.00

Hospital Charge Code	270667175
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.00
Max. Negotiated Rate	$2,095.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,905.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.00

MODULAR CUP TM 56MM MULTI H

Facility

$8,660.00

Hospital Charge Code	270667175
Hospital Revenue Code	278
Min. Negotiated Rate	$208.71
Max. Negotiated Rate	$4,330.00
Rate for Payer: Aetna Commercial	$3,290.80
Rate for Payer: Aetna Medicare Advantage	$2,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,208.30
Rate for Payer: Cigna Commercial	$4,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,905.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.00
Rate for Payer: UnitedHealthcare Community & State	$208.71
Rate for Payer: Wellpoint Medicaid Managed Care	$229.49

MODULAR CUP TM 58MM MULTI H

Facility

$8,660.00

Hospital Charge Code	270667172
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.00
Max. Negotiated Rate	$2,095.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,905.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.00

MODULAR CUP TM 58MM MULTI H

Facility

$8,660.00

Hospital Charge Code	270667172
Hospital Revenue Code	278
Min. Negotiated Rate	$208.71
Max. Negotiated Rate	$4,330.00
Rate for Payer: Aetna Commercial	$3,290.80
Rate for Payer: Aetna Medicare Advantage	$2,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,208.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,208.30
Rate for Payer: Cigna Commercial	$4,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,905.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.00
Rate for Payer: UnitedHealthcare Community & State	$208.71
Rate for Payer: Wellpoint Medicaid Managed Care	$229.49

MODULAR HEAD 28MM EXTRA SHORT

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270706146
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

MODULAR HEAD 28MM EXTRA SHORT

Facility

$2,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270706146
Hospital Revenue Code	278
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

MODULAR HEAD 46MM

Facility

$11,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270675297
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

MODULAR HEAD 46MM

Facility

$11,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270675297
Hospital Revenue Code	278
Min. Negotiated Rate	$271.12
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50
Rate for Payer: UnitedHealthcare Community & State	$271.12
Rate for Payer: Wellpoint Medicaid Managed Care	$298.12

MODULAR HEAD CONSTRAIN 36/-6mm

Facility

$8,945.00

Service Code	HCPCS C1713
Hospital Charge Code	270665221
Hospital Revenue Code	278
Min. Negotiated Rate	$1,341.75
Max. Negotiated Rate	$2,164.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,789.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,164.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,967.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,341.75

MODULAR HEAD CONSTRAIN 36/-6mm

Facility

$8,945.00

Service Code	HCPCS C1713
Hospital Charge Code	270665221
Hospital Revenue Code	278
Min. Negotiated Rate	$215.57
Max. Negotiated Rate	$4,472.50
Rate for Payer: Aetna Commercial	$3,399.10
Rate for Payer: Aetna Medicare Advantage	$2,683.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,280.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,280.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,789.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,280.97
Rate for Payer: Cigna Commercial	$4,472.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,164.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,967.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,341.75
Rate for Payer: UnitedHealthcare Community & State	$215.57
Rate for Payer: Wellpoint Medicaid Managed Care	$237.04

MODULAR POST 25MM

Facility

$7,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270699160
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

MODULAR POST 25MM

Facility

$7,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270699160
Hospital Revenue Code	278
Min. Negotiated Rate	$174.72
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$174.72
Rate for Payer: Wellpoint Medicaid Managed Care	$192.12

MODULAR STEM LARGE

Facility

$9,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270678493
Hospital Revenue Code	278
Min. Negotiated Rate	$222.93
Max. Negotiated Rate	$4,625.00
Rate for Payer: Aetna Commercial	$3,515.00
Rate for Payer: Aetna Medicare Advantage	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.75
Rate for Payer: Cigna Commercial	$4,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50
Rate for Payer: UnitedHealthcare Community & State	$222.93
Rate for Payer: Wellpoint Medicaid Managed Care	$245.12

MODULAR STEM LARGE

Facility

$9,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270678493
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

MODULAR STEM SMALL

Facility

$27,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270675298
Hospital Revenue Code	278
Min. Negotiated Rate	$4,087.50
Max. Negotiated Rate	$6,594.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,594.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,995.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,087.50

MODULAR STEM SMALL

Facility

$27,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270675298
Hospital Revenue Code	278
Min. Negotiated Rate	$656.73
Max. Negotiated Rate	$13,625.00
Rate for Payer: Aetna Commercial	$10,355.00
Rate for Payer: Aetna Medicare Advantage	$8,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,948.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,948.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,948.75
Rate for Payer: Cigna Commercial	$13,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,594.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,995.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,087.50
Rate for Payer: UnitedHealthcare Community & State	$656.73
Rate for Payer: Wellpoint Medicaid Managed Care	$722.12

MODULAR TOWER TULIP 39MT0401

Facility

$6,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270698634
Hospital Revenue Code	278
Min. Negotiated Rate	$147.97
Max. Negotiated Rate	$3,070.00
Rate for Payer: Aetna Commercial	$2,333.20
Rate for Payer: Aetna Medicare Advantage	$1,842.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,565.70
Rate for Payer: Cigna Commercial	$3,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,350.80
Rate for Payer: Qualcare PPO/HMO/WC	$921.00
Rate for Payer: UnitedHealthcare Community & State	$147.97
Rate for Payer: Wellpoint Medicaid Managed Care	$162.71

Know your out-of-pocket cost for care.

All Charges