Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHELL 60MM TRIDENT ACETABULAR

Facility

$6,808.15

Service Code	HCPCS C1776
Hospital Charge Code	270695458
Hospital Revenue Code	278
Min. Negotiated Rate	$1,021.22
Max. Negotiated Rate	$1,647.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,361.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,647.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,497.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,021.22

SHELL ACEBLR 52m CLUS 62005222

Facility

$5,996.10

Hospital Charge Code	270633332
Hospital Revenue Code	278
Min. Negotiated Rate	$899.41
Max. Negotiated Rate	$1,451.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,199.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,451.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,319.14
Rate for Payer: Qualcare PPO/HMO/WC	$899.41

SHELL ACEBLR 52m CLUS 62005222

Facility

$5,996.10

Hospital Charge Code	270633332
Hospital Revenue Code	278
Min. Negotiated Rate	$144.51
Max. Negotiated Rate	$2,998.05
Rate for Payer: Aetna Commercial	$2,278.52
Rate for Payer: Aetna Medicare Advantage	$1,798.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,529.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,529.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,199.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,529.01
Rate for Payer: Cigna Commercial	$2,998.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,451.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,319.14
Rate for Payer: Qualcare PPO/HMO/WC	$899.41
Rate for Payer: UnitedHealthcare Community & State	$144.51
Rate for Payer: Wellpoint Medicaid Managed Care	$158.90

SHELL ACET 48mm OD 6200-48-22

Facility

$5,467.25

Hospital Charge Code	270630439
Hospital Revenue Code	278
Min. Negotiated Rate	$131.76
Max. Negotiated Rate	$2,733.62
Rate for Payer: Aetna Commercial	$2,077.55
Rate for Payer: Aetna Medicare Advantage	$1,640.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,394.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,394.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,093.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,394.15
Rate for Payer: Cigna Commercial	$2,733.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,323.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,202.80
Rate for Payer: Qualcare PPO/HMO/WC	$820.09
Rate for Payer: UnitedHealthcare Community & State	$131.76
Rate for Payer: Wellpoint Medicaid Managed Care	$144.88

SHELL ACET 48mm OD 6200-48-22

Facility

$5,467.25

Hospital Charge Code	270630439
Hospital Revenue Code	278
Min. Negotiated Rate	$820.09
Max. Negotiated Rate	$1,323.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,093.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,323.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,202.80
Rate for Payer: Qualcare PPO/HMO/WC	$820.09

SHELL ACET 56mmOD 6200-50-22

Facility

$5,467.25

Hospital Charge Code	270631620
Hospital Revenue Code	278
Min. Negotiated Rate	$820.09
Max. Negotiated Rate	$1,323.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,093.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,323.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,202.80
Rate for Payer: Qualcare PPO/HMO/WC	$820.09

SHELL ACET 56mmOD 6200-50-22

Facility

$5,467.25

Hospital Charge Code	270631620
Hospital Revenue Code	278
Min. Negotiated Rate	$131.76
Max. Negotiated Rate	$2,733.62
Rate for Payer: Aetna Commercial	$2,077.55
Rate for Payer: Aetna Medicare Advantage	$1,640.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,394.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,394.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,093.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,394.15
Rate for Payer: Cigna Commercial	$2,733.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,323.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,202.80
Rate for Payer: Qualcare PPO/HMO/WC	$820.09
Rate for Payer: UnitedHealthcare Community & State	$131.76
Rate for Payer: Wellpoint Medicaid Managed Care	$144.88

SHELL ACET 66mm CLUST 62006622

Facility

$5,186.25

Hospital Charge Code	270633434
Hospital Revenue Code	278
Min. Negotiated Rate	$124.99
Max. Negotiated Rate	$2,593.12
Rate for Payer: Aetna Commercial	$1,970.78
Rate for Payer: Aetna Medicare Advantage	$1,555.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,037.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,322.49
Rate for Payer: Cigna Commercial	$2,593.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,255.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,140.97
Rate for Payer: Qualcare PPO/HMO/WC	$777.94
Rate for Payer: UnitedHealthcare Community & State	$124.99
Rate for Payer: Wellpoint Medicaid Managed Care	$137.44

SHELL ACET 66mm CLUST 62006622

Facility

$5,186.25

Hospital Charge Code	270633434
Hospital Revenue Code	278
Min. Negotiated Rate	$777.94
Max. Negotiated Rate	$1,255.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,037.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,255.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,140.97
Rate for Payer: Qualcare PPO/HMO/WC	$777.94

SHELL ACETAB 58 SZ 25 16104158

Facility

$7,965.00

Service Code	HCPCS C1776
Hospital Charge Code	270644876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,194.75
Max. Negotiated Rate	$1,927.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,593.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,927.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,752.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.75

SHELL ACETAB 58 SZ 25 16104158

Facility

$7,965.00

Service Code	HCPCS C1776
Hospital Charge Code	270644876
Hospital Revenue Code	278
Min. Negotiated Rate	$191.96
Max. Negotiated Rate	$3,982.50
Rate for Payer: Aetna Commercial	$3,026.70
Rate for Payer: Aetna Medicare Advantage	$2,389.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,031.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,031.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,593.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,031.08
Rate for Payer: Cigna Commercial	$3,982.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,927.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,752.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,194.75
Rate for Payer: UnitedHealthcare Community & State	$191.96
Rate for Payer: Wellpoint Medicaid Managed Care	$211.07

SHELL ACETAB CLUST TRIDENT 62G

Facility

$12,287.50

Service Code	HCPCS C1776
Hospital Charge Code	270699084
Hospital Revenue Code	278
Min. Negotiated Rate	$1,843.12
Max. Negotiated Rate	$2,973.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,457.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,973.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,703.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,843.12

SHELL ACETAB CLUST TRIDENT 62G

Facility

$12,287.50

Service Code	HCPCS C1776
Hospital Charge Code	270699084
Hospital Revenue Code	278
Min. Negotiated Rate	$296.13
Max. Negotiated Rate	$6,143.75
Rate for Payer: Aetna Commercial	$4,669.25
Rate for Payer: Aetna Medicare Advantage	$3,686.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,133.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,133.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,133.31
Rate for Payer: Cigna Commercial	$6,143.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,973.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,703.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,843.12
Rate for Payer: UnitedHealthcare Community & State	$296.13
Rate for Payer: Wellpoint Medicaid Managed Care	$325.62

SHELL ACETAB DM MPACT DIA 60

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694021
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

SHELL ACETAB DM MPACT DIA 60

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694021
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

SHELL ACETAB LTD G7PPS

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690736
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

SHELL ACETAB LTD G7PPS

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690736
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

SHELL ACETAB MPAC 54

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270695279
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

SHELL ACETAB MPAC 54

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270695279
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

SHELL ACETAB MPACT DOUBLE MOB

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270693603
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

SHELL ACETAB MPACT DOUBLE MOB

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270693603
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

SHELL ACETAB MPACT MULTI 60

Facility

$16,695.00

Service Code	HCPCS C1776
Hospital Charge Code	270694022
Hospital Revenue Code	278
Min. Negotiated Rate	$2,504.25
Max. Negotiated Rate	$4,040.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,339.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,040.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,672.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,504.25

SHELL ACETAB MPACT MULTI 60

Facility

$16,695.00

Service Code	HCPCS C1776
Hospital Charge Code	270694022
Hospital Revenue Code	278
Min. Negotiated Rate	$402.35
Max. Negotiated Rate	$8,347.50
Rate for Payer: Aetna Commercial	$6,344.10
Rate for Payer: Aetna Medicare Advantage	$5,008.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,257.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,257.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,339.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,257.23
Rate for Payer: Cigna Commercial	$8,347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,040.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,672.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,504.25
Rate for Payer: UnitedHealthcare Community & State	$402.35
Rate for Payer: Wellpoint Medicaid Managed Care	$442.42

SHELL ACETAB TRIDENT II 50MM

Facility

$5,888.95

Service Code	HCPCS C1776
Hospital Charge Code	270697068
Hospital Revenue Code	278
Min. Negotiated Rate	$141.92
Max. Negotiated Rate	$2,944.47
Rate for Payer: Aetna Commercial	$2,237.80
Rate for Payer: Aetna Medicare Advantage	$1,766.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,501.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,501.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,501.68
Rate for Payer: Cigna Commercial	$2,944.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,295.57
Rate for Payer: Qualcare PPO/HMO/WC	$883.34
Rate for Payer: UnitedHealthcare Community & State	$141.92
Rate for Payer: Wellpoint Medicaid Managed Care	$156.06

SHELL ACETAB TRIDENT II 50MM

Facility

$5,888.95

Service Code	HCPCS C1776
Hospital Charge Code	270697068
Hospital Revenue Code	278
Min. Negotiated Rate	$883.34
Max. Negotiated Rate	$1,425.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,295.57
Rate for Payer: Qualcare PPO/HMO/WC	$883.34

Know your out-of-pocket cost for care.

All Charges