Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHELL ACETAB TRITANIUM II 58MM

Facility

$5,858.55

Service Code	HCPCS C1776
Hospital Charge Code	270697927
Hospital Revenue Code	278
Min. Negotiated Rate	$878.78
Max. Negotiated Rate	$1,417.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,171.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,417.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,288.88
Rate for Payer: Qualcare PPO/HMO/WC	$878.78

SHELL ACETAB TRITANIUM II 58MM

Facility

$5,858.55

Service Code	HCPCS C1776
Hospital Charge Code	270697927
Hospital Revenue Code	278
Min. Negotiated Rate	$141.19
Max. Negotiated Rate	$2,929.28
Rate for Payer: Aetna Commercial	$2,226.25
Rate for Payer: Aetna Medicare Advantage	$1,757.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,493.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,493.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,171.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,493.93
Rate for Payer: Cigna Commercial	$2,929.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,417.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,288.88
Rate for Payer: Qualcare PPO/HMO/WC	$878.78
Rate for Payer: UnitedHealthcare Community & State	$141.19
Rate for Payer: Wellpoint Medicaid Managed Care	$155.25

SHELL ACETABULAR 3-HOLE 48mm

Facility

$5,550.00

Hospital Charge Code	270644360
Hospital Revenue Code	278
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$1,343.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,221.00
Rate for Payer: Qualcare PPO/HMO/WC	$832.50

SHELL ACETABULAR 3-HOLE 48mm

Facility

$5,550.00

Hospital Charge Code	270644360
Hospital Revenue Code	278
Min. Negotiated Rate	$133.75
Max. Negotiated Rate	$2,775.00
Rate for Payer: Aetna Commercial	$2,109.00
Rate for Payer: Aetna Medicare Advantage	$1,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,415.25
Rate for Payer: Cigna Commercial	$2,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,221.00
Rate for Payer: Qualcare PPO/HMO/WC	$832.50
Rate for Payer: UnitedHealthcare Community & State	$133.75
Rate for Payer: Wellpoint Medicaid Managed Care	$147.07

SHELL ACETABULAR 50 MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270688348
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$3,804.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,458.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

SHELL ACETABULAR 50 MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270688348
Hospital Revenue Code	278
Min. Negotiated Rate	$378.85
Max. Negotiated Rate	$7,860.00
Rate for Payer: Aetna Commercial	$5,973.60
Rate for Payer: Aetna Medicare Advantage	$4,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,008.60
Rate for Payer: Cigna Commercial	$7,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,458.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00
Rate for Payer: UnitedHealthcare Community & State	$378.85
Rate for Payer: Wellpoint Medicaid Managed Care	$416.58

SHELL ACETABULAR 50MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	2706883482
Hospital Revenue Code	278
Min. Negotiated Rate	$378.85
Max. Negotiated Rate	$7,860.00
Rate for Payer: Aetna Commercial	$5,973.60
Rate for Payer: Aetna Medicare Advantage	$4,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,008.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,008.60
Rate for Payer: Cigna Commercial	$7,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,458.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00
Rate for Payer: UnitedHealthcare Community & State	$378.85
Rate for Payer: Wellpoint Medicaid Managed Care	$416.58

SHELL ACETABULAR 50MM

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	2706883482
Hospital Revenue Code	278
Min. Negotiated Rate	$2,358.00
Max. Negotiated Rate	$3,804.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,804.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,458.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,358.00

SHELL ACETABULAR 50mm SIZE 23

Facility

$9,235.00

Hospital Charge Code	270646477
Hospital Revenue Code	278
Min. Negotiated Rate	$1,385.25
Max. Negotiated Rate	$2,234.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,847.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,234.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,031.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,385.25

SHELL ACETABULAR 50mm SIZE 23

Facility

$9,235.00

Hospital Charge Code	270646477
Hospital Revenue Code	278
Min. Negotiated Rate	$222.56
Max. Negotiated Rate	$4,617.50
Rate for Payer: Aetna Commercial	$3,509.30
Rate for Payer: Aetna Medicare Advantage	$2,770.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,354.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,354.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,354.93
Rate for Payer: Cigna Commercial	$4,617.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,234.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,031.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,385.25
Rate for Payer: UnitedHealthcare Community & State	$222.56
Rate for Payer: Wellpoint Medicaid Managed Care	$244.73

SHELL ACETABULAR 52mm MPACTDM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681003
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 ACETABULAR 52mm MPACTDM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681003
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 ACETABULAR 54MM

Facility

$6,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270689571
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

SHELL ACETABULAR 54MM

Facility

$6,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270689571
Hospital Revenue Code	278
Min. Negotiated Rate	$162.68
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$162.68
Rate for Payer: Wellpoint Medicaid Managed Care	$178.88

SHELL ACETABULAR 54mm SIZE 24

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270665222
Hospital Revenue Code	278
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

SHELL ACETABULAR 54mm SIZE 24

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270665222
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SHELL ACETABULAR 56MM SZ F

Facility

$6,750.00

Hospital Charge Code	270677541
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

SHELL ACETABULAR 56MM SZ F

Facility

$6,750.00

Hospital Charge Code	270677541
Hospital Revenue Code	278
Min. Negotiated Rate	$162.68
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$162.68
Rate for Payer: Wellpoint Medicaid Managed Care	$178.88

SHELL ACETABULAR 58 MPACT

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694004
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 ACETABULAR 58 MPACT

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694004
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 ACETABULAR 62mm SIZE 26

Facility

$8,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270645622
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$1,966.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,787.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75

SHELL ACETABULAR 62mm SIZE 26

Facility

$8,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270645622
Hospital Revenue Code	278
Min. Negotiated Rate	$195.81
Max. Negotiated Rate	$4,062.50
Rate for Payer: Aetna Commercial	$3,087.50
Rate for Payer: Aetna Medicare Advantage	$2,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,071.88
Rate for Payer: Cigna Commercial	$4,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,787.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75
Rate for Payer: UnitedHealthcare Community & State	$195.81
Rate for Payer: Wellpoint Medicaid Managed Care	$215.31

SHELL ACETABULAR 70mm MPACTH

Facility

$19,475.00

Service Code	HCPCS C1776
Hospital Charge Code	270684305
Hospital Revenue Code	278
Min. Negotiated Rate	$2,921.25
Max. Negotiated Rate	$4,712.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,712.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,284.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,921.25

SHELL ACETABULAR 70mm MPACTH

Facility

$19,475.00

Service Code	HCPCS C1776
Hospital Charge Code	270684305
Hospital Revenue Code	278
Min. Negotiated Rate	$469.35
Max. Negotiated Rate	$9,737.50
Rate for Payer: Aetna Commercial	$7,400.50
Rate for Payer: Aetna Medicare Advantage	$5,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,966.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,966.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,966.12
Rate for Payer: Cigna Commercial	$9,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,712.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,284.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,921.25
Rate for Payer: UnitedHealthcare Community & State	$469.35
Rate for Payer: Wellpoint Medicaid Managed Care	$516.09

SHELL ACETABULAR CLUSTER 44MM

Facility

$6,349.50

Hospital Charge Code	270676685
Hospital Revenue Code	278
Min. Negotiated Rate	$153.02
Max. Negotiated Rate	$3,174.75
Rate for Payer: Aetna Commercial	$2,412.81
Rate for Payer: Aetna Medicare Advantage	$1,904.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,619.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,619.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,269.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,619.12
Rate for Payer: Cigna Commercial	$3,174.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,536.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,396.89
Rate for Payer: Qualcare PPO/HMO/WC	$952.42
Rate for Payer: UnitedHealthcare Community & State	$153.02
Rate for Payer: Wellpoint Medicaid Managed Care	$168.26

Know your out-of-pocket cost for care.

All Charges