Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHELL ACETABULAR CLUSTER 44MM

Facility

$6,349.50

Hospital Charge Code	270676685
Hospital Revenue Code	278
Min. Negotiated Rate	$952.42
Max. Negotiated Rate	$1,536.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,269.90
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

SHELL ACETABULAR CLUSTER 52MM

Facility

$9,047.50

Service Code	HCPCS C1776
Hospital Charge Code	270646336
Hospital Revenue Code	278
Min. Negotiated Rate	$1,357.12
Max. Negotiated Rate	$2,189.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,809.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,189.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,990.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,357.12

SHELL ACETABULAR CLUSTER 52MM

Facility

$9,047.50

Service Code	HCPCS C1776
Hospital Charge Code	270646336
Hospital Revenue Code	278
Min. Negotiated Rate	$218.04
Max. Negotiated Rate	$4,523.75
Rate for Payer: Aetna Commercial	$3,438.05
Rate for Payer: Aetna Medicare Advantage	$2,714.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,307.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,307.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,809.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,307.11
Rate for Payer: Cigna Commercial	$4,523.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,189.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,990.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,357.12
Rate for Payer: UnitedHealthcare Community & State	$218.04
Rate for Payer: Wellpoint Medicaid Managed Care	$239.76

SHELL ACETABULAR CLUSTER 54MM

Facility

$4,734.70

Service Code	HCPCS C1776
Hospital Charge Code	270692082
Hospital Revenue Code	278
Min. Negotiated Rate	$114.11
Max. Negotiated Rate	$2,367.35
Rate for Payer: Aetna Commercial	$1,799.19
Rate for Payer: Aetna Medicare Advantage	$1,420.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,207.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,207.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,207.35
Rate for Payer: Cigna Commercial	$2,367.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,041.63
Rate for Payer: Qualcare PPO/HMO/WC	$710.21
Rate for Payer: UnitedHealthcare Community & State	$114.11
Rate for Payer: Wellpoint Medicaid Managed Care	$125.47

SHELL ACETABULAR CLUSTER 54MM

Facility

$4,734.70

Service Code	HCPCS C1776
Hospital Charge Code	270692082
Hospital Revenue Code	278
Min. Negotiated Rate	$710.21
Max. Negotiated Rate	$1,145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,041.63
Rate for Payer: Qualcare PPO/HMO/WC	$710.21

SHELL ACETABULAR MULTI-HOLE 50

Facility

$14,140.00

Service Code	HCPCS C1776
Hospital Charge Code	270679047
Hospital Revenue Code	278
Min. Negotiated Rate	$2,121.00
Max. Negotiated Rate	$3,421.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,828.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,421.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,110.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,121.00

SHELL ACETABULAR MULTI-HOLE 50

Facility

$14,140.00

Service Code	HCPCS C1776
Hospital Charge Code	270679047
Hospital Revenue Code	278
Min. Negotiated Rate	$340.77
Max. Negotiated Rate	$7,070.00
Rate for Payer: Aetna Commercial	$5,373.20
Rate for Payer: Aetna Medicare Advantage	$4,242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,605.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,828.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,605.70
Rate for Payer: Cigna Commercial	$7,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,421.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,110.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,121.00
Rate for Payer: UnitedHealthcare Community & State	$340.77
Rate for Payer: Wellpoint Medicaid Managed Care	$374.71

SHELL ACETABULAR OSSETIA TI 4

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270690530
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 OSSETIA TI 4

Facility

$15,720.00

Service Code	HCPCS C1776
Hospital Charge Code	270690530
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 SECTOR 64MM

Facility

$7,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270700355
Hospital Revenue Code	278
Min. Negotiated Rate	$1,063.12
Max. Negotiated Rate	$1,715.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,715.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,559.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,063.12

SHELL ACETABULAR SECTOR 64MM

Facility

$7,087.50

Service Code	HCPCS C1776
Hospital Charge Code	270700355
Hospital Revenue Code	278
Min. Negotiated Rate	$170.81
Max. Negotiated Rate	$3,543.75
Rate for Payer: Aetna Commercial	$2,693.25
Rate for Payer: Aetna Medicare Advantage	$2,126.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,807.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,807.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,417.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,807.31
Rate for Payer: Cigna Commercial	$3,543.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,715.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,559.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,063.12
Rate for Payer: UnitedHealthcare Community & State	$170.81
Rate for Payer: Wellpoint Medicaid Managed Care	$187.82

SHELL ACETABULAR SZ 22 52mm

Facility

$4,500.00

Hospital Charge Code	270664060
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 SZ 22 52mm

Facility

$4,500.00

Hospital Charge Code	270664060
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 ACETABULATE HOLE 54x23mm

Facility

$11,790.00

Service Code	HCPCS C1776
Hospital Charge Code	270679674
Hospital Revenue Code	278
Min. Negotiated Rate	$1,768.50
Max. Negotiated Rate	$2,853.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,358.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,853.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,593.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,768.50

SHELL ACETABULATE HOLE 54x23mm

Facility

$11,790.00

Service Code	HCPCS C1776
Hospital Charge Code	270679674
Hospital Revenue Code	278
Min. Negotiated Rate	$284.14
Max. Negotiated Rate	$5,895.00
Rate for Payer: Aetna Commercial	$4,480.20
Rate for Payer: Aetna Medicare Advantage	$3,537.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,006.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,006.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,358.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,006.45
Rate for Payer: Cigna Commercial	$5,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,853.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,593.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,768.50
Rate for Payer: UnitedHealthcare Community & State	$284.14
Rate for Payer: Wellpoint Medicaid Managed Care	$312.44

SHELL ACETABULR 3H 62 CP158127

Facility

$10,090.00

Hospital Charge Code	270641541
Hospital Revenue Code	278
Min. Negotiated Rate	$243.17
Max. Negotiated Rate	$5,045.00
Rate for Payer: Aetna Commercial	$3,834.20
Rate for Payer: Aetna Medicare Advantage	$3,027.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,572.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,572.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,018.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,572.95
Rate for Payer: Cigna Commercial	$5,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,441.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,219.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,513.50
Rate for Payer: UnitedHealthcare Community & State	$243.17
Rate for Payer: Wellpoint Medicaid Managed Care	$267.38

SHELL ACETABULR 3H 62 CP158127

Facility

$10,090.00

Hospital Charge Code	270641541
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.50
Max. Negotiated Rate	$2,441.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,018.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,441.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,219.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,513.50

SHELL ACET LTD G7 PPS 60 G

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690625
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

SHELL ACET LTD G7 PPS 60 G

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

SHELL ACET LTD PPS G7 50 MM

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689753
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 ACET LTD PPS G7 50 MM

Facility

$6,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689753
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 ACET OSSEO TI SZ3 50MM

Facility

$18,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270679688
Hospital Revenue Code	278
Min. Negotiated Rate	$2,848.50
Max. Negotiated Rate	$4,595.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,798.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,595.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,177.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,848.50

SHELL ACET OSSEO TI SZ3 50MM

Facility

$18,990.00

Service Code	HCPCS C1776
Hospital Charge Code	270679688
Hospital Revenue Code	278
Min. Negotiated Rate	$457.66
Max. Negotiated Rate	$9,495.00
Rate for Payer: Aetna Commercial	$7,216.20
Rate for Payer: Aetna Medicare Advantage	$5,697.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,842.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,842.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,798.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,842.45
Rate for Payer: Cigna Commercial	$9,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,595.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,177.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,848.50
Rate for Payer: UnitedHealthcare Community & State	$457.66
Rate for Payer: Wellpoint Medicaid Managed Care	$503.24

SHELL ACET TI SOLID 54MM SZ E

Facility

$5,671.60

Service Code	HCPCS C1776
Hospital Charge Code	270692155
Hospital Revenue Code	278
Min. Negotiated Rate	$136.69
Max. Negotiated Rate	$2,835.80
Rate for Payer: Aetna Commercial	$2,155.21
Rate for Payer: Aetna Medicare Advantage	$1,701.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,446.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,446.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,134.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,446.26
Rate for Payer: Cigna Commercial	$2,835.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,372.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,247.75
Rate for Payer: Qualcare PPO/HMO/WC	$850.74
Rate for Payer: UnitedHealthcare Community & State	$136.69
Rate for Payer: Wellpoint Medicaid Managed Care	$150.30

SHELL ACET TI SOLID 54MM SZ E

Facility

$5,671.60

Service Code	HCPCS C1776
Hospital Charge Code	270692155
Hospital Revenue Code	278
Min. Negotiated Rate	$850.74
Max. Negotiated Rate	$1,372.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,134.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,372.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,247.75
Rate for Payer: Qualcare PPO/HMO/WC	$850.74

Know your out-of-pocket cost for care.

All Charges