Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHELL RAD 3HOL 56mm 12-104156

Facility

$6,477.65

Hospital Charge Code	270630536
Hospital Revenue Code	278
Min. Negotiated Rate	$971.65
Max. Negotiated Rate	$1,567.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,567.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,425.08
Rate for Payer: Qualcare PPO/HMO/WC	$971.65

SHELL RADIAL 3H 24x64 12104164

Facility

$6,289.35

Hospital Charge Code	270632966
Hospital Revenue Code	278
Min. Negotiated Rate	$151.57
Max. Negotiated Rate	$3,144.68
Rate for Payer: Aetna Commercial	$2,389.95
Rate for Payer: Aetna Medicare Advantage	$1,886.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,603.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,603.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,257.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,603.78
Rate for Payer: Cigna Commercial	$3,144.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,522.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,383.66
Rate for Payer: Qualcare PPO/HMO/WC	$943.40
Rate for Payer: UnitedHealthcare Community & State	$151.57
Rate for Payer: Wellpoint Medicaid Managed Care	$166.67

SHELL RADIAL 3H 24x64 12104164

Facility

$6,289.35

Hospital Charge Code	270632966
Hospital Revenue Code	278
Min. Negotiated Rate	$943.40
Max. Negotiated Rate	$1,522.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,257.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,522.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,383.66
Rate for Payer: Qualcare PPO/HMO/WC	$943.40

SHELL RINGLOC ACETABULAR 54MM

Facility

$7,965.00

Hospital Charge Code	270664896
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 RINGLOC ACETABULAR 54MM

Facility

$7,965.00

Hospital Charge Code	270664896
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 RINGLOC ACETABULAR 60 MM

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675682
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 RINGLOC ACETABULAR 60 MM

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675682
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 SHORT 29MM

Facility

$10,000.00

Hospital Charge Code	270702407
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 SHORT 29MM

Facility

$10,000.00

Hospital Charge Code	270702407
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 SHORT 30MM FLAREHAWK

Facility

$18,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270692112
Hospital Revenue Code	278
Min. Negotiated Rate	$439.82
Max. Negotiated Rate	$9,125.00
Rate for Payer: Aetna Commercial	$6,935.00
Rate for Payer: Aetna Medicare Advantage	$5,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,653.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,653.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,653.75
Rate for Payer: Cigna Commercial	$9,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,416.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,015.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,737.50
Rate for Payer: UnitedHealthcare Community & State	$439.82
Rate for Payer: Wellpoint Medicaid Managed Care	$483.62

SHELL SHORT 30MM FLAREHAWK

Facility

$18,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270692112
Hospital Revenue Code	278
Min. Negotiated Rate	$2,737.50
Max. Negotiated Rate	$4,416.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,416.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,015.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,737.50

SHELL TRIDENT II 3H SZ C 46MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270691375
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

SHELL TRIDENT II 3H SZ C 46MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270691375
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SHELL TRIDENT II CLUSTER 52mm

Facility

$6,055.50

Service Code	HCPCS C1776
Hospital Charge Code	270685519
Hospital Revenue Code	278
Min. Negotiated Rate	$908.33
Max. Negotiated Rate	$1,465.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,211.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,465.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,332.21
Rate for Payer: Qualcare PPO/HMO/WC	$908.33

SHELL TRIDENT II CLUSTER 52mm

Facility

$6,055.50

Service Code	HCPCS C1776
Hospital Charge Code	270685519
Hospital Revenue Code	278
Min. Negotiated Rate	$145.94
Max. Negotiated Rate	$3,027.75
Rate for Payer: Aetna Commercial	$2,301.09
Rate for Payer: Aetna Medicare Advantage	$1,816.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,544.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,544.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,211.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,544.15
Rate for Payer: Cigna Commercial	$3,027.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,465.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,332.21
Rate for Payer: Qualcare PPO/HMO/WC	$908.33
Rate for Payer: UnitedHealthcare Community & State	$145.94
Rate for Payer: Wellpoint Medicaid Managed Care	$160.47

SHELL TRIDENT II CLUSTER 52MM

Facility

$6,055.00

Service Code	HCPCS C1776
Hospital Charge Code	270686454
Hospital Revenue Code	278
Min. Negotiated Rate	$908.25
Max. Negotiated Rate	$1,465.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,211.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,465.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,332.10
Rate for Payer: Qualcare PPO/HMO/WC	$908.25

SHELL TRIDENT II CLUSTER 52MM

Facility

$6,055.00

Service Code	HCPCS C1776
Hospital Charge Code	270686454
Hospital Revenue Code	278
Min. Negotiated Rate	$145.93
Max. Negotiated Rate	$3,027.50
Rate for Payer: Aetna Commercial	$2,300.90
Rate for Payer: Aetna Medicare Advantage	$1,816.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,544.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,544.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,211.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,544.03
Rate for Payer: Cigna Commercial	$3,027.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,465.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,332.10
Rate for Payer: Qualcare PPO/HMO/WC	$908.25
Rate for Payer: UnitedHealthcare Community & State	$145.93
Rate for Payer: Wellpoint Medicaid Managed Care	$160.46

SHELL TRIDENTII TRITANIUM 54MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686547
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

SHELL TRIDENTII TRITANIUM 54MM

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686547
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SHELL TRIDENT II TRITA SOL 52E

Facility

$5,697.75

Service Code	HCPCS C1776
Hospital Charge Code	270693166
Hospital Revenue Code	278
Min. Negotiated Rate	$137.32
Max. Negotiated Rate	$2,848.88
Rate for Payer: Aetna Commercial	$2,165.14
Rate for Payer: Aetna Medicare Advantage	$1,709.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,452.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,452.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,139.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,452.93
Rate for Payer: Cigna Commercial	$2,848.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,253.51
Rate for Payer: Qualcare PPO/HMO/WC	$854.66
Rate for Payer: UnitedHealthcare Community & State	$137.32
Rate for Payer: Wellpoint Medicaid Managed Care	$150.99

SHELL TRIDENT II TRITA SOL 52E

Facility

$5,697.75

Service Code	HCPCS C1776
Hospital Charge Code	270693166
Hospital Revenue Code	278
Min. Negotiated Rate	$854.66
Max. Negotiated Rate	$1,378.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,139.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,253.51
Rate for Payer: Qualcare PPO/HMO/WC	$854.66

SHELL TRID TRITA CLUSHLE 60MM

Facility

$6,808.15

Service Code	HCPCS C1776
Hospital Charge Code	270659458
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 TRID TRITA CLUSHLE 60MM

Facility

$6,808.15

Service Code	HCPCS C1776
Hospital Charge Code	270659458
Hospital Revenue Code	278
Min. Negotiated Rate	$164.08
Max. Negotiated Rate	$3,404.07
Rate for Payer: Aetna Commercial	$2,587.10
Rate for Payer: Aetna Medicare Advantage	$2,042.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,736.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,736.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,361.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,736.08
Rate for Payer: Cigna Commercial	$3,404.07
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
Rate for Payer: UnitedHealthcare Community & State	$164.08
Rate for Payer: Wellpoint Medicaid Managed Care	$180.42

SHELL TRITANIUM HEMI S 48MM

Facility

$6,433.45

Service Code	HCPCS C1776
Hospital Charge Code	270682913
Hospital Revenue Code	278
Min. Negotiated Rate	$965.02
Max. Negotiated Rate	$1,556.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,286.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,556.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,415.36
Rate for Payer: Qualcare PPO/HMO/WC	$965.02

SHELL TRITANIUM HEMI S 48MM

Facility

$6,433.45

Service Code	HCPCS C1776
Hospital Charge Code	270682913
Hospital Revenue Code	278
Min. Negotiated Rate	$155.05
Max. Negotiated Rate	$3,216.72
Rate for Payer: Aetna Commercial	$2,444.71
Rate for Payer: Aetna Medicare Advantage	$1,930.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,640.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,640.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,286.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,640.53
Rate for Payer: Cigna Commercial	$3,216.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,556.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,415.36
Rate for Payer: Qualcare PPO/HMO/WC	$965.02
Rate for Payer: UnitedHealthcare Community & State	$155.05
Rate for Payer: Wellpoint Medicaid Managed Care	$170.49

Know your out-of-pocket cost for care.

All Charges