Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHELL TRITANIUM HEMI S 58MM

Facility

$5,625.90

Service Code	HCPCS C1776
Hospital Charge Code	270681086
Hospital Revenue Code	278
Min. Negotiated Rate	$135.58
Max. Negotiated Rate	$2,812.95
Rate for Payer: Aetna Commercial	$2,137.84
Rate for Payer: Aetna Medicare Advantage	$1,687.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.60
Rate for Payer: Cigna Commercial	$2,812.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.70
Rate for Payer: Qualcare PPO/HMO/WC	$843.88
Rate for Payer: UnitedHealthcare Community & State	$135.58
Rate for Payer: Wellpoint Medicaid Managed Care	$149.09

SHELL TRITANIUM HEMI S 58MM

Facility

$5,625.90

Service Code	HCPCS C1776
Hospital Charge Code	270681086
Hospital Revenue Code	278
Min. Negotiated Rate	$843.88
Max. Negotiated Rate	$1,361.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.70
Rate for Payer: Qualcare PPO/HMO/WC	$843.88

SHELL TRITANIUM HEMISPHER 50MM

Facility

$12,083.50

Service Code	HCPCS C1776
Hospital Charge Code	270680443
Hospital Revenue Code	278
Min. Negotiated Rate	$291.21
Max. Negotiated Rate	$6,041.75
Rate for Payer: Aetna Commercial	$4,591.73
Rate for Payer: Aetna Medicare Advantage	$3,625.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,081.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,081.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,416.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,081.29
Rate for Payer: Cigna Commercial	$6,041.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,924.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,658.37
Rate for Payer: Qualcare PPO/HMO/WC	$1,812.53
Rate for Payer: UnitedHealthcare Community & State	$291.21
Rate for Payer: Wellpoint Medicaid Managed Care	$320.21

SHELL TRITANIUM HEMISPHER 50MM

Facility

$12,083.50

Service Code	HCPCS C1776
Hospital Charge Code	270680443
Hospital Revenue Code	278
Min. Negotiated Rate	$1,812.53
Max. Negotiated Rate	$2,924.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,416.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,924.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,658.37
Rate for Payer: Qualcare PPO/HMO/WC	$1,812.53

SHELL TRITANIUM HEMISPHER 52MM

Facility

$6,506.50

Service Code	HCPCS C1776
Hospital Charge Code	270671317
Hospital Revenue Code	278
Min. Negotiated Rate	$975.98
Max. Negotiated Rate	$1,574.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,301.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,574.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,431.43
Rate for Payer: Qualcare PPO/HMO/WC	$975.98

SHELL TRITANIUM HEMISPHER 52MM

Facility

$6,506.50

Service Code	HCPCS C1776
Hospital Charge Code	270671317
Hospital Revenue Code	278
Min. Negotiated Rate	$156.81
Max. Negotiated Rate	$3,253.25
Rate for Payer: Aetna Commercial	$2,472.47
Rate for Payer: Aetna Medicare Advantage	$1,951.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,659.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,659.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,301.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,659.16
Rate for Payer: Cigna Commercial	$3,253.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,574.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,431.43
Rate for Payer: Qualcare PPO/HMO/WC	$975.98
Rate for Payer: UnitedHealthcare Community & State	$156.81
Rate for Payer: Wellpoint Medicaid Managed Care	$172.42

SHELL TRITANIUM HEMISPHER 54MM

Facility

$6,506.50

Service Code	HCPCS C1776
Hospital Charge Code	270676579
Hospital Revenue Code	278
Min. Negotiated Rate	$156.81
Max. Negotiated Rate	$3,253.25
Rate for Payer: Aetna Commercial	$2,472.47
Rate for Payer: Aetna Medicare Advantage	$1,951.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,659.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,659.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,301.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,659.16
Rate for Payer: Cigna Commercial	$3,253.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,574.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,431.43
Rate for Payer: Qualcare PPO/HMO/WC	$975.98
Rate for Payer: UnitedHealthcare Community & State	$156.81
Rate for Payer: Wellpoint Medicaid Managed Care	$172.42

SHELL TRITANIUM HEMISPHER 54MM

Facility

$6,506.50

Service Code	HCPCS C1776
Hospital Charge Code	270676579
Hospital Revenue Code	278
Min. Negotiated Rate	$975.98
Max. Negotiated Rate	$1,574.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,301.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,574.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,431.43
Rate for Payer: Qualcare PPO/HMO/WC	$975.98

SHELL ZIM ACETAB 48MM 62004820

Facility

$8,803.25

Hospital Charge Code	270621551
Hospital Revenue Code	278
Min. Negotiated Rate	$1,320.49
Max. Negotiated Rate	$2,130.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,760.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,130.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,936.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.49

SHELL ZIM ACETAB 48MM 62004820

Facility

$8,803.25

Hospital Charge Code	270621551
Hospital Revenue Code	278
Min. Negotiated Rate	$212.16
Max. Negotiated Rate	$4,401.62
Rate for Payer: Aetna Commercial	$3,345.24
Rate for Payer: Aetna Medicare Advantage	$2,640.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,244.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,244.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,760.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,244.83
Rate for Payer: Cigna Commercial	$4,401.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,130.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,936.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.49
Rate for Payer: UnitedHealthcare Community & State	$212.16
Rate for Payer: Wellpoint Medicaid Managed Care	$233.29

SHELL ZIM ACETAB 50MM 62005020

Facility

$4,500.85

Hospital Charge Code	270615366
Hospital Revenue Code	278
Min. Negotiated Rate	$108.47
Max. Negotiated Rate	$2,250.43
Rate for Payer: Aetna Commercial	$1,710.32
Rate for Payer: Aetna Medicare Advantage	$1,350.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.72
Rate for Payer: Cigna Commercial	$2,250.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.19
Rate for Payer: Qualcare PPO/HMO/WC	$675.13
Rate for Payer: UnitedHealthcare Community & State	$108.47
Rate for Payer: Wellpoint Medicaid Managed Care	$119.27

SHELL ZIM ACETAB 50MM 62005020

Facility

$4,500.85

Hospital Charge Code	270615366
Hospital Revenue Code	278
Min. Negotiated Rate	$675.13
Max. Negotiated Rate	$1,089.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.19
Rate for Payer: Qualcare PPO/HMO/WC	$675.13

SHELL ZIM ACETAB 52MM 62005220

Facility

$4,633.65

Hospital Charge Code	270619101
Hospital Revenue Code	278
Min. Negotiated Rate	$695.05
Max. Negotiated Rate	$1,121.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$926.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,121.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,019.40
Rate for Payer: Qualcare PPO/HMO/WC	$695.05

SHELL ZIM ACETAB 52MM 62005220

Facility

$4,633.65

Hospital Charge Code	270619101
Hospital Revenue Code	278
Min. Negotiated Rate	$111.67
Max. Negotiated Rate	$2,316.82
Rate for Payer: Aetna Commercial	$1,760.79
Rate for Payer: Aetna Medicare Advantage	$1,390.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,181.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,181.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$926.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,181.58
Rate for Payer: Cigna Commercial	$2,316.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,121.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,019.40
Rate for Payer: Qualcare PPO/HMO/WC	$695.05
Rate for Payer: UnitedHealthcare Community & State	$111.67
Rate for Payer: Wellpoint Medicaid Managed Care	$122.79

SHELL ZIM ACETAB 54MM 62005420

Facility

$4,717.65

Hospital Charge Code	270612226
Hospital Revenue Code	278
Min. Negotiated Rate	$113.70
Max. Negotiated Rate	$2,358.82
Rate for Payer: Aetna Commercial	$1,792.71
Rate for Payer: Aetna Medicare Advantage	$1,415.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$943.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,203.00
Rate for Payer: Cigna Commercial	$2,358.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,141.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,037.88
Rate for Payer: Qualcare PPO/HMO/WC	$707.65
Rate for Payer: UnitedHealthcare Community & State	$113.70
Rate for Payer: Wellpoint Medicaid Managed Care	$125.02

SHELL ZIM ACETAB 54MM 62005420

Facility

$4,717.65

Hospital Charge Code	270612226
Hospital Revenue Code	278
Min. Negotiated Rate	$707.65
Max. Negotiated Rate	$1,141.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$943.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,141.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,037.88
Rate for Payer: Qualcare PPO/HMO/WC	$707.65

SHELL ZIM ACETAB 56MM 62005620

Facility

$6,235.25

Hospital Charge Code	270605651
Hospital Revenue Code	278
Min. Negotiated Rate	$935.29
Max. Negotiated Rate	$1,508.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,247.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,508.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,371.76
Rate for Payer: Qualcare PPO/HMO/WC	$935.29

SHELL ZIM ACETAB 56MM 62005620

Facility

$6,235.25

Hospital Charge Code	270605651
Hospital Revenue Code	278
Min. Negotiated Rate	$150.27
Max. Negotiated Rate	$3,117.62
Rate for Payer: Aetna Commercial	$2,369.39
Rate for Payer: Aetna Medicare Advantage	$1,870.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,589.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,589.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,247.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,589.99
Rate for Payer: Cigna Commercial	$3,117.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,508.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,371.76
Rate for Payer: Qualcare PPO/HMO/WC	$935.29
Rate for Payer: UnitedHealthcare Community & State	$150.27
Rate for Payer: Wellpoint Medicaid Managed Care	$165.23

SHELL ZIM ACETAB 56MM 62005622

Facility

$5,996.10

Hospital Charge Code	270608926
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 ZIM ACETAB 56MM 62005622

Facility

$5,996.10

Hospital Charge Code	270608926
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 ZIM ACETAB 58 62005822

Facility

$4,552.85

Hospital Charge Code	270626486
Hospital Revenue Code	278
Min. Negotiated Rate	$109.72
Max. Negotiated Rate	$2,276.43
Rate for Payer: Aetna Commercial	$1,730.08
Rate for Payer: Aetna Medicare Advantage	$1,365.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,160.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,160.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$910.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,160.98
Rate for Payer: Cigna Commercial	$2,276.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,101.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,001.63
Rate for Payer: Qualcare PPO/HMO/WC	$682.93
Rate for Payer: UnitedHealthcare Community & State	$109.72
Rate for Payer: Wellpoint Medicaid Managed Care	$120.65

SHELL ZIM ACETAB 58 62005822

Facility

$4,552.85

Hospital Charge Code	270626486
Hospital Revenue Code	278
Min. Negotiated Rate	$682.93
Max. Negotiated Rate	$1,101.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$910.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,101.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,001.63
Rate for Payer: Qualcare PPO/HMO/WC	$682.93

SHELL ZIM ACETAB 60MM 62006020

Facility

$6,537.65

Hospital Charge Code	270605998
Hospital Revenue Code	278
Min. Negotiated Rate	$980.65
Max. Negotiated Rate	$1,582.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,582.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,438.28
Rate for Payer: Qualcare PPO/HMO/WC	$980.65

SHELL ZIM ACETAB 60MM 62006020

Facility

$6,537.65

Hospital Charge Code	270605998
Hospital Revenue Code	278
Min. Negotiated Rate	$157.56
Max. Negotiated Rate	$3,268.82
Rate for Payer: Aetna Commercial	$2,484.31
Rate for Payer: Aetna Medicare Advantage	$1,961.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,667.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,667.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,667.10
Rate for Payer: Cigna Commercial	$3,268.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,582.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,438.28
Rate for Payer: Qualcare PPO/HMO/WC	$980.65
Rate for Payer: UnitedHealthcare Community & State	$157.56
Rate for Payer: Wellpoint Medicaid Managed Care	$173.25

SHELL ZIM ACETAB 62MM 62006220

Facility

$4,717.65

Hospital Charge Code	270611866
Hospital Revenue Code	278
Min. Negotiated Rate	$113.70
Max. Negotiated Rate	$2,358.82
Rate for Payer: Aetna Commercial	$1,792.71
Rate for Payer: Aetna Medicare Advantage	$1,415.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$943.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,203.00
Rate for Payer: Cigna Commercial	$2,358.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,141.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,037.88
Rate for Payer: Qualcare PPO/HMO/WC	$707.65
Rate for Payer: UnitedHealthcare Community & State	$113.70
Rate for Payer: Wellpoint Medicaid Managed Care	$125.02

Know your out-of-pocket cost for care.

All Charges