Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BIOLOX DELTA MOD HEAD 40MM MED

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270706200
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

BIOLOX DELTA MOD HEAD 40MM MED

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270706200
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

BIOLOX DELTA OPTION 36MM 3MM

Facility

$12,262.75

Service Code	HCPCS C1713
Hospital Charge Code	270706205
Hospital Revenue Code	278
Min. Negotiated Rate	$1,839.41
Max. Negotiated Rate	$2,967.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,452.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,967.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,697.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,839.41

BIOLOX DELTA OPTION 36MM 3MM

Facility

$12,262.75

Service Code	HCPCS C1713
Hospital Charge Code	270706205
Hospital Revenue Code	278
Min. Negotiated Rate	$295.53
Max. Negotiated Rate	$6,131.38
Rate for Payer: Aetna Commercial	$4,659.85
Rate for Payer: Aetna Medicare Advantage	$3,678.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,127.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,127.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,452.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,127.00
Rate for Payer: Cigna Commercial	$6,131.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,967.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,697.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,839.41
Rate for Payer: UnitedHealthcare Community & State	$295.53
Rate for Payer: Wellpoint Medicaid Managed Care	$324.96

BIOLOX DELTA TA FEM HEAD 36

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270667178
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

BIOLOX DELTA TA FEM HEAD 36

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270667178
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

BIOLOX MOD CERAMIC HEAD36MM

Facility

$1,949.00

Service Code	HCPCS C1713
Hospital Charge Code	270702515
Hospital Revenue Code	278
Min. Negotiated Rate	$46.97
Max. Negotiated Rate	$974.50
Rate for Payer: Aetna Commercial	$740.62
Rate for Payer: Aetna Medicare Advantage	$584.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$497.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$497.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$389.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$497.00
Rate for Payer: Cigna Commercial	$974.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$428.78
Rate for Payer: Qualcare PPO/HMO/WC	$292.35
Rate for Payer: UnitedHealthcare Community & State	$46.97
Rate for Payer: Wellpoint Medicaid Managed Care	$51.65

BIOLOX MOD CERAMIC HEAD36MM

Facility

$1,949.00

Service Code	HCPCS C1713
Hospital Charge Code	270702515
Hospital Revenue Code	278
Min. Negotiated Rate	$292.35
Max. Negotiated Rate	$471.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$389.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$428.78
Rate for Payer: Qualcare PPO/HMO/WC	$292.35

BIOLOX MODULAR CERAMIC HEAD 36

Facility

$5,995.00

Service Code	HCPCS C1713
Hospital Charge Code	270702514
Hospital Revenue Code	278
Min. Negotiated Rate	$899.25
Max. Negotiated Rate	$1,450.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,450.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,318.90
Rate for Payer: Qualcare PPO/HMO/WC	$899.25

BIOLOX MODULAR CERAMIC HEAD 36

Facility

$5,995.00

Service Code	HCPCS C1713
Hospital Charge Code	270702514
Hospital Revenue Code	278
Min. Negotiated Rate	$144.48
Max. Negotiated Rate	$2,997.50
Rate for Payer: Aetna Commercial	$2,278.10
Rate for Payer: Aetna Medicare Advantage	$1,798.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,528.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,528.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,199.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,528.72
Rate for Payer: Cigna Commercial	$2,997.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,450.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,318.90
Rate for Payer: Qualcare PPO/HMO/WC	$899.25
Rate for Payer: UnitedHealthcare Community & State	$144.48
Rate for Payer: Wellpoint Medicaid Managed Care	$158.87

BIOMESH CLLGN 8cmX12cm 481812

Facility

$5,828.00

Hospital Charge Code	270635508
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,914.00
Rate for Payer: Aetna Commercial	$2,214.64
Rate for Payer: Aetna Medicare Advantage	$1,748.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,486.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,486.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,165.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,486.14
Rate for Payer: Cigna Commercial	$2,914.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,410.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,282.16
Rate for Payer: Qualcare PPO/HMO/WC	$874.20
Rate for Payer: UnitedHealthcare Community & State	$140.45
Rate for Payer: Wellpoint Medicaid Managed Care	$154.44

BIOMESH CLLGN 8cmX12cm 481812

Facility

$5,828.00

Hospital Charge Code	270635508
Hospital Revenue Code	278
Min. Negotiated Rate	$874.20
Max. Negotiated Rate	$1,410.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,165.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,410.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,282.16
Rate for Payer: Qualcare PPO/HMO/WC	$874.20

BIOMET END CAP OFFSET 5MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	270645062
Hospital Revenue Code	278
Min. Negotiated Rate	$103.50
Max. Negotiated Rate	$166.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.80
Rate for Payer: Qualcare PPO/HMO/WC	$103.50

BIOMET END CAP OFFSET 5MM

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	270645062
Hospital Revenue Code	278
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$345.00
Rate for Payer: Aetna Commercial	$262.20
Rate for Payer: Aetna Medicare Advantage	$207.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.95
Rate for Payer: Cigna Commercial	$345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.80
Rate for Payer: Qualcare PPO/HMO/WC	$103.50
Rate for Payer: UnitedHealthcare Community & State	$16.63
Rate for Payer: Wellpoint Medicaid Managed Care	$18.29

BIOMET ILOK STEM TIB TRAY 75MM

Facility

$10,416.65

Service Code	HCPCS C1776
Hospital Charge Code	270685140
Hospital Revenue Code	278
Min. Negotiated Rate	$251.04
Max. Negotiated Rate	$5,208.32
Rate for Payer: Aetna Commercial	$3,958.33
Rate for Payer: Aetna Medicare Advantage	$3,124.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,656.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,656.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,083.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,656.25
Rate for Payer: Cigna Commercial	$5,208.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,520.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,291.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,562.50
Rate for Payer: UnitedHealthcare Community & State	$251.04
Rate for Payer: Wellpoint Medicaid Managed Care	$276.04

BIOMET ILOK STEM TIB TRAY 75MM

Facility

$10,416.65

Service Code	HCPCS C1776
Hospital Charge Code	270685140
Hospital Revenue Code	278
Min. Negotiated Rate	$1,562.50
Max. Negotiated Rate	$2,520.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,083.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,520.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,291.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,562.50

BIOMET ILOK STEM TIB TRAY 79MM

Facility

$14,160.00

Service Code	HCPCS C1776
Hospital Charge Code	270681757
Hospital Revenue Code	278
Min. Negotiated Rate	$2,124.00
Max. Negotiated Rate	$3,426.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,832.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,426.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,115.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,124.00

BIOMET ILOK STEM TIB TRAY 79MM

Facility

$14,160.00

Service Code	HCPCS C1776
Hospital Charge Code	270681757
Hospital Revenue Code	278
Min. Negotiated Rate	$341.26
Max. Negotiated Rate	$7,080.00
Rate for Payer: Aetna Commercial	$5,380.80
Rate for Payer: Aetna Medicare Advantage	$4,248.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,610.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,610.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,832.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,610.80
Rate for Payer: Cigna Commercial	$7,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,426.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,115.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,124.00
Rate for Payer: UnitedHealthcare Community & State	$341.26
Rate for Payer: Wellpoint Medicaid Managed Care	$375.24

BIOMET TIB BLOCK 10MM 71

Facility

$5,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270690778
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

BIOMET TIB BLOCK 10MM 71

Facility

$5,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270690778
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

BIOMET TIB BLOCK 6MM 71

Facility

$5,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270688653
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

BIOMET TIB BLOCK 6MM 71

Facility

$5,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270688653
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

BIO NDLE FRANSEEN LNG 20G15CM

Facility

$24.35

Hospital Charge Code	270658326
Hospital Revenue Code	272
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$12.18
Rate for Payer: Aetna Commercial	$9.25
Rate for Payer: Aetna Medicare Advantage	$7.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.21
Rate for Payer: Cigna Commercial	$12.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.30
Rate for Payer: Oxford Commercial	$4.87
Rate for Payer: Qualcare PPO/HMO/WC	$3.65
Rate for Payer: UnitedHealthcare Commercial	$4.87
Rate for Payer: UnitedHealthcare Community & State	$0.59
Rate for Payer: Wellpoint Medicaid Managed Care	$0.65

BIO NDLE FRANSEEN LNG 20G15CM

Facility

$24.35

Hospital Charge Code	270658326
Hospital Revenue Code	272
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$3.65
Rate for Payer: Qualcare PPO/HMO/WC	$3.65

BIOPATCH BLUE 1 IN DISK W/7MM

Facility

$34.98

Hospital Charge Code	270671184
Hospital Revenue Code	272
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$17.49
Rate for Payer: Aetna Commercial	$13.29
Rate for Payer: Aetna Medicare Advantage	$10.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.92
Rate for Payer: Cigna Commercial	$17.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.49
Rate for Payer: Oxford Commercial	$7.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$7.00
Rate for Payer: UnitedHealthcare Community & State	$0.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

Know your out-of-pocket cost for care.

All Charges