Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BIPOLAR HEAD 41MM OD 22MM HEAD

Facility

$3,500.00

Hospital Charge Code	270676226
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 44MM

Facility

$3,000.00

Hospital Charge Code	270675288
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

BIPOLAR HEAD 44MM

Facility

$3,000.00

Hospital Charge Code	270675288
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

BIPOLAR HEAD 44MM OD 28MM HEAD

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676159
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 44MM OD 28MM HEAD

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676159
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

BIPOLAR HEAD 45MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675313
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

BIPOLAR HEAD 45MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675313
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 47MM OD 28MM HEAD

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676219
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

BIPOLAR HEAD 47MM OD 28MM HEAD

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676219
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 49MM OD 28MM HEAD

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675841
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

BIPOLAR HEAD 49MM OD 28MM HEAD

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675841
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 50MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675416
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD 50MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675416
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

BIPOLAR HEAD COMP UNIV 44X28MM

Facility

$5,833.30

Service Code	HCPCS C1776
Hospital Charge Code	270697701
Hospital Revenue Code	278
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$1,411.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,166.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,411.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,283.33
Rate for Payer: Qualcare PPO/HMO/WC	$875.00

BIPOLAR HEAD COMP UNIV 44X28MM

Facility

$5,833.30

Service Code	HCPCS C1776
Hospital Charge Code	270697701
Hospital Revenue Code	278
Min. Negotiated Rate	$140.58
Max. Negotiated Rate	$2,916.65
Rate for Payer: Aetna Commercial	$2,216.65
Rate for Payer: Aetna Medicare Advantage	$1,749.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,487.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,487.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,166.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,487.49
Rate for Payer: Cigna Commercial	$2,916.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,411.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,283.33
Rate for Payer: Qualcare PPO/HMO/WC	$875.00
Rate for Payer: UnitedHealthcare Community & State	$140.58
Rate for Payer: Wellpoint Medicaid Managed Care	$154.58

BI-POLAR HEAD SELF CENTERING

Facility

$6,770.00

Service Code	HCPCS C1776
Hospital Charge Code	270663840
Hospital Revenue Code	278
Min. Negotiated Rate	$1,015.50
Max. Negotiated Rate	$1,638.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,354.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,638.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,489.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,015.50

BI-POLAR HEAD SELF CENTERING

Facility

$6,770.00

Service Code	HCPCS C1776
Hospital Charge Code	270663840
Hospital Revenue Code	278
Min. Negotiated Rate	$163.16
Max. Negotiated Rate	$3,385.00
Rate for Payer: Aetna Commercial	$2,572.60
Rate for Payer: Aetna Medicare Advantage	$2,031.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,726.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,726.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,354.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,726.35
Rate for Payer: Cigna Commercial	$3,385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,638.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,489.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,015.50
Rate for Payer: UnitedHealthcare Community & State	$163.16
Rate for Payer: Wellpoint Medicaid Managed Care	$179.41

BIPOLAR HEAD SZ 42MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675406
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

BIPOLAR HEAD SZ 42MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675406
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

BIPOLAR HEAD SZ 44MM HEAD 2

Facility

$14,695.00

Hospital Charge Code	270667793
Hospital Revenue Code	278
Min. Negotiated Rate	$354.15
Max. Negotiated Rate	$7,347.50
Rate for Payer: Aetna Commercial	$5,584.10
Rate for Payer: Aetna Medicare Advantage	$4,408.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,747.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,747.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,939.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,747.22
Rate for Payer: Cigna Commercial	$7,347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,556.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,232.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,204.25
Rate for Payer: UnitedHealthcare Community & State	$354.15
Rate for Payer: Wellpoint Medicaid Managed Care	$389.42

BIPOLAR HEAD SZ 44MM HEAD 2

Facility

$14,695.00

Hospital Charge Code	270667793
Hospital Revenue Code	278
Min. Negotiated Rate	$2,204.25
Max. Negotiated Rate	$3,556.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,939.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,556.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,232.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,204.25

BIPOLAR HIP REPLACEMENT

Facility

$15,113.50

Service Code	HCPCS 27236
Hospital Charge Code	16000869
Hospital Revenue Code	360
Min. Negotiated Rate	$2,267.03
Max. Negotiated Rate	$2,267.03
Rate for Payer: Qualcare PPO/HMO/WC	$2,267.03

BIPOLAR HIP REPLACEMENT

Facility

$15,113.50

Service Code	HCPCS 27236
Hospital Charge Code	16000869
Hospital Revenue Code	360
Min. Negotiated Rate	$364.24
Max. Negotiated Rate	$31,117.67
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,117.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,117.67
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,534.05
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,267.03
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$364.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$400.51

BIPOLAR LINER

Facility

$1,437.55

Hospital Charge Code	270656965
Hospital Revenue Code	278
Min. Negotiated Rate	$34.64
Max. Negotiated Rate	$718.77
Rate for Payer: Aetna Commercial	$546.27
Rate for Payer: Aetna Medicare Advantage	$431.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$366.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$366.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$287.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$366.58
Rate for Payer: Cigna Commercial	$718.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$316.26
Rate for Payer: Qualcare PPO/HMO/WC	$215.63
Rate for Payer: UnitedHealthcare Community & State	$34.64
Rate for Payer: Wellpoint Medicaid Managed Care	$38.10

BIPOLAR LINER

Facility

$1,437.55

Hospital Charge Code	270656965
Hospital Revenue Code	278
Min. Negotiated Rate	$215.63
Max. Negotiated Rate	$347.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$287.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$316.26
Rate for Payer: Qualcare PPO/HMO/WC	$215.63

Know your out-of-pocket cost for care.

All Charges