Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ACETABULAR LINER

Facility

$9,265.00

Service Code	HCPCS C1776
Hospital Charge Code	270668427
Hospital Revenue Code	278
Min. Negotiated Rate	$223.29
Max. Negotiated Rate	$4,632.50
Rate for Payer: Aetna Commercial	$3,520.70
Rate for Payer: Aetna Medicare Advantage	$2,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,362.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,362.57
Rate for Payer: Cigna Commercial	$4,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,242.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,038.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,389.75
Rate for Payer: UnitedHealthcare Community & State	$223.29
Rate for Payer: Wellpoint Medicaid Managed Care	$245.52

ACETABULAR LINER

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270664059
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

ACETABULAR LINER 36MM.

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270703610
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

ACETABULAR LINER 36MM.

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270703610
Hospital Revenue Code	278
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

ACETABULAR LINER +4 EL-28/44

Facility

$6,995.00

Hospital Charge Code	270669136
Hospital Revenue Code	278
Min. Negotiated Rate	$168.58
Max. Negotiated Rate	$3,497.50
Rate for Payer: Aetna Commercial	$2,658.10
Rate for Payer: Aetna Medicare Advantage	$2,098.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,783.72
Rate for Payer: Cigna Commercial	$3,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25
Rate for Payer: UnitedHealthcare Community & State	$168.58
Rate for Payer: Wellpoint Medicaid Managed Care	$185.37

ACETABULAR LINER +4 EL-28/44

Facility

$6,995.00

Hospital Charge Code	270669136
Hospital Revenue Code	278
Min. Negotiated Rate	$1,049.25
Max. Negotiated Rate	$1,692.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25

ACETABULAR LINER +4 EL-28/46

Facility

$6,995.00

Hospital Charge Code	270669137
Hospital Revenue Code	278
Min. Negotiated Rate	$168.58
Max. Negotiated Rate	$3,497.50
Rate for Payer: Aetna Commercial	$2,658.10
Rate for Payer: Aetna Medicare Advantage	$2,098.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,783.72
Rate for Payer: Cigna Commercial	$3,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25
Rate for Payer: UnitedHealthcare Community & State	$168.58
Rate for Payer: Wellpoint Medicaid Managed Care	$185.37

ACETABULAR LINER +4 EL-28/46

Facility

$6,995.00

Hospital Charge Code	270669137
Hospital Revenue Code	278
Min. Negotiated Rate	$1,049.25
Max. Negotiated Rate	$1,692.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25

ACETABULAR LINER +4 EL-28/48

Facility

$6,995.00

Hospital Charge Code	270669138
Hospital Revenue Code	278
Min. Negotiated Rate	$1,049.25
Max. Negotiated Rate	$1,692.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25

ACETABULAR LINER +4 EL-28/48

Facility

$6,995.00

Hospital Charge Code	270669138
Hospital Revenue Code	278
Min. Negotiated Rate	$168.58
Max. Negotiated Rate	$3,497.50
Rate for Payer: Aetna Commercial	$2,658.10
Rate for Payer: Aetna Medicare Advantage	$2,098.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,783.72
Rate for Payer: Cigna Commercial	$3,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25
Rate for Payer: UnitedHealthcare Community & State	$168.58
Rate for Payer: Wellpoint Medicaid Managed Care	$185.37

ACETABULAR LINER +4 EL-28/50

Facility

$6,995.00

Hospital Charge Code	270669139
Hospital Revenue Code	278
Min. Negotiated Rate	$168.58
Max. Negotiated Rate	$3,497.50
Rate for Payer: Aetna Commercial	$2,658.10
Rate for Payer: Aetna Medicare Advantage	$2,098.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,783.72
Rate for Payer: Cigna Commercial	$3,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25
Rate for Payer: UnitedHealthcare Community & State	$168.58
Rate for Payer: Wellpoint Medicaid Managed Care	$185.37

ACETABULAR LINER +4 EL-28/50

Facility

$6,995.00

Hospital Charge Code	270669139
Hospital Revenue Code	278
Min. Negotiated Rate	$1,049.25
Max. Negotiated Rate	$1,692.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25

ACETABULAR LINER +4 EL-28/52

Facility

$6,995.00

Hospital Charge Code	270669140
Hospital Revenue Code	278
Min. Negotiated Rate	$168.58
Max. Negotiated Rate	$3,497.50
Rate for Payer: Aetna Commercial	$2,658.10
Rate for Payer: Aetna Medicare Advantage	$2,098.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,783.72
Rate for Payer: Cigna Commercial	$3,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25
Rate for Payer: UnitedHealthcare Community & State	$168.58
Rate for Payer: Wellpoint Medicaid Managed Care	$185.37

ACETABULAR LINER +4 EL-28/52

Facility

$6,995.00

Hospital Charge Code	270669140
Hospital Revenue Code	278
Min. Negotiated Rate	$1,049.25
Max. Negotiated Rate	$1,692.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25

ACETABULAR LINER +4 EL-28/54

Facility

$6,995.00

Hospital Charge Code	270669141
Hospital Revenue Code	278
Min. Negotiated Rate	$1,049.25
Max. Negotiated Rate	$1,692.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25

ACETABULAR LINER +4 EL-28/54

Facility

$6,995.00

Hospital Charge Code	270669141
Hospital Revenue Code	278
Min. Negotiated Rate	$168.58
Max. Negotiated Rate	$3,497.50
Rate for Payer: Aetna Commercial	$2,658.10
Rate for Payer: Aetna Medicare Advantage	$2,098.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,783.72
Rate for Payer: Cigna Commercial	$3,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25
Rate for Payer: UnitedHealthcare Community & State	$168.58
Rate for Payer: Wellpoint Medicaid Managed Care	$185.37

ACETABULAR LINER +4 EL-28/56

Facility

$6,995.00

Hospital Charge Code	270669142
Hospital Revenue Code	278
Min. Negotiated Rate	$1,049.25
Max. Negotiated Rate	$1,692.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25

ACETABULAR LINER +4 EL-28/56

Facility

$6,995.00

Hospital Charge Code	270669142
Hospital Revenue Code	278
Min. Negotiated Rate	$168.58
Max. Negotiated Rate	$3,497.50
Rate for Payer: Aetna Commercial	$2,658.10
Rate for Payer: Aetna Medicare Advantage	$2,098.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,783.72
Rate for Payer: Cigna Commercial	$3,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25
Rate for Payer: UnitedHealthcare Community & State	$168.58
Rate for Payer: Wellpoint Medicaid Managed Care	$185.37

ACETABULAR LINER +4 EL-32/48

Facility

$6,995.00

Hospital Charge Code	270669146
Hospital Revenue Code	278
Min. Negotiated Rate	$168.58
Max. Negotiated Rate	$3,497.50
Rate for Payer: Aetna Commercial	$2,658.10
Rate for Payer: Aetna Medicare Advantage	$2,098.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,783.72
Rate for Payer: Cigna Commercial	$3,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25
Rate for Payer: UnitedHealthcare Community & State	$168.58
Rate for Payer: Wellpoint Medicaid Managed Care	$185.37

ACETABULAR LINER +4 EL-32/48

Facility

$6,995.00

Hospital Charge Code	270669146
Hospital Revenue Code	278
Min. Negotiated Rate	$1,049.25
Max. Negotiated Rate	$1,692.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25

ACETABULAR LINER +4 EL-32/50

Facility

$6,995.00

Hospital Charge Code	270669147
Hospital Revenue Code	278
Min. Negotiated Rate	$168.58
Max. Negotiated Rate	$3,497.50
Rate for Payer: Aetna Commercial	$2,658.10
Rate for Payer: Aetna Medicare Advantage	$2,098.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,783.72
Rate for Payer: Cigna Commercial	$3,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25
Rate for Payer: UnitedHealthcare Community & State	$168.58
Rate for Payer: Wellpoint Medicaid Managed Care	$185.37

ACETABULAR LINER +4 EL-32/50

Facility

$6,995.00

Hospital Charge Code	270669147
Hospital Revenue Code	278
Min. Negotiated Rate	$1,049.25
Max. Negotiated Rate	$1,692.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25

ACETABULAR LINER +4 EL-32/52

Facility

$6,995.00

Hospital Charge Code	270669148
Hospital Revenue Code	278
Min. Negotiated Rate	$1,049.25
Max. Negotiated Rate	$1,692.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25

ACETABULAR LINER +4 EL-32/52

Facility

$6,995.00

Hospital Charge Code	270669148
Hospital Revenue Code	278
Min. Negotiated Rate	$168.58
Max. Negotiated Rate	$3,497.50
Rate for Payer: Aetna Commercial	$2,658.10
Rate for Payer: Aetna Medicare Advantage	$2,098.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,783.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,783.72
Rate for Payer: Cigna Commercial	$3,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25
Rate for Payer: UnitedHealthcare Community & State	$168.58
Rate for Payer: Wellpoint Medicaid Managed Care	$185.37

ACETABULAR LINER +4 EL-32/54

Facility

$6,995.00

Hospital Charge Code	270669149
Hospital Revenue Code	278
Min. Negotiated Rate	$1,049.25
Max. Negotiated Rate	$1,692.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,399.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,692.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,538.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,049.25

Know your out-of-pocket cost for care.

All Charges