Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEM AUG VNGRD DIST65X10 RL/RM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672832
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FEM COMP PS TRIATH PS LT SZ5

Facility

$7,971.40

Service Code	HCPCS C1776
Hospital Charge Code	270694177
Hospital Revenue Code	278
Min. Negotiated Rate	$192.11
Max. Negotiated Rate	$3,985.70
Rate for Payer: Aetna Commercial	$3,029.13
Rate for Payer: Aetna Medicare Advantage	$2,391.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,032.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,032.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,594.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,032.71
Rate for Payer: Cigna Commercial	$3,985.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,753.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,195.71
Rate for Payer: UnitedHealthcare Community & State	$192.11
Rate for Payer: Wellpoint Medicaid Managed Care	$211.24

FEM COMP PS TRIATH PS LT SZ5

Facility

$7,971.40

Service Code	HCPCS C1776
Hospital Charge Code	270694177
Hospital Revenue Code	278
Min. Negotiated Rate	$1,195.71
Max. Negotiated Rate	$1,929.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,594.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,753.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,195.71

FEM COMP PS TRIATH PS RT SZ5

Facility

$10,774.30

Service Code	HCPCS C1776
Hospital Charge Code	270694176
Hospital Revenue Code	278
Min. Negotiated Rate	$259.66
Max. Negotiated Rate	$5,387.15
Rate for Payer: Aetna Commercial	$4,094.23
Rate for Payer: Aetna Medicare Advantage	$3,232.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,747.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,747.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,154.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,747.45
Rate for Payer: Cigna Commercial	$5,387.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,607.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,370.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,616.14
Rate for Payer: UnitedHealthcare Community & State	$259.66
Rate for Payer: Wellpoint Medicaid Managed Care	$285.52

FEM COMP PS TRIATH PS RT SZ5

Facility

$10,774.30

Service Code	HCPCS C1776
Hospital Charge Code	270694176
Hospital Revenue Code	278
Min. Negotiated Rate	$1,616.14
Max. Negotiated Rate	$2,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,154.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,607.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,370.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,616.14

FEM COMP TRIATHLON PS SZ3 RT

Facility

$11,109.45

Service Code	HCPCS C1776
Hospital Charge Code	270695255
Hospital Revenue Code	278
Min. Negotiated Rate	$267.74
Max. Negotiated Rate	$5,554.73
Rate for Payer: Aetna Commercial	$4,221.59
Rate for Payer: Aetna Medicare Advantage	$3,332.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,832.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,832.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,221.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,832.91
Rate for Payer: Cigna Commercial	$5,554.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,688.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,444.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,666.42
Rate for Payer: UnitedHealthcare Community & State	$267.74
Rate for Payer: Wellpoint Medicaid Managed Care	$294.40

FEM COMP TRIATHLON PS SZ3 RT

Facility

$11,109.45

Service Code	HCPCS C1776
Hospital Charge Code	270695255
Hospital Revenue Code	278
Min. Negotiated Rate	$1,666.42
Max. Negotiated Rate	$2,688.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,221.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,688.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,444.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,666.42

FEM CONSTRAINED 60 LT 145231

Facility

$23,460.85

Hospital Charge Code	270635589
Hospital Revenue Code	278
Min. Negotiated Rate	$565.41
Max. Negotiated Rate	$11,730.42
Rate for Payer: Aetna Commercial	$8,915.12
Rate for Payer: Aetna Medicare Advantage	$7,038.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,982.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,982.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,692.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,982.52
Rate for Payer: Cigna Commercial	$11,730.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,677.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,161.39
Rate for Payer: Qualcare PPO/HMO/WC	$3,519.13
Rate for Payer: UnitedHealthcare Community & State	$565.41
Rate for Payer: Wellpoint Medicaid Managed Care	$621.71

FEM CONSTRAINED 60 LT 145231

Facility

$23,460.85

Hospital Charge Code	270635589
Hospital Revenue Code	278
Min. Negotiated Rate	$3,519.13
Max. Negotiated Rate	$5,677.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,692.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,677.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,161.39
Rate for Payer: Qualcare PPO/HMO/WC	$3,519.13

FEM DISTAL VANGUARD 65 X 5

Facility

$6,090.00

Service Code	HCPCS C1776
Hospital Charge Code	270692338
Hospital Revenue Code	278
Min. Negotiated Rate	$913.50
Max. Negotiated Rate	$1,473.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,339.80
Rate for Payer: Qualcare PPO/HMO/WC	$913.50

FEM DISTAL VANGUARD 65 X 5

Facility

$6,090.00

Service Code	HCPCS C1776
Hospital Charge Code	270692338
Hospital Revenue Code	278
Min. Negotiated Rate	$146.77
Max. Negotiated Rate	$3,045.00
Rate for Payer: Aetna Commercial	$2,314.20
Rate for Payer: Aetna Medicare Advantage	$1,827.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,552.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,552.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,552.95
Rate for Payer: Cigna Commercial	$3,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,339.80
Rate for Payer: Qualcare PPO/HMO/WC	$913.50
Rate for Payer: UnitedHealthcare Community & State	$146.77
Rate for Payer: Wellpoint Medicaid Managed Care	$161.38

Femerol Head 28 medium

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677406
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

Femerol Head 28 medium

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677406
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

FEM HD ARTIC 28MM 12/14 TAP

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270657701
Hospital Revenue Code	278
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

FEM HD ARTIC 28MM 12/14 TAP

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270657701
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

FEM HD TYP1 TAPER 3MM NECK

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695267
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

FEM HD TYP1 TAPER 3MM NECK

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695267
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

FEM. HEAD 36MM

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270703611
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

FEM. HEAD 36MM

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270703611
Hospital Revenue Code	278
Min. Negotiated Rate	$102.42
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,615.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50
Rate for Payer: UnitedHealthcare Community & State	$102.42
Rate for Payer: Wellpoint Medicaid Managed Care	$112.62

FEM HEAD 36MM +8MMREF397164795

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270703599
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

FEM HEAD 36MM +8MMREF397164795

Facility

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270703599
Hospital Revenue Code	278
Min. Negotiated Rate	$102.42
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,615.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50
Rate for Payer: UnitedHealthcare Community & State	$102.42
Rate for Payer: Wellpoint Medicaid Managed Care	$112.62

FEM HEAD BALL EZE 28MM 12/14

Facility

$2,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270698951
Hospital Revenue Code	278
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$635.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$577.50
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

FEM HEAD BALL EZE 28MM 12/14

Facility

$2,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270698951
Hospital Revenue Code	278
Min. Negotiated Rate	$63.26
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$577.50
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Community & State	$63.26
Rate for Payer: Wellpoint Medicaid Managed Care	$69.56

FEM HEAD BIOLOX UNI TAPER SZ40

Facility

$4,686.15

Service Code	HCPCS C1776
Hospital Charge Code	270697194
Hospital Revenue Code	278
Min. Negotiated Rate	$112.94
Max. Negotiated Rate	$2,343.07
Rate for Payer: Aetna Commercial	$1,780.74
Rate for Payer: Aetna Medicare Advantage	$1,405.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,194.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,194.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$937.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,194.97
Rate for Payer: Cigna Commercial	$2,343.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,134.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,030.95
Rate for Payer: Qualcare PPO/HMO/WC	$702.92
Rate for Payer: UnitedHealthcare Community & State	$112.94
Rate for Payer: Wellpoint Medicaid Managed Care	$124.18

FEM HEAD BIOLOX UNI TAPER SZ40

Facility

$4,686.15

Service Code	HCPCS C1776
Hospital Charge Code	270697194
Hospital Revenue Code	278
Min. Negotiated Rate	$702.92
Max. Negotiated Rate	$1,134.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$937.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,134.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,030.95
Rate for Payer: Qualcare PPO/HMO/WC	$702.92

Know your out-of-pocket cost for care.

All Charges