Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL POSTERIOR

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270691267
Hospital Revenue Code	278
Min. Negotiated Rate	$174.43
Max. Negotiated Rate	$3,618.95
Rate for Payer: Aetna Commercial	$2,750.40
Rate for Payer: Aetna Medicare Advantage	$2,171.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,845.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,845.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,845.66
Rate for Payer: Cigna Commercial	$3,618.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,592.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.68
Rate for Payer: UnitedHealthcare Community & State	$174.43
Rate for Payer: Wellpoint Medicaid Managed Care	$191.80

FEMORAL POSTERIOR

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270691267
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.68
Max. Negotiated Rate	$1,751.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,592.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.68

FEMORAL POSTERIOR SIZE 4 N

Facility

$10,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688759
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

FEMORAL POSTERIOR SIZE 4 N

Facility

$10,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270688759
Hospital Revenue Code	278
Min. Negotiated Rate	$259.07
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$259.07
Rate for Payer: Wellpoint Medicaid Managed Care	$284.88

FEMORAL POSTERIOR STAB. SZ1 LF

Facility

$5,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270670878
Hospital Revenue Code	278
Min. Negotiated Rate	$138.57
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$2,185.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Community & State	$138.57
Rate for Payer: Wellpoint Medicaid Managed Care	$152.38

FEMORAL POSTERIOR STAB. SZ1 LF

Facility

$5,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270670878
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$1,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

FEMORAL POSTERIOR STAB. SZ1 RT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270671563
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

FEMORAL POSTERIOR STAB. SZ1 RT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270671563
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

FEMORAL POSTERIOR STAB. SZ2 LF

Facility

$5,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270668731
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$1,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

FEMORAL POSTERIOR STAB. SZ2 LF

Facility

$5,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270668731
Hospital Revenue Code	278
Min. Negotiated Rate	$138.57
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$2,185.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Community & State	$138.57
Rate for Payer: Wellpoint Medicaid Managed Care	$152.38

FEMORAL POSTERIOR STAB. SZ3 RT

Facility

$9,475.20

Hospital Charge Code	270670881
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.28
Max. Negotiated Rate	$2,293.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,293.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.28

FEMORAL POSTERIOR STAB. SZ3 RT

Facility

$9,475.20

Hospital Charge Code	270670881
Hospital Revenue Code	278
Min. Negotiated Rate	$228.35
Max. Negotiated Rate	$4,737.60
Rate for Payer: Aetna Commercial	$3,600.58
Rate for Payer: Aetna Medicare Advantage	$2,842.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,416.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,416.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,416.18
Rate for Payer: Cigna Commercial	$4,737.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,293.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,084.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.28
Rate for Payer: UnitedHealthcare Community & State	$228.35
Rate for Payer: Wellpoint Medicaid Managed Care	$251.09

FEMORAL POSTERIOR SZ3 5MM SRW

Facility

$5,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668741
Hospital Revenue Code	278
Min. Negotiated Rate	$131.22
Max. Negotiated Rate	$2,722.50
Rate for Payer: Aetna Commercial	$2,069.10
Rate for Payer: Aetna Medicare Advantage	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,388.47
Rate for Payer: Cigna Commercial	$2,722.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,317.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,197.90
Rate for Payer: Qualcare PPO/HMO/WC	$816.75
Rate for Payer: UnitedHealthcare Community & State	$131.22
Rate for Payer: Wellpoint Medicaid Managed Care	$144.29

FEMORAL POSTERIOR SZ3 5MM SRW

Facility

$5,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668741
Hospital Revenue Code	278
Min. Negotiated Rate	$816.75
Max. Negotiated Rate	$1,317.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,089.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,317.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,197.90
Rate for Payer: Qualcare PPO/HMO/WC	$816.75

FEMORAL POSTERIOR SZ 7 PS

Facility

$7,524.55

Service Code	HCPCS C1776
Hospital Charge Code	270681040
Hospital Revenue Code	278
Min. Negotiated Rate	$1,128.68
Max. Negotiated Rate	$1,820.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,504.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,820.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,655.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,128.68

FEMORAL POSTERIOR SZ 7 PS

Facility

$7,524.55

Service Code	HCPCS C1776
Hospital Charge Code	270681040
Hospital Revenue Code	278
Min. Negotiated Rate	$181.34
Max. Negotiated Rate	$3,762.28
Rate for Payer: Aetna Commercial	$2,859.33
Rate for Payer: Aetna Medicare Advantage	$2,257.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,918.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,918.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,504.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,918.76
Rate for Payer: Cigna Commercial	$3,762.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,820.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,655.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,128.68
Rate for Payer: UnitedHealthcare Community & State	$181.34
Rate for Payer: Wellpoint Medicaid Managed Care	$199.40

FEMORAL POST STAB SZ 2 LT

Facility

$5,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270675278
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$1,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

FEMORAL POST STAB SZ 2 LT

Facility

$5,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270675278
Hospital Revenue Code	278
Min. Negotiated Rate	$138.57
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$2,185.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Community & State	$138.57
Rate for Payer: Wellpoint Medicaid Managed Care	$152.38

FEMORAL POST STAB SZ 4 LF

Facility

$5,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270673793
Hospital Revenue Code	278
Min. Negotiated Rate	$138.57
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$2,185.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Community & State	$138.57
Rate for Payer: Wellpoint Medicaid Managed Care	$152.38

FEMORAL POST STAB SZ 4 LF

Facility

$5,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270673793
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$1,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

FEMORAL POST STAB. SZ4 RIGHT

Facility

$8,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270669599
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$1,966.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,787.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75

FEMORAL POST STAB. SZ4 RIGHT

Facility

$8,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270669599
Hospital Revenue Code	278
Min. Negotiated Rate	$195.81
Max. Negotiated Rate	$4,062.50
Rate for Payer: Aetna Commercial	$3,087.50
Rate for Payer: Aetna Medicare Advantage	$2,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,071.88
Rate for Payer: Cigna Commercial	$4,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,787.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75
Rate for Payer: UnitedHealthcare Community & State	$195.81
Rate for Payer: Wellpoint Medicaid Managed Care	$215.31

FEMORAL PREP KIT SZ4 CR

Facility

$2,340.00

Hospital Charge Code	270698200
Hospital Revenue Code	272
Min. Negotiated Rate	$56.39
Max. Negotiated Rate	$1,170.00
Rate for Payer: Aetna Commercial	$889.20
Rate for Payer: Aetna Medicare Advantage	$702.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$596.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$596.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$596.70
Rate for Payer: Cigna Commercial	$1,170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.00
Rate for Payer: Oxford Commercial	$468.00
Rate for Payer: Qualcare PPO/HMO/WC	$351.00
Rate for Payer: UnitedHealthcare Commercial	$468.00
Rate for Payer: UnitedHealthcare Community & State	$56.39
Rate for Payer: Wellpoint Medicaid Managed Care	$62.01

FEMORAL PREP KIT SZ4 CR

Facility

$2,340.00

Hospital Charge Code	270698200
Hospital Revenue Code	272
Min. Negotiated Rate	$351.00
Max. Negotiated Rate	$351.00
Rate for Payer: Qualcare PPO/HMO/WC	$351.00

FEMORAL PREP KIT SZ5 CR

Facility

$2,340.00

Hospital Charge Code	270698202
Hospital Revenue Code	272
Min. Negotiated Rate	$351.00
Max. Negotiated Rate	$351.00
Rate for Payer: Qualcare PPO/HMO/WC	$351.00

Know your out-of-pocket cost for care.

All Charges