Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL PREP KIT SZ5 CR

Facility

$2,340.00

Hospital Charge Code	270698202
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 PROLONG LPS FLEX

Facility

$11,725.00

Hospital Charge Code	270658853
Hospital Revenue Code	278
Min. Negotiated Rate	$1,758.75
Max. Negotiated Rate	$2,837.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,837.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,579.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,758.75

FEMORAL PROLONG LPS FLEX

Facility

$11,725.00

Hospital Charge Code	270658853
Hospital Revenue Code	278
Min. Negotiated Rate	$282.57
Max. Negotiated Rate	$5,862.50
Rate for Payer: Aetna Commercial	$4,455.50
Rate for Payer: Aetna Medicare Advantage	$3,517.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,989.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,989.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,989.88
Rate for Payer: Cigna Commercial	$5,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,837.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,579.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,758.75
Rate for Payer: UnitedHealthcare Community & State	$282.57
Rate for Payer: Wellpoint Medicaid Managed Care	$310.71

FEMORAL PROXIMAL HIGH OFFSET

Facility

$36,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270690936
Hospital Revenue Code	278
Min. Negotiated Rate	$5,431.50
Max. Negotiated Rate	$8,762.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,762.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,966.20
Rate for Payer: Qualcare PPO/HMO/WC	$5,431.50

FEMORAL PROXIMAL HIGH OFFSET

Facility

$36,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270690936
Hospital Revenue Code	278
Min. Negotiated Rate	$872.66
Max. Negotiated Rate	$18,105.00
Rate for Payer: Aetna Commercial	$13,759.80
Rate for Payer: Aetna Medicare Advantage	$10,863.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,233.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,233.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,233.55
Rate for Payer: Cigna Commercial	$18,105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,762.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,966.20
Rate for Payer: Qualcare PPO/HMO/WC	$5,431.50
Rate for Payer: UnitedHealthcare Community & State	$872.66
Rate for Payer: Wellpoint Medicaid Managed Care	$959.57

FEMORAL P/S 67.5mm LEFT

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270642378
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

FEMORAL P/S 67.5mm LEFT

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270642378
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

FEMORAL PS 67.5RIGHT 183110

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270636754
Hospital Revenue Code	278
Min. Negotiated Rate	$2,584.50
Max. Negotiated Rate	$4,169.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,790.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50

FEMORAL PS 67.5RIGHT 183110

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270636754
Hospital Revenue Code	278
Min. Negotiated Rate	$415.24
Max. Negotiated Rate	$8,615.00
Rate for Payer: Aetna Commercial	$6,547.40
Rate for Payer: Aetna Medicare Advantage	$5,169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,393.65
Rate for Payer: Cigna Commercial	$8,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,790.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50
Rate for Payer: UnitedHealthcare Community & State	$415.24
Rate for Payer: Wellpoint Medicaid Managed Care	$456.60

FEMORAL PS 72.5mm RIGHT

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270667611
Hospital Revenue Code	278
Min. Negotiated Rate	$2,584.50
Max. Negotiated Rate	$4,169.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,790.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50

FEMORAL PS 72.5mm RIGHT

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270667611
Hospital Revenue Code	278
Min. Negotiated Rate	$415.24
Max. Negotiated Rate	$8,615.00
Rate for Payer: Aetna Commercial	$6,547.40
Rate for Payer: Aetna Medicare Advantage	$5,169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,393.65
Rate for Payer: Cigna Commercial	$8,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,790.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50
Rate for Payer: UnitedHealthcare Community & State	$415.24
Rate for Payer: Wellpoint Medicaid Managed Care	$456.60

FEMORAL PS 75MM RIGHT 183114

Facility

$15,770.00

Hospital Charge Code	270640788
Hospital Revenue Code	278
Min. Negotiated Rate	$380.06
Max. Negotiated Rate	$7,885.00
Rate for Payer: Aetna Commercial	$5,992.60
Rate for Payer: Aetna Medicare Advantage	$4,731.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,021.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,021.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,154.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,021.35
Rate for Payer: Cigna Commercial	$7,885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,816.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,469.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,365.50
Rate for Payer: UnitedHealthcare Community & State	$380.06
Rate for Payer: Wellpoint Medicaid Managed Care	$417.90

FEMORAL PS 75MM RIGHT 183114

Facility

$15,770.00

Hospital Charge Code	270640788
Hospital Revenue Code	278
Min. Negotiated Rate	$2,365.50
Max. Negotiated Rate	$3,816.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,154.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,816.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,469.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,365.50

FEMORAL PS ATTUNE 52 MM 7 RT

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686059
Hospital Revenue Code	278
Min. Negotiated Rate	$277.15
Max. Negotiated Rate	$5,750.00
Rate for Payer: Aetna Commercial	$4,370.00
Rate for Payer: Aetna Medicare Advantage	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,932.50
Rate for Payer: Cigna Commercial	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,530.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00
Rate for Payer: UnitedHealthcare Community & State	$277.15
Rate for Payer: Wellpoint Medicaid Managed Care	$304.75

FEMORAL PS ATTUNE 52 MM 7 RT

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686059
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$2,783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,530.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

FEMORAL PS ATTUNE 52 MM 7 RT

Facility

$10,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270673973
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 PS ATTUNE 52 MM 7 RT

Facility

$10,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270673973
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 PS CMT CCR STD SZ4

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690739
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

FEMORAL PS CMT CCR STD SZ4

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690739
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

FEMORAL PS CMT CCR STD SZ 5

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692692
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

FEMORAL PS CMT CCR STD SZ 5

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692692
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

FEMORAL PS CMT CCR STD SZ 9 R

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689752
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

FEMORAL PS CMT CCR STD SZ 9 R

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689752
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

FEMORAL PS COMPONENT 72.5mm LT

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270641310
Hospital Revenue Code	278
Min. Negotiated Rate	$415.24
Max. Negotiated Rate	$8,615.00
Rate for Payer: Aetna Commercial	$6,547.40
Rate for Payer: Aetna Medicare Advantage	$5,169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,393.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,393.65
Rate for Payer: Cigna Commercial	$8,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,790.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50
Rate for Payer: UnitedHealthcare Community & State	$415.24
Rate for Payer: Wellpoint Medicaid Managed Care	$456.60

FEMORAL PS COMPONENT 72.5mm LT

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270641310
Hospital Revenue Code	278
Min. Negotiated Rate	$2,584.50
Max. Negotiated Rate	$4,169.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,446.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,169.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,790.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,584.50

Know your out-of-pocket cost for care.

All Charges