Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL P/S LEFT 70 183132

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270639107
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 P/S LEFT 70 183132

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270639107
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 PSN CCR NRW SZ7

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690107
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 PSN CCR NRW SZ7

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690107
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 PSN CMT CCR SZ 5

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690102
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 PSN CMT CCR SZ 5

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690102
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 PSN PS CMT SZ 8

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690742
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 PSN PS CMT SZ 8

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690742
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 OPEN BOX 60mm LEFT

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270646502
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 OPEN BOX 60mm LEFT

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270646502
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 OPEN BOX 62.5MM LFT

Facility

$11,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270677827
Hospital Revenue Code	278
Min. Negotiated Rate	$1,657.50
Max. Negotiated Rate	$2,674.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,674.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,431.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,657.50

FEMORAL PS OPEN BOX 62.5MM LFT

Facility

$11,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270677827
Hospital Revenue Code	278
Min. Negotiated Rate	$266.31
Max. Negotiated Rate	$5,525.00
Rate for Payer: Aetna Commercial	$4,199.00
Rate for Payer: Aetna Medicare Advantage	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,817.75
Rate for Payer: Cigna Commercial	$5,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,674.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,431.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,657.50
Rate for Payer: UnitedHealthcare Community & State	$266.31
Rate for Payer: Wellpoint Medicaid Managed Care	$292.82

FEMORAL PS OPEN BOX 65MM RT

Facility

$11,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270647013
Hospital Revenue Code	278
Min. Negotiated Rate	$1,657.50
Max. Negotiated Rate	$2,674.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,674.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,431.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,657.50

FEMORAL PS OPEN BOX 65MM RT

Facility

$11,050.00

Service Code	HCPCS C1776
Hospital Charge Code	270647013
Hospital Revenue Code	278
Min. Negotiated Rate	$266.31
Max. Negotiated Rate	$5,525.00
Rate for Payer: Aetna Commercial	$4,199.00
Rate for Payer: Aetna Medicare Advantage	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,817.75
Rate for Payer: Cigna Commercial	$5,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,674.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,431.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,657.50
Rate for Payer: UnitedHealthcare Community & State	$266.31
Rate for Payer: Wellpoint Medicaid Managed Care	$292.82

FEMORAL PS OPEN BOX 67.5mm RT

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270646612
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 OPEN BOX 67.5mm RT

Facility

$17,230.00

Service Code	HCPCS C1776
Hospital Charge Code	270646612
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 OPEN BOX 75MM LEFT

Facility

$11,050.00

Hospital Charge Code	270676548
Hospital Revenue Code	278
Min. Negotiated Rate	$266.31
Max. Negotiated Rate	$5,525.00
Rate for Payer: Aetna Commercial	$4,199.00
Rate for Payer: Aetna Medicare Advantage	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,817.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,817.75
Rate for Payer: Cigna Commercial	$5,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,674.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,431.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,657.50
Rate for Payer: UnitedHealthcare Community & State	$266.31
Rate for Payer: Wellpoint Medicaid Managed Care	$292.82

FEMORAL PS OPEN BOX 75MM LEFT

Facility

$11,050.00

Hospital Charge Code	270676548
Hospital Revenue Code	278
Min. Negotiated Rate	$1,657.50
Max. Negotiated Rate	$2,674.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,674.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,431.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,657.50

FEMORAL P/S RIGHT 70 183112

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270639712
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 P/S RIGHT 70 183112

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270639712
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 TRIATHL SZ6 RT

Facility

$6,859.95

Service Code	HCPCS C1776
Hospital Charge Code	270691172
Hospital Revenue Code	278
Min. Negotiated Rate	$165.32
Max. Negotiated Rate	$3,429.97
Rate for Payer: Aetna Commercial	$2,606.78
Rate for Payer: Aetna Medicare Advantage	$2,057.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,749.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,749.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,371.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,749.29
Rate for Payer: Cigna Commercial	$3,429.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,660.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,509.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,028.99
Rate for Payer: UnitedHealthcare Community & State	$165.32
Rate for Payer: Wellpoint Medicaid Managed Care	$181.79

FEMORAL PS TRIATHL SZ6 RT

Facility

$6,859.95

Service Code	HCPCS C1776
Hospital Charge Code	270691172
Hospital Revenue Code	278
Min. Negotiated Rate	$1,028.99
Max. Negotiated Rate	$1,660.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,371.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,660.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,509.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,028.99

FEMORAL RGT 70MM 145153

Facility

$13,312.70

Hospital Charge Code	270636513
Hospital Revenue Code	278
Min. Negotiated Rate	$1,996.90
Max. Negotiated Rate	$3,221.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,662.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,221.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,928.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,996.90

FEMORAL RGT 70MM 145153

Facility

$13,312.70

Hospital Charge Code	270636513
Hospital Revenue Code	278
Min. Negotiated Rate	$320.84
Max. Negotiated Rate	$6,656.35
Rate for Payer: Aetna Commercial	$5,058.83
Rate for Payer: Aetna Medicare Advantage	$3,993.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,662.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,394.74
Rate for Payer: Cigna Commercial	$6,656.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,221.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,928.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,996.90
Rate for Payer: UnitedHealthcare Community & State	$320.84
Rate for Payer: Wellpoint Medicaid Managed Care	$352.79

FEMORAL RM 45 102100

Facility

$9,042.45

Hospital Charge Code	270632446
Hospital Revenue Code	278
Min. Negotiated Rate	$1,356.37
Max. Negotiated Rate	$2,188.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,808.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,188.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,989.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,356.37

Know your out-of-pocket cost for care.

All Charges