Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL TAP STEM EXT OFF-SZ 11

Facility

$7,170.00

Hospital Charge Code	270669102
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.50
Max. Negotiated Rate	$1,735.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50

FEMORAL TAP STEM EXT OFF-SZ 11

Facility

$7,170.00

Hospital Charge Code	270669102
Hospital Revenue Code	278
Min. Negotiated Rate	$172.80
Max. Negotiated Rate	$3,585.00
Rate for Payer: Aetna Commercial	$2,724.60
Rate for Payer: Aetna Medicare Advantage	$2,151.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,828.35
Rate for Payer: Cigna Commercial	$3,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50
Rate for Payer: UnitedHealthcare Community & State	$172.80
Rate for Payer: Wellpoint Medicaid Managed Care	$190.00

FEMORAL TAP STEM EXT OFF-SZ 12

Facility

$7,170.00

Hospital Charge Code	270669103
Hospital Revenue Code	278
Min. Negotiated Rate	$172.80
Max. Negotiated Rate	$3,585.00
Rate for Payer: Aetna Commercial	$2,724.60
Rate for Payer: Aetna Medicare Advantage	$2,151.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,828.35
Rate for Payer: Cigna Commercial	$3,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50
Rate for Payer: UnitedHealthcare Community & State	$172.80
Rate for Payer: Wellpoint Medicaid Managed Care	$190.00

FEMORAL TAP STEM EXT OFF-SZ 12

Facility

$7,170.00

Hospital Charge Code	270669103
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.50
Max. Negotiated Rate	$1,735.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50

FEMORAL TAP STEM EXT OFF-SZ 3

Facility

$7,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270669094
Hospital Revenue Code	278
Min. Negotiated Rate	$172.80
Max. Negotiated Rate	$3,585.00
Rate for Payer: Aetna Commercial	$2,724.60
Rate for Payer: Aetna Medicare Advantage	$2,151.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,828.35
Rate for Payer: Cigna Commercial	$3,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50
Rate for Payer: UnitedHealthcare Community & State	$172.80
Rate for Payer: Wellpoint Medicaid Managed Care	$190.00

FEMORAL TAP STEM EXT OFF-SZ 3

Facility

$7,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270669094
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.50
Max. Negotiated Rate	$1,735.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50

FEMORAL TAP STEM EXT OFF-SZ 6

Facility

$7,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270669097
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.50
Max. Negotiated Rate	$1,735.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50

FEMORAL TAP STEM EXT OFF-SZ 6

Facility

$7,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270669097
Hospital Revenue Code	278
Min. Negotiated Rate	$172.80
Max. Negotiated Rate	$3,585.00
Rate for Payer: Aetna Commercial	$2,724.60
Rate for Payer: Aetna Medicare Advantage	$2,151.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,828.35
Rate for Payer: Cigna Commercial	$3,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50
Rate for Payer: UnitedHealthcare Community & State	$172.80
Rate for Payer: Wellpoint Medicaid Managed Care	$190.00

FEMORAL TAP STEM EXT OFF-SZ 7

Facility

$7,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270669098
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.50
Max. Negotiated Rate	$1,735.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50

FEMORAL TAP STEM EXT OFF-SZ 7

Facility

$7,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270669098
Hospital Revenue Code	278
Min. Negotiated Rate	$172.80
Max. Negotiated Rate	$3,585.00
Rate for Payer: Aetna Commercial	$2,724.60
Rate for Payer: Aetna Medicare Advantage	$2,151.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,828.35
Rate for Payer: Cigna Commercial	$3,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50
Rate for Payer: UnitedHealthcare Community & State	$172.80
Rate for Payer: Wellpoint Medicaid Managed Care	$190.00

FEMORAL TAP STEM EXT OFF-SZ 8

Facility

$7,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270669099
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.50
Max. Negotiated Rate	$1,735.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50

FEMORAL TAP STEM EXT OFF-SZ 8

Facility

$7,170.00

Service Code	HCPCS C1776
Hospital Charge Code	270669099
Hospital Revenue Code	278
Min. Negotiated Rate	$172.80
Max. Negotiated Rate	$3,585.00
Rate for Payer: Aetna Commercial	$2,724.60
Rate for Payer: Aetna Medicare Advantage	$2,151.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,828.35
Rate for Payer: Cigna Commercial	$3,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50
Rate for Payer: UnitedHealthcare Community & State	$172.80
Rate for Payer: Wellpoint Medicaid Managed Care	$190.00

FEMORAL TAP STEM EXT OFF-SZ 9

Facility

$7,170.00

Hospital Charge Code	270669100
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.50
Max. Negotiated Rate	$1,735.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50

FEMORAL TAP STEM EXT OFF-SZ 9

Facility

$7,170.00

Hospital Charge Code	270669100
Hospital Revenue Code	278
Min. Negotiated Rate	$172.80
Max. Negotiated Rate	$3,585.00
Rate for Payer: Aetna Commercial	$2,724.60
Rate for Payer: Aetna Medicare Advantage	$2,151.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,828.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,434.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,828.35
Rate for Payer: Cigna Commercial	$3,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,735.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,577.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.50
Rate for Payer: UnitedHealthcare Community & State	$172.80
Rate for Payer: Wellpoint Medicaid Managed Care	$190.00

FEMORAL TRIATHION SZ3 PS RT

Facility

$7,524.55

Service Code	HCPCS C1776
Hospital Charge Code	270682130
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 TRIATHION SZ3 PS RT

Facility

$7,524.55

Service Code	HCPCS C1776
Hospital Charge Code	270682130
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 TRIATHLON PS SZ2 RT

Facility

$10,774.35

Service Code	HCPCS C1776
Hospital Charge Code	270698199
Hospital Revenue Code	278
Min. Negotiated Rate	$1,616.15
Max. Negotiated Rate	$2,607.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,154.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,607.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,370.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,616.15

FEMORAL TRIATHLON PS SZ2 RT

Facility

$10,774.35

Service Code	HCPCS C1776
Hospital Charge Code	270698199
Hospital Revenue Code	278
Min. Negotiated Rate	$259.66
Max. Negotiated Rate	$5,387.18
Rate for Payer: Aetna Commercial	$4,094.25
Rate for Payer: Aetna Medicare Advantage	$3,232.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,747.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,747.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,154.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,747.46
Rate for Payer: Cigna Commercial	$5,387.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,607.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,370.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,616.15
Rate for Payer: UnitedHealthcare Community & State	$259.66
Rate for Payer: Wellpoint Medicaid Managed Care	$285.52

FEMORAL TRIATHLON SZ 3 LT PS

Facility

$7,524.50

Service Code	HCPCS C1776
Hospital Charge Code	270691799
Hospital Revenue Code	278
Min. Negotiated Rate	$1,128.67
Max. Negotiated Rate	$1,820.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,504.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,820.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,655.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,128.67

FEMORAL TRIATHLON SZ 3 LT PS

Facility

$7,524.50

Service Code	HCPCS C1776
Hospital Charge Code	270691799
Hospital Revenue Code	278
Min. Negotiated Rate	$181.34
Max. Negotiated Rate	$3,762.25
Rate for Payer: Aetna Commercial	$2,859.31
Rate for Payer: Aetna Medicare Advantage	$2,257.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,918.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,918.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,504.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,918.75
Rate for Payer: Cigna Commercial	$3,762.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,820.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,655.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,128.67
Rate for Payer: UnitedHealthcare Community & State	$181.34
Rate for Payer: Wellpoint Medicaid Managed Care	$199.40

FEMORAL WEDGE DISTAL 4MM #3

Facility

$6,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270687681
Hospital Revenue Code	278
Min. Negotiated Rate	$910.50
Max. Negotiated Rate	$1,468.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,214.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,468.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,335.40
Rate for Payer: Qualcare PPO/HMO/WC	$910.50

FEMORAL WEDGE DISTAL 4MM #3

Facility

$6,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270687681
Hospital Revenue Code	278
Min. Negotiated Rate	$146.29
Max. Negotiated Rate	$3,035.00
Rate for Payer: Aetna Commercial	$2,306.60
Rate for Payer: Aetna Medicare Advantage	$1,821.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,214.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,547.85
Rate for Payer: Cigna Commercial	$3,035.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,468.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,335.40
Rate for Payer: Qualcare PPO/HMO/WC	$910.50
Rate for Payer: UnitedHealthcare Community & State	$146.29
Rate for Payer: Wellpoint Medicaid Managed Care	$160.85

FEMORAL WEDGE DISTAL 4MM # 4

Facility

$6,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270687952
Hospital Revenue Code	278
Min. Negotiated Rate	$146.29
Max. Negotiated Rate	$3,035.00
Rate for Payer: Aetna Commercial	$2,306.60
Rate for Payer: Aetna Medicare Advantage	$1,821.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,214.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,547.85
Rate for Payer: Cigna Commercial	$3,035.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,468.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,335.40
Rate for Payer: Qualcare PPO/HMO/WC	$910.50
Rate for Payer: UnitedHealthcare Community & State	$146.29
Rate for Payer: Wellpoint Medicaid Managed Care	$160.85

FEMORAL WEDGE DISTAL 4MM # 4

Facility

$6,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270687952
Hospital Revenue Code	278
Min. Negotiated Rate	$910.50
Max. Negotiated Rate	$1,468.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,214.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,468.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,335.40
Rate for Payer: Qualcare PPO/HMO/WC	$910.50

FEMORAL WEDGE DISTAL 8MM #3

Facility

$6,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270687680
Hospital Revenue Code	278
Min. Negotiated Rate	$910.50
Max. Negotiated Rate	$1,468.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,214.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,468.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,335.40
Rate for Payer: Qualcare PPO/HMO/WC	$910.50

Know your out-of-pocket cost for care.

All Charges