Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL WEDGE DISTAL 8MM #3

Facility

$6,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270687680
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 POSTERIOR 3/10 M

Facility

$6,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270687678
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 POSTERIOR 3/10 M

Facility

$6,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270687678
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 POSYERIOR 5MM #

Facility

$6,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270687953
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 POSYERIOR 5MM #

Facility

$6,070.00

Service Code	HCPCS C1776
Hospital Charge Code	270687953
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

FEMORL OSS RESURFACING 3CM LT

Facility

$42,405.00

Service Code	HCPCS C1776
Hospital Charge Code	270638564
Hospital Revenue Code	278
Min. Negotiated Rate	$6,360.75
Max. Negotiated Rate	$10,262.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,481.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,262.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,329.10
Rate for Payer: Qualcare PPO/HMO/WC	$6,360.75

FEMORL OSS RESURFACING 3CM LT

Facility

$42,405.00

Service Code	HCPCS C1776
Hospital Charge Code	270638564
Hospital Revenue Code	278
Min. Negotiated Rate	$1,021.96
Max. Negotiated Rate	$21,202.50
Rate for Payer: Aetna Commercial	$16,113.90
Rate for Payer: Aetna Medicare Advantage	$12,721.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,813.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,813.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,481.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,813.27
Rate for Payer: Cigna Commercial	$21,202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,262.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,329.10
Rate for Payer: Qualcare PPO/HMO/WC	$6,360.75
Rate for Payer: UnitedHealthcare Community & State	$1,021.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1,123.73

FEMO-STOP HD

Facility

$525.00

Hospital Charge Code	270657903
Hospital Revenue Code	272
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.50
Rate for Payer: Oxford Commercial	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Commercial	$105.00
Rate for Payer: UnitedHealthcare Community & State	$12.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.91

FEMO-STOP HD

Facility

$5,250.00

Hospital Charge Code	270657903N
Hospital Revenue Code	272
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,575.00
Rate for Payer: Oxford Commercial	$1,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Commercial	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

FEMO-STOP HD

Facility

$525.00

Hospital Charge Code	270657903S
Hospital Revenue Code	272
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$78.75
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

FEMO-STOP HD

Facility

$525.00

Hospital Charge Code	270657903
Hospital Revenue Code	272
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$78.75
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

FEMO-STOP HD

Facility

$5,250.00

Hospital Charge Code	270657903N
Hospital Revenue Code	272
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$787.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

FEMO-STOP HD

Facility

$525.00

Hospital Charge Code	270657903S
Hospital Revenue Code	272
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.50
Rate for Payer: Oxford Commercial	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Commercial	$105.00
Rate for Payer: UnitedHealthcare Community & State	$12.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.91

FEM OXFORD TWIN SMALL

Facility

$900.00

Service Code	HCPCS C1776
Hospital Charge Code	270684003
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

FEM OXFORD TWIN SMALL

Facility

$900.00

Service Code	HCPCS C1776
Hospital Charge Code	270684003
Hospital Revenue Code	278
Min. Negotiated Rate	$21.69
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Community & State	$21.69
Rate for Payer: Wellpoint Medicaid Managed Care	$23.85

FEM-POP ATHER W/STENT-BI

Facility

$93,917.89

Service Code	HCPCS 3722750
Hospital Charge Code	321037227B
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

FEM-POP ATHER W/STENT-BI

Facility

$93,917.89

Service Code	HCPCS 3722750
Hospital Charge Code	2690535
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28,175.37
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,263.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2,488.82

FEM-POP ATHER W/STENT-BI

Facility

$93,917.89

Service Code	HCPCS 3722750
Hospital Charge Code	321037227B
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28,175.37
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,263.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2,488.82

FEM-POP ATHER W/STENT-BI

Facility

$93,917.89

Service Code	HCPCS 3722750
Hospital Charge Code	2690535
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

FEM-POP ATHER W/STENT-BI

Facility

$58,375.00

Service Code	HCPCS 3722750
Hospital Charge Code	7411806
Hospital Revenue Code	361
Min. Negotiated Rate	$8,756.25
Max. Negotiated Rate	$8,756.25
Rate for Payer: Qualcare PPO/HMO/WC	$8,756.25

FEM-POP ATHER W/STENT-BI

Facility

$93,917.89

Service Code	HCPCS 3722750
Hospital Charge Code	3668372275
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28,175.37
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,263.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2,488.82

FEM-POP ATHER W/STENT-BI

Facility

$93,917.89

Service Code	HCPCS 3722750
Hospital Charge Code	3668372275
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

FEM-POP ATHER W/STENT-BI

Facility

$93,917.89

Service Code	HCPCS 3722750
Hospital Charge Code	411037227B
Hospital Revenue Code	361
Min. Negotiated Rate	$1,626.00
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28,175.37
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,263.42
Rate for Payer: Wellpoint Medicaid Managed Care	$2,488.82

FEM-POP ATHER W/STENT-BI

Facility

$93,917.89

Service Code	HCPCS 3722750
Hospital Charge Code	411037227B
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

FEM-POP ATHER W/STENT-BI

Facility

$58,375.00

Service Code	HCPCS 3722750
Hospital Charge Code	7411806
Hospital Revenue Code	361
Min. Negotiated Rate	$1,406.84
Max. Negotiated Rate	$29,187.50
Rate for Payer: Aetna Commercial	$22,182.50
Rate for Payer: Aetna Medicare Advantage	$17,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,885.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,885.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,885.62
Rate for Payer: Cigna Commercial	$29,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$8,756.25
Rate for Payer: UnitedHealthcare Community & State	$1,406.84
Rate for Payer: Wellpoint Medicaid Managed Care	$1,546.94

Know your out-of-pocket cost for care.

All Charges