Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEM PSN PS CMT CCR STD SZ 10L

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698387
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

FEM PSN PS CMT CCR STD SZ 10L

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698387
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

FEMRL FPP NC ECHO POR 12X 40MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691841
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

FEMRL FPP NC ECHO POR 12X 40MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691841
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

FEMRL PS 57.5 LEFT OPEN 183122

Facility

$11,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270650855
Hospital Revenue Code	278
Min. Negotiated Rate	$265.10
Max. Negotiated Rate	$5,500.00
Rate for Payer: Aetna Commercial	$4,180.00
Rate for Payer: Aetna Medicare Advantage	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,805.00
Rate for Payer: Cigna Commercial	$5,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,662.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00
Rate for Payer: UnitedHealthcare Community & State	$265.10
Rate for Payer: Wellpoint Medicaid Managed Care	$291.50

FEMRL PS 57.5 LEFT OPEN 183122

Facility

$11,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270650855
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$2,662.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,662.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00

FEM ST 12X14 TAPR WPORCOATSZ2

Facility

$9,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270691333
Hospital Revenue Code	278
Min. Negotiated Rate	$233.77
Max. Negotiated Rate	$4,850.00
Rate for Payer: Aetna Commercial	$3,686.00
Rate for Payer: Aetna Medicare Advantage	$2,910.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,473.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,473.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,940.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,473.50
Rate for Payer: Cigna Commercial	$4,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,347.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,134.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,455.00
Rate for Payer: UnitedHealthcare Community & State	$233.77
Rate for Payer: Wellpoint Medicaid Managed Care	$257.05

FEM ST 12X14 TAPR WPORCOATSZ2

Facility

$9,700.00

Service Code	HCPCS C1776
Hospital Charge Code	270691333
Hospital Revenue Code	278
Min. Negotiated Rate	$1,455.00
Max. Negotiated Rate	$2,347.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,347.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,134.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,455.00

FEM STABLIZER RT TRIATH SZ2

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270693302
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

FEM STABLIZER RT TRIATH SZ2

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270693302
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

FEMSTAT 2%/28GM

Facility

$101.00

Hospital Charge Code	60632971
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$50.50
Rate for Payer: Aetna Commercial	$38.38
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.30
Rate for Payer: Oxford Commercial	$20.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$20.20
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

FEMSTAT 2%/28GM

Facility

$101.00

Hospital Charge Code	60632971
Hospital Revenue Code	250
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

FEM STEM 12/14 TAP SZ2 STD97MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695674
Hospital Revenue Code	278
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

FEM STEM 12/14 TAP SZ2 STD97MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695674
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

FEM STEM 132D SZ6 35MM 111MM

Facility

$13,600.00

Service Code	HCPCS C1776
Hospital Charge Code	270695130
Hospital Revenue Code	278
Min. Negotiated Rate	$327.76
Max. Negotiated Rate	$6,800.00
Rate for Payer: Aetna Commercial	$5,168.00
Rate for Payer: Aetna Medicare Advantage	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,468.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,468.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,468.00
Rate for Payer: Cigna Commercial	$6,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,291.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,992.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,040.00
Rate for Payer: UnitedHealthcare Community & State	$327.76
Rate for Payer: Wellpoint Medicaid Managed Care	$360.40

FEM STEM 132D SZ6 35MM 111MM

Facility

$13,600.00

Service Code	HCPCS C1776
Hospital Charge Code	270695130
Hospital Revenue Code	278
Min. Negotiated Rate	$2,040.00
Max. Negotiated Rate	$3,291.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,291.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,992.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,040.00

FEM STEM STD 12/14 SZ3 108MM

Facility

$9,712.50

Service Code	HCPCS C1776
Hospital Charge Code	270696051
Hospital Revenue Code	278
Min. Negotiated Rate	$234.07
Max. Negotiated Rate	$4,856.25
Rate for Payer: Aetna Commercial	$3,690.75
Rate for Payer: Aetna Medicare Advantage	$2,913.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,476.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,476.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,476.69
Rate for Payer: Cigna Commercial	$4,856.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,350.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,136.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,456.88
Rate for Payer: UnitedHealthcare Community & State	$234.07
Rate for Payer: Wellpoint Medicaid Managed Care	$257.38

FEM STEM STD 12/14 SZ3 108MM

Facility

$9,712.50

Service Code	HCPCS C1776
Hospital Charge Code	270696051
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.88
Max. Negotiated Rate	$2,350.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,942.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,350.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,136.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,456.88

FEM TOTAL COMP STAB TRIATHLON

Facility

$65,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270691989
Hospital Revenue Code	278
Min. Negotiated Rate	$1,576.98
Max. Negotiated Rate	$32,717.50
Rate for Payer: Aetna Commercial	$24,865.30
Rate for Payer: Aetna Medicare Advantage	$19,630.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,685.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,685.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,087.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,685.92
Rate for Payer: Cigna Commercial	$32,717.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,835.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,395.70
Rate for Payer: Qualcare PPO/HMO/WC	$9,815.25
Rate for Payer: UnitedHealthcare Community & State	$1,576.98
Rate for Payer: Wellpoint Medicaid Managed Care	$1,734.03

FEM TOTAL COMP STAB TRIATHLON

Facility

$65,435.00

Service Code	HCPCS C1776
Hospital Charge Code	270691989
Hospital Revenue Code	278
Min. Negotiated Rate	$9,815.25
Max. Negotiated Rate	$15,835.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,087.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,835.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,395.70
Rate for Payer: Qualcare PPO/HMO/WC	$9,815.25

FEM TPR LC 133 T1 HO 13X146MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695266
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

FEM TPR LC 133 T1 HO 13X146MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695266
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

FEMUR

Facility

$11,724.30

Hospital Charge Code	270657022
Hospital Revenue Code	278
Min. Negotiated Rate	$282.56
Max. Negotiated Rate	$5,862.15
Rate for Payer: Aetna Commercial	$4,455.23
Rate for Payer: Aetna Medicare Advantage	$3,517.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,989.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,989.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,344.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,989.70
Rate for Payer: Cigna Commercial	$5,862.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,837.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,579.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,758.64
Rate for Payer: UnitedHealthcare Community & State	$282.56
Rate for Payer: Wellpoint Medicaid Managed Care	$310.69

FEMUR

Facility

$11,724.30

Hospital Charge Code	270657022
Hospital Revenue Code	278
Min. Negotiated Rate	$1,758.64
Max. Negotiated Rate	$2,837.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,344.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,837.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,579.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,758.64

FEMUR 1 VIEW BILAT

Facility

$5,100.00

Service Code	HCPCS 7355150
Hospital Charge Code	2011595
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

Know your out-of-pocket cost for care.

All Charges