Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PSN ASF PS 11MM PLY L 6-9 CD

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270692331
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

PSN ASF PS 11MM PLY L 6-9 CD

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270692331
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

PSN ASF PS 11MM VE 3-5

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692282
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

PSN ASF PS 11MM VE 3-5

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692282
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN ASF PS 12 MM PLY L 6-9 CD

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270692961
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

PSN ASF PS 12 MM PLY L 6-9 CD

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270692961
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

PSN ASF PS 12MM PLY R -3 5 EF

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270686487
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

PSN ASF PS 12MM PLY R -3 5 EF

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270686487
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

PSN ASF PS 12MM VE R 3-5 CD

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697526
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

PSN ASF PS 12MM VE R 3-5 CD

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697526
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN ASFPS TIB INS 10MMPLY6-9CD

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270689983
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

PSN ASFPS TIB INS 10MMPLY6-9CD

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270689983
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

PSN ASF TIB OPS 16MM CMT SZ G

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270696902
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN ASF TIB OPS 16MM CMT SZ G

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270696902
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

PSN ASK PS 10MM VE

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692921
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PSN ASK PS 10MM VE

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692921
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

PSN CM FM/CM TB/CPS/PE PSN PT

Facility

$24,500.00

Hospital Charge Code	270703145
Hospital Revenue Code	278
Min. Negotiated Rate	$3,675.00
Max. Negotiated Rate	$5,929.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,929.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,675.00

PSN CM FM/CM TB/CPS/PE PSN PT

Facility

$24,500.00

Hospital Charge Code	270703145
Hospital Revenue Code	278
Min. Negotiated Rate	$590.45
Max. Negotiated Rate	$12,250.00
Rate for Payer: Aetna Commercial	$9,310.00
Rate for Payer: Aetna Medicare Advantage	$7,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,247.50
Rate for Payer: Cigna Commercial	$12,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,929.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,390.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,675.00
Rate for Payer: UnitedHealthcare Community & State	$590.45
Rate for Payer: Wellpoint Medicaid Managed Care	$649.25

PSN CTD FEMUR TM SZ 9

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270695784
Hospital Revenue Code	278
Min. Negotiated Rate	$4,630.50
Max. Negotiated Rate	$7,470.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50

PSN CTD FEMUR TM SZ 9

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270695784
Hospital Revenue Code	278
Min. Negotiated Rate	$743.97
Max. Negotiated Rate	$15,435.00
Rate for Payer: Aetna Commercial	$11,730.60
Rate for Payer: Aetna Medicare Advantage	$9,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,871.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,871.85
Rate for Payer: Cigna Commercial	$15,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,470.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,791.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,630.50
Rate for Payer: UnitedHealthcare Community & State	$743.97
Rate for Payer: Wellpoint Medicaid Managed Care	$818.05

PSN FEM CCR NRW SZ 8 RT

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698697
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

PSN FEM CCR NRW SZ 8 RT

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270698697
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

PSN FEM CCR STS SZ4

Facility

$10,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270694091
Hospital Revenue Code	278
Min. Negotiated Rate	$261.97
Max. Negotiated Rate	$5,435.00
Rate for Payer: Aetna Commercial	$4,130.60
Rate for Payer: Aetna Medicare Advantage	$3,261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,771.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,771.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,771.85
Rate for Payer: Cigna Commercial	$5,435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,630.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,391.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,630.50
Rate for Payer: UnitedHealthcare Community & State	$261.97
Rate for Payer: Wellpoint Medicaid Managed Care	$288.06

PSN FEM CCR STS SZ4

Facility

$10,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270694091
Hospital Revenue Code	278
Min. Negotiated Rate	$1,630.50
Max. Negotiated Rate	$2,630.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,174.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,630.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,391.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,630.50

PSN FEM CNT CCR STD SZ 11 RT

Facility

$53,215.00

Service Code	HCPCS C1776
Hospital Charge Code	270697604
Hospital Revenue Code	278
Min. Negotiated Rate	$7,982.25
Max. Negotiated Rate	$12,878.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,643.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,878.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11,707.30
Rate for Payer: Qualcare PPO/HMO/WC	$7,982.25

Know your out-of-pocket cost for care.

All Charges