Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PSN FEM PS CMT CCR SZ 9

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694051
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 PS CMT CCR SZ 9

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694051
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 PS POR CCR NEW SZ 4 R

Facility

$60,350.00

Service Code	HCPCS C1776
Hospital Charge Code	270703870
Hospital Revenue Code	278
Min. Negotiated Rate	$9,052.50
Max. Negotiated Rate	$14,604.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,604.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13,277.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,052.50

PSN FEM PS POR CCR NEW SZ 4 R

Facility

$60,350.00

Service Code	HCPCS C1776
Hospital Charge Code	270703870
Hospital Revenue Code	278
Min. Negotiated Rate	$1,454.43
Max. Negotiated Rate	$30,175.00
Rate for Payer: Aetna Commercial	$22,933.00
Rate for Payer: Aetna Medicare Advantage	$18,105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,389.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,389.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,070.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,389.25
Rate for Payer: Cigna Commercial	$30,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,604.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13,277.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,052.50
Rate for Payer: UnitedHealthcare Community & State	$1,454.43
Rate for Payer: Wellpoint Medicaid Managed Care	$1,599.28

PSN FEM PS POR CCR NRW SZ6

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270695671
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 PS POR CCR NRW SZ6

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270695671
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 FEM PS POR CCR STD SZ12 R

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270694198
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 FEM PS POR CCR STD SZ12 R

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270694198
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 PSPOR CCRSTD SZ6 R

Facility

$27,475.00

Service Code	HCPCS C1776
Hospital Charge Code	270694858
Hospital Revenue Code	278
Min. Negotiated Rate	$662.15
Max. Negotiated Rate	$13,737.50
Rate for Payer: Aetna Commercial	$10,440.50
Rate for Payer: Aetna Medicare Advantage	$8,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,006.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,006.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,006.12
Rate for Payer: Cigna Commercial	$13,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,648.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,044.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,121.25
Rate for Payer: UnitedHealthcare Community & State	$662.15
Rate for Payer: Wellpoint Medicaid Managed Care	$728.09

PSN FEM PSPOR CCRSTD SZ6 R

Facility

$27,475.00

Service Code	HCPCS C1776
Hospital Charge Code	270694858
Hospital Revenue Code	278
Min. Negotiated Rate	$4,121.25
Max. Negotiated Rate	$6,648.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,648.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,044.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,121.25

PSN FEM PS POR CCR STD SZ 7

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270693727
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 PS POR CCR STD SZ 7

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270696396
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 PS POR CCR STD SZ 7

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270696396
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 FEM PS POR CCR STD SZ 7

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270693727
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 FEM PS POR CCR STD SZ9 L

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270693999
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 PS POR CCR STD SZ9 L

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270693999
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 FEM PS POR CCR SZ7

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270696123
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 FEM PS POR CCR SZ7

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270696123
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 PS POR STD SZ 10

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270694593
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 FEM PS POR STD SZ 10

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270694593
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 TIB FIXED KEEL SZ R

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270690586
Hospital Revenue Code	278
Min. Negotiated Rate	$445.55
Max. Negotiated Rate	$9,243.75
Rate for Payer: Aetna Commercial	$7,025.25
Rate for Payer: Aetna Medicare Advantage	$5,546.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,714.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,714.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,714.31
Rate for Payer: Cigna Commercial	$9,243.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,067.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,773.12
Rate for Payer: UnitedHealthcare Community & State	$445.55
Rate for Payer: Wellpoint Medicaid Managed Care	$489.92

PSN FEM TIB FIXED KEEL SZ R

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270690586
Hospital Revenue Code	278
Min. Negotiated Rate	$2,773.12
Max. Negotiated Rate	$4,473.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,067.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,773.12

PSN F SCREW 25MM

Facility

$840.00

Service Code	HCPCS C1713
Hospital Charge Code	270691313
Hospital Revenue Code	278
Min. Negotiated Rate	$20.24
Max. Negotiated Rate	$420.00
Rate for Payer: Aetna Commercial	$319.20
Rate for Payer: Aetna Medicare Advantage	$252.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.20
Rate for Payer: Cigna Commercial	$420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$184.80
Rate for Payer: Qualcare PPO/HMO/WC	$126.00
Rate for Payer: UnitedHealthcare Community & State	$20.24
Rate for Payer: Wellpoint Medicaid Managed Care	$22.26

PSN F SCREW 25MM

Facility

$840.00

Service Code	HCPCS C1713
Hospital Charge Code	270691313
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$203.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$184.80
Rate for Payer: Qualcare PPO/HMO/WC	$126.00

PSN FSM PS POR CCR STD SZ 8

Facility

$30,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270696052
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

Know your out-of-pocket cost for care.

All Charges