Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PSN REV 3 OFFSET STEM EXTENS

Facility

$19,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270697606
Hospital Revenue Code	278
Min. Negotiated Rate	$468.62
Max. Negotiated Rate	$9,722.50
Rate for Payer: Aetna Commercial	$7,389.10
Rate for Payer: Aetna Medicare Advantage	$5,833.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,958.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,958.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,889.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,958.48
Rate for Payer: Cigna Commercial	$9,722.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,705.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,277.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,916.75
Rate for Payer: UnitedHealthcare Community & State	$468.62
Rate for Payer: Wellpoint Medicaid Managed Care	$515.29

PSN REV 3 OFFSET STEM EXTENS

Facility

$19,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270697606
Hospital Revenue Code	278
Min. Negotiated Rate	$2,916.75
Max. Negotiated Rate	$4,705.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,889.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,705.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,277.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,916.75

PSN REV 6MM OFFSET EXT 13X135M

Facility

$18,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270694284
Hospital Revenue Code	278
Min. Negotiated Rate	$454.29
Max. Negotiated Rate	$9,425.00
Rate for Payer: Aetna Commercial	$7,163.00
Rate for Payer: Aetna Medicare Advantage	$5,655.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,806.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,806.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,806.75
Rate for Payer: Cigna Commercial	$9,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,561.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,147.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,827.50
Rate for Payer: UnitedHealthcare Community & State	$454.29
Rate for Payer: Wellpoint Medicaid Managed Care	$499.52

PSN REV 6MM OFFSET EXT 13X135M

Facility

$18,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270694284
Hospital Revenue Code	278
Min. Negotiated Rate	$2,827.50
Max. Negotiated Rate	$4,561.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,561.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,147.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,827.50

PSN REV ART SURF VE EF 20MM

Facility

$18,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270694635
Hospital Revenue Code	278
Min. Negotiated Rate	$436.81
Max. Negotiated Rate	$9,062.50
Rate for Payer: Aetna Commercial	$6,887.50
Rate for Payer: Aetna Medicare Advantage	$5,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,621.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,621.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,621.88
Rate for Payer: Cigna Commercial	$9,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,386.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,987.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.75
Rate for Payer: UnitedHealthcare Community & State	$436.81
Rate for Payer: Wellpoint Medicaid Managed Care	$480.31

PSN REV ART SURF VE EF 20MM

Facility

$18,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270694635
Hospital Revenue Code	278
Min. Negotiated Rate	$2,718.75
Max. Negotiated Rate	$4,386.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,386.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,987.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.75

PSN REV CCK ART 14 MM 3-5

Facility

$15,450.00

Service Code	HCPCS C1776
Hospital Charge Code	270692735
Hospital Revenue Code	278
Min. Negotiated Rate	$2,317.50
Max. Negotiated Rate	$3,738.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,738.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,399.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.50

PSN REV CCK ART 14 MM 3-5

Facility

$15,450.00

Service Code	HCPCS C1776
Hospital Charge Code	270692735
Hospital Revenue Code	278
Min. Negotiated Rate	$372.35
Max. Negotiated Rate	$7,725.00
Rate for Payer: Aetna Commercial	$5,871.00
Rate for Payer: Aetna Medicare Advantage	$4,635.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,939.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,939.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,090.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,939.75
Rate for Payer: Cigna Commercial	$7,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,738.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,399.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.50
Rate for Payer: UnitedHealthcare Community & State	$372.35
Rate for Payer: Wellpoint Medicaid Managed Care	$409.43

PSNREVCCKARTSRFVE10MMRT11-13GH

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270697637
Hospital Revenue Code	278
Min. Negotiated Rate	$449.92
Max. Negotiated Rate	$9,334.38
Rate for Payer: Aetna Commercial	$7,094.12
Rate for Payer: Aetna Medicare Advantage	$5,600.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,760.53
Rate for Payer: Cigna Commercial	$9,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,107.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31
Rate for Payer: UnitedHealthcare Community & State	$449.92
Rate for Payer: Wellpoint Medicaid Managed Care	$494.72

PSNREVCCKARTSRFVE10MMRT11-13GH

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270697637
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$4,517.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,107.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSNREVCCKARTSURFVE10MML7-9EF

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270697458
Hospital Revenue Code	278
Min. Negotiated Rate	$449.92
Max. Negotiated Rate	$9,334.38
Rate for Payer: Aetna Commercial	$7,094.12
Rate for Payer: Aetna Medicare Advantage	$5,600.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,760.53
Rate for Payer: Cigna Commercial	$9,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,107.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31
Rate for Payer: UnitedHealthcare Community & State	$449.92
Rate for Payer: Wellpoint Medicaid Managed Care	$494.72

PSNREVCCKARTSURFVE10MML7-9EF

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270697458
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$4,517.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,107.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSNREVCCKARTSURFVE10MMR11-13EF

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270699726
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$4,517.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,107.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSNREVCCKARTSURFVE10MMR11-13EF

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270699726
Hospital Revenue Code	278
Min. Negotiated Rate	$449.92
Max. Negotiated Rate	$9,334.38
Rate for Payer: Aetna Commercial	$7,094.12
Rate for Payer: Aetna Medicare Advantage	$5,600.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,760.53
Rate for Payer: Cigna Commercial	$9,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,107.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31
Rate for Payer: UnitedHealthcare Community & State	$449.92
Rate for Payer: Wellpoint Medicaid Managed Care	$494.72

PSNREVCCKARTSURFVE12MML3-5CD

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270696395
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$4,517.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,107.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSNREVCCKARTSURFVE12MML3-5CD

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270696395
Hospital Revenue Code	278
Min. Negotiated Rate	$449.92
Max. Negotiated Rate	$9,334.38
Rate for Payer: Aetna Commercial	$7,094.12
Rate for Payer: Aetna Medicare Advantage	$5,600.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,760.53
Rate for Payer: Cigna Commercial	$9,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,107.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31
Rate for Payer: UnitedHealthcare Community & State	$449.92
Rate for Payer: Wellpoint Medicaid Managed Care	$494.72

PSN REV CCK ART SURF VE 12MM R

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270699094
Hospital Revenue Code	278
Min. Negotiated Rate	$449.92
Max. Negotiated Rate	$9,334.38
Rate for Payer: Aetna Commercial	$7,094.12
Rate for Payer: Aetna Medicare Advantage	$5,600.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,760.53
Rate for Payer: Cigna Commercial	$9,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,107.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31
Rate for Payer: UnitedHealthcare Community & State	$449.92
Rate for Payer: Wellpoint Medicaid Managed Care	$494.72

PSN REV CCK ART SURF VE 12MM R

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270699094
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$4,517.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,107.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSNREVCCKARTSURFVE14MML7-9CD

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270697667
Hospital Revenue Code	278
Min. Negotiated Rate	$449.92
Max. Negotiated Rate	$9,334.38
Rate for Payer: Aetna Commercial	$7,094.12
Rate for Payer: Aetna Medicare Advantage	$5,600.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,760.53
Rate for Payer: Cigna Commercial	$9,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,107.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31
Rate for Payer: UnitedHealthcare Community & State	$449.92
Rate for Payer: Wellpoint Medicaid Managed Care	$494.72

PSNREVCCKARTSURFVE14MML7-9CD

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270697667
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$4,517.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,107.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSNREVCCKARTSURFVE14MML7-9EF

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270697460
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$4,517.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,107.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSNREVCCKARTSURFVE14MML7-9EF

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270697460
Hospital Revenue Code	278
Min. Negotiated Rate	$449.92
Max. Negotiated Rate	$9,334.38
Rate for Payer: Aetna Commercial	$7,094.12
Rate for Payer: Aetna Medicare Advantage	$5,600.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,760.53
Rate for Payer: Cigna Commercial	$9,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,107.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31
Rate for Payer: UnitedHealthcare Community & State	$449.92
Rate for Payer: Wellpoint Medicaid Managed Care	$494.72

PSN REV CCK ART SURF VE 18MM L

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270696797
Hospital Revenue Code	278
Min. Negotiated Rate	$449.92
Max. Negotiated Rate	$9,334.38
Rate for Payer: Aetna Commercial	$7,094.12
Rate for Payer: Aetna Medicare Advantage	$5,600.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,760.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,760.53
Rate for Payer: Cigna Commercial	$9,334.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,107.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31
Rate for Payer: UnitedHealthcare Community & State	$449.92
Rate for Payer: Wellpoint Medicaid Managed Care	$494.72

PSN REV CCK ART SURF VE 18MM L

Facility

$18,668.75

Service Code	HCPCS C1776
Hospital Charge Code	270696797
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.31
Max. Negotiated Rate	$4,517.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,733.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,517.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,107.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,800.31

PSN REV CCK VE 12MM L 11-13 GH

Facility

$18,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270695149
Hospital Revenue Code	278
Min. Negotiated Rate	$2,718.75
Max. Negotiated Rate	$4,386.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,386.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,987.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.75

Know your out-of-pocket cost for care.

All Charges