Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PSN REV TIB FIXED CMT SZ E

Facility

$18,486.25

Service Code	HCPCS C1776
Hospital Charge Code	270694636
Hospital Revenue Code	278
Min. Negotiated Rate	$2,772.94
Max. Negotiated Rate	$4,473.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,697.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,066.97
Rate for Payer: Qualcare PPO/HMO/WC	$2,772.94

PSN REV TIB FIXED KEEL CMT

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270690590
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 REV TIB FIXED KEEL CMT

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270690590
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 REV TIB FIX KEEL CMT SZ C

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270694074
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 REV TIB FIX KEEL CMT SZ C

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270694074
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 REV TIB FIX KEEL CMT SZG L

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270695145
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 REV TIB FIX KEEL CMT SZG L

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270695145
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

PSNREVTIBFIXKEELCMT SZ G RT

Facility

$19,067.50

Service Code	HCPCS C1776
Hospital Charge Code	270697636
Hospital Revenue Code	278
Min. Negotiated Rate	$2,860.12
Max. Negotiated Rate	$4,614.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,813.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,614.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,194.85
Rate for Payer: Qualcare PPO/HMO/WC	$2,860.12

PSNREVTIBFIXKEELCMT SZ G RT

Facility

$19,067.50

Service Code	HCPCS C1776
Hospital Charge Code	270697636
Hospital Revenue Code	278
Min. Negotiated Rate	$459.53
Max. Negotiated Rate	$9,533.75
Rate for Payer: Aetna Commercial	$7,245.65
Rate for Payer: Aetna Medicare Advantage	$5,720.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,862.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,862.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,813.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,862.21
Rate for Payer: Cigna Commercial	$9,533.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,614.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,194.85
Rate for Payer: Qualcare PPO/HMO/WC	$2,860.12
Rate for Payer: UnitedHealthcare Community & State	$459.53
Rate for Payer: Wellpoint Medicaid Managed Care	$505.29

PSN REV TIB FIX KNEE L CMT SZF

Facility

$19,067.50

Service Code	HCPCS C1776
Hospital Charge Code	270697457
Hospital Revenue Code	278
Min. Negotiated Rate	$2,860.12
Max. Negotiated Rate	$4,614.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,813.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,614.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,194.85
Rate for Payer: Qualcare PPO/HMO/WC	$2,860.12

PSN REV TIB FIX KNEE L CMT SZF

Facility

$19,067.50

Service Code	HCPCS C1776
Hospital Charge Code	270697457
Hospital Revenue Code	278
Min. Negotiated Rate	$459.53
Max. Negotiated Rate	$9,533.75
Rate for Payer: Aetna Commercial	$7,245.65
Rate for Payer: Aetna Medicare Advantage	$5,720.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,862.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,862.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,813.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,862.21
Rate for Payer: Cigna Commercial	$9,533.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,614.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,194.85
Rate for Payer: Qualcare PPO/HMO/WC	$2,860.12
Rate for Payer: UnitedHealthcare Community & State	$459.53
Rate for Payer: Wellpoint Medicaid Managed Care	$505.29

PSN REV TIB FXD KEEL CMT SZF/R

Facility

$19,067.50

Service Code	HCPCS C1776
Hospital Charge Code	270699725
Hospital Revenue Code	278
Min. Negotiated Rate	$459.53
Max. Negotiated Rate	$9,533.75
Rate for Payer: Aetna Commercial	$7,245.65
Rate for Payer: Aetna Medicare Advantage	$5,720.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,862.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,862.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,813.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,862.21
Rate for Payer: Cigna Commercial	$9,533.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,614.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,194.85
Rate for Payer: Qualcare PPO/HMO/WC	$2,860.12
Rate for Payer: UnitedHealthcare Community & State	$459.53
Rate for Payer: Wellpoint Medicaid Managed Care	$505.29

PSN REV TIB FXD KEEL CMT SZF/R

Facility

$19,067.50

Service Code	HCPCS C1776
Hospital Charge Code	270699725
Hospital Revenue Code	278
Min. Negotiated Rate	$2,860.12
Max. Negotiated Rate	$4,614.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,813.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,614.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,194.85
Rate for Payer: Qualcare PPO/HMO/WC	$2,860.12

PSN REV TIB HALF BLACK SZ

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270690587
Hospital Revenue Code	278
Min. Negotiated Rate	$192.20
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$192.20
Rate for Payer: Wellpoint Medicaid Managed Care	$211.34

PSN REV TIB HALF BLACK SZ

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270690587
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

PSN REV TIB HALF BLK SZCD 10MM

Facility

$8,228.75

Service Code	HCPCS C1776
Hospital Charge Code	270697322
Hospital Revenue Code	278
Min. Negotiated Rate	$1,234.31
Max. Negotiated Rate	$1,991.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,991.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,810.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.31

PSN REV TIB HALF BLK SZCD 10MM

Facility

$8,228.75

Service Code	HCPCS C1776
Hospital Charge Code	270697322
Hospital Revenue Code	278
Min. Negotiated Rate	$198.31
Max. Negotiated Rate	$4,114.38
Rate for Payer: Aetna Commercial	$3,126.93
Rate for Payer: Aetna Medicare Advantage	$2,468.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,098.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,098.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,098.33
Rate for Payer: Cigna Commercial	$4,114.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,991.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,810.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.31
Rate for Payer: UnitedHealthcare Community & State	$198.31
Rate for Payer: Wellpoint Medicaid Managed Care	$218.06

PSN REV TIB HALF BLOCK 10MM

Facility

$8,228.75

Service Code	HCPCS C1776
Hospital Charge Code	270697332
Hospital Revenue Code	278
Min. Negotiated Rate	$198.31
Max. Negotiated Rate	$4,114.38
Rate for Payer: Aetna Commercial	$3,126.93
Rate for Payer: Aetna Medicare Advantage	$2,468.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,098.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,098.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,098.33
Rate for Payer: Cigna Commercial	$4,114.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,991.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,810.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.31
Rate for Payer: UnitedHealthcare Community & State	$198.31
Rate for Payer: Wellpoint Medicaid Managed Care	$218.06

PSN REV TIB HALF BLOCK 10MM

Facility

$8,228.75

Service Code	HCPCS C1776
Hospital Charge Code	270697332
Hospital Revenue Code	278
Min. Negotiated Rate	$1,234.31
Max. Negotiated Rate	$1,991.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,991.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,810.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.31

PSNREV TIB HALFBLOCK SZEF 10MM

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270694632
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

PSNREV TIB HALFBLOCK SZEF 10MM

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270694632
Hospital Revenue Code	278
Min. Negotiated Rate	$192.20
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$192.20
Rate for Payer: Wellpoint Medicaid Managed Care	$211.34

PSN REV TIBHALFBLOCKSZEFRL10MM

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270694633
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

PSN REV TIBHALFBLOCKSZEFRL10MM

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270694633
Hospital Revenue Code	278
Min. Negotiated Rate	$192.20
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$192.20
Rate for Payer: Wellpoint Medicaid Managed Care	$211.34

PSNREVTIBINSCCKVE18MMR3-5CD

Facility

$18,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270695262
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

PSNREVTIBINSCCKVE18MMR3-5CD

Facility

$18,125.00

Service Code	HCPCS C1776
Hospital Charge Code	270695262
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

Know your out-of-pocket cost for care.

All Charges