Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STEM 12mmX 250mm

Facility

$12,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677750
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

STEM 12mmX 250mm

Facility

$12,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677750
Hospital Revenue Code	278
Min. Negotiated Rate	$301.25
Max. Negotiated Rate	$6,250.00
Rate for Payer: Aetna Commercial	$4,750.00
Rate for Payer: Aetna Medicare Advantage	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,187.50
Rate for Payer: Cigna Commercial	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00
Rate for Payer: UnitedHealthcare Community & State	$301.25
Rate for Payer: Wellpoint Medicaid Managed Care	$331.25

STEM 12MMX50MM TRIATHLON

Facility

$11,965.00

Service Code	HCPCS C1776
Hospital Charge Code	270691990
Hospital Revenue Code	278
Min. Negotiated Rate	$288.36
Max. Negotiated Rate	$5,982.50
Rate for Payer: Aetna Commercial	$4,546.70
Rate for Payer: Aetna Medicare Advantage	$3,589.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,393.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,051.07
Rate for Payer: Cigna Commercial	$5,982.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,895.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,632.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,794.75
Rate for Payer: UnitedHealthcare Community & State	$288.36
Rate for Payer: Wellpoint Medicaid Managed Care	$317.07

STEM 12MMX50MM TRIATHLON

Facility

$11,965.00

Service Code	HCPCS C1776
Hospital Charge Code	270691990
Hospital Revenue Code	278
Min. Negotiated Rate	$1,794.75
Max. Negotiated Rate	$2,895.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,393.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,895.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,632.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,794.75

STEM 3M FEMUR SZ 11 LEFT

Facility

$18,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270692715
Hospital Revenue Code	278
Min. Negotiated Rate	$2,835.00
Max. Negotiated Rate	$4,573.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,573.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,158.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,835.00

STEM 3M FEMUR SZ 11 LEFT

Facility

$18,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270692715
Hospital Revenue Code	278
Min. Negotiated Rate	$455.49
Max. Negotiated Rate	$9,450.00
Rate for Payer: Aetna Commercial	$7,182.00
Rate for Payer: Aetna Medicare Advantage	$5,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,819.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,819.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,819.50
Rate for Payer: Cigna Commercial	$9,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,573.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,158.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,835.00
Rate for Payer: UnitedHealthcare Community & State	$455.49
Rate for Payer: Wellpoint Medicaid Managed Care	$500.85

STEM 5 DEG PSN TIB SZ C L

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689591
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

STEM 5 DEG PSN TIB SZ C L

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689591
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

STEM 5 DEG SZ F RIGHT

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690962
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

STEM 5 DEG SZ F RIGHT

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690962
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

STEM 6.5MM 496-S065

Facility

$5,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270628373
Hospital Revenue Code	278
Min. Negotiated Rate	$896.25
Max. Negotiated Rate	$1,445.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,445.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,314.50
Rate for Payer: Qualcare PPO/HMO/WC	$896.25

STEM 6.5MM 496-S065

Facility

$5,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270628373
Hospital Revenue Code	278
Min. Negotiated Rate	$144.00
Max. Negotiated Rate	$2,987.50
Rate for Payer: Aetna Commercial	$2,270.50
Rate for Payer: Aetna Medicare Advantage	$1,792.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,523.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,523.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,523.62
Rate for Payer: Cigna Commercial	$2,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,445.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,314.50
Rate for Payer: Qualcare PPO/HMO/WC	$896.25
Rate for Payer: UnitedHealthcare Community & State	$144.00
Rate for Payer: Wellpoint Medicaid Managed Care	$158.34

STEM 7853-013-21

Facility

$10,546.45

Hospital Charge Code	270629986
Hospital Revenue Code	278
Min. Negotiated Rate	$254.17
Max. Negotiated Rate	$5,273.23
Rate for Payer: Aetna Commercial	$4,007.65
Rate for Payer: Aetna Medicare Advantage	$3,163.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,689.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,689.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,109.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,689.34
Rate for Payer: Cigna Commercial	$5,273.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,552.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,320.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,581.97
Rate for Payer: UnitedHealthcare Community & State	$254.17
Rate for Payer: Wellpoint Medicaid Managed Care	$279.48

STEM 7853-013-21

Facility

$10,546.45

Hospital Charge Code	270629986
Hospital Revenue Code	278
Min. Negotiated Rate	$1,581.97
Max. Negotiated Rate	$2,552.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,109.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,552.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,320.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,581.97

STEM 7MM DIA X 2MM TR

Facility

$9,820.00

Hospital Charge Code	270666832
Hospital Revenue Code	278
Min. Negotiated Rate	$1,473.00
Max. Negotiated Rate	$2,376.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,964.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,376.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,160.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,473.00

STEM 7MM DIA X 2MM TR

Facility

$9,820.00

Hospital Charge Code	270666832
Hospital Revenue Code	278
Min. Negotiated Rate	$236.66
Max. Negotiated Rate	$4,910.00
Rate for Payer: Aetna Commercial	$3,731.60
Rate for Payer: Aetna Medicare Advantage	$2,946.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,504.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,504.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,964.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,504.10
Rate for Payer: Cigna Commercial	$4,910.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,376.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,160.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,473.00
Rate for Payer: UnitedHealthcare Community & State	$236.66
Rate for Payer: Wellpoint Medicaid Managed Care	$260.23

STEM 7MM STD ECHO BIMETRIC LAT

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693216
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

STEM 7MM STD ECHO BIMETRIC LAT

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693216
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

STEM 8.0MM x 4.0MM TI ALLOY

Facility

$10,825.00

Service Code	HCPCS C1776
Hospital Charge Code	270682453
Hospital Revenue Code	278
Min. Negotiated Rate	$260.88
Max. Negotiated Rate	$5,412.50
Rate for Payer: Aetna Commercial	$4,113.50
Rate for Payer: Aetna Medicare Advantage	$3,247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,760.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,760.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,760.38
Rate for Payer: Cigna Commercial	$5,412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,619.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,381.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,623.75
Rate for Payer: UnitedHealthcare Community & State	$260.88
Rate for Payer: Wellpoint Medicaid Managed Care	$286.86

STEM 8.0MM x 4.0MM TI ALLOY

Facility

$10,825.00

Service Code	HCPCS C1776
Hospital Charge Code	270682453
Hospital Revenue Code	278
Min. Negotiated Rate	$1,623.75
Max. Negotiated Rate	$2,619.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,619.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,381.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,623.75

STEM 8MM DIA X 4.0MM TR

Facility

$10,825.00

Service Code	HCPCS C1776
Hospital Charge Code	270682462
Hospital Revenue Code	278
Min. Negotiated Rate	$1,623.75
Max. Negotiated Rate	$2,619.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,619.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,381.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,623.75

STEM 8MM DIA X 4.0MM TR

Facility

$10,825.00

Service Code	HCPCS C1776
Hospital Charge Code	270682462
Hospital Revenue Code	278
Min. Negotiated Rate	$260.88
Max. Negotiated Rate	$5,412.50
Rate for Payer: Aetna Commercial	$4,113.50
Rate for Payer: Aetna Medicare Advantage	$3,247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,760.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,760.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,760.38
Rate for Payer: Cigna Commercial	$5,412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,619.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,381.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,623.75
Rate for Payer: UnitedHealthcare Community & State	$260.88
Rate for Payer: Wellpoint Medicaid Managed Care	$286.86

STEM 8MM REUNION RFX

Facility

$37,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270700460
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$9,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

STEM 8MM REUNION RFX

Facility

$37,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270700460
Hospital Revenue Code	278
Min. Negotiated Rate	$903.75
Max. Negotiated Rate	$18,750.00
Rate for Payer: Aetna Commercial	$14,250.00
Rate for Payer: Aetna Medicare Advantage	$11,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,562.50
Rate for Payer: Cigna Commercial	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,250.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00
Rate for Payer: UnitedHealthcare Community & State	$903.75
Rate for Payer: Wellpoint Medicaid Managed Care	$993.75

STEM 9MM DIA X 0MM TR

Facility

$9,820.00

Hospital Charge Code	270666834
Hospital Revenue Code	278
Min. Negotiated Rate	$1,473.00
Max. Negotiated Rate	$2,376.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,964.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,376.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,160.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,473.00

Know your out-of-pocket cost for care.

All Charges