Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STEM CEMENTRAZLER 9.25MM

Facility

$375.00

Service Code	HCPCS C1776
Hospital Charge Code	270696313
Hospital Revenue Code	278
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

STEM CEMENTRAZLER 9.25MM

Facility

$375.00

Service Code	HCPCS C1776
Hospital Charge Code	270696313
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

STEM CEM IM OSS 13X150

Facility

$14,310.00

Service Code	HCPCS C1776
Hospital Charge Code	270691646
Hospital Revenue Code	278
Min. Negotiated Rate	$2,146.50
Max. Negotiated Rate	$3,463.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,862.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,463.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,148.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,146.50

STEM CEM IM OSS 13X150

Facility

$14,310.00

Service Code	HCPCS C1776
Hospital Charge Code	270691646
Hospital Revenue Code	278
Min. Negotiated Rate	$344.87
Max. Negotiated Rate	$7,155.00
Rate for Payer: Aetna Commercial	$5,437.80
Rate for Payer: Aetna Medicare Advantage	$4,293.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,649.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,649.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,649.05
Rate for Payer: Cigna Commercial	$7,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,463.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,148.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,146.50
Rate for Payer: UnitedHealthcare Community & State	$344.87
Rate for Payer: Wellpoint Medicaid Managed Care	$379.21

STEM CENTRALIZER 10.5 CEMENTED

Facility

$393.75

Service Code	HCPCS C1776
Hospital Charge Code	270700571
Hospital Revenue Code	278
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$196.88
Rate for Payer: Aetna Commercial	$149.62
Rate for Payer: Aetna Medicare Advantage	$118.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.41
Rate for Payer: Cigna Commercial	$196.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$86.62
Rate for Payer: Qualcare PPO/HMO/WC	$59.06
Rate for Payer: UnitedHealthcare Community & State	$9.49
Rate for Payer: Wellpoint Medicaid Managed Care	$10.43

STEM CENTRALIZER 10.5 CEMENTED

Facility

$393.75

Service Code	HCPCS C1776
Hospital Charge Code	270700571
Hospital Revenue Code	278
Min. Negotiated Rate	$59.06
Max. Negotiated Rate	$95.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$86.62
Rate for Payer: Qualcare PPO/HMO/WC	$59.06

STEM COLLARED 11MMX135MM

Facility

$19,180.00

Hospital Charge Code	270662231
Hospital Revenue Code	278
Min. Negotiated Rate	$2,877.00
Max. Negotiated Rate	$4,641.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,836.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,641.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,219.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,877.00

STEM COLLARED 11MMX135MM

Facility

$19,180.00

Hospital Charge Code	270662231
Hospital Revenue Code	278
Min. Negotiated Rate	$462.24
Max. Negotiated Rate	$9,590.00
Rate for Payer: Aetna Commercial	$7,288.40
Rate for Payer: Aetna Medicare Advantage	$5,754.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,890.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,890.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,890.90
Rate for Payer: Cigna Commercial	$9,590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,641.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,219.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,877.00
Rate for Payer: UnitedHealthcare Community & State	$462.24
Rate for Payer: Wellpoint Medicaid Managed Care	$508.27

STEM COLLARED STD 2

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687120
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

STEM COLLARED STD 2

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687120
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

STEM COLLARED STD 3

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687121
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

STEM COLLARED STD 3

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270687121
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

STEM COLLARED STD 4

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688585
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

STEM COLLARED STD 4

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688585
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

STEM COMPLETE XR 123 DEG SZ 8

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270694946
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 COMPLETE XR 123 DEG SZ 8

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270694946
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 COMP PRIMARY 7MM MINI

Facility

$14,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690732
Hospital Revenue Code	278
Min. Negotiated Rate	$2,175.00
Max. Negotiated Rate	$3,509.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,190.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00

STEM COMP PRIMARY 7MM MINI

Facility

$14,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690732
Hospital Revenue Code	278
Min. Negotiated Rate	$349.45
Max. Negotiated Rate	$7,250.00
Rate for Payer: Aetna Commercial	$5,510.00
Rate for Payer: Aetna Medicare Advantage	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,697.50
Rate for Payer: Cigna Commercial	$7,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,190.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00
Rate for Payer: UnitedHealthcare Community & State	$349.45
Rate for Payer: Wellpoint Medicaid Managed Care	$384.25

STEM COMP PRIMARY STD 12X122MM

Facility

$14,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695586
Hospital Revenue Code	278
Min. Negotiated Rate	$2,175.00
Max. Negotiated Rate	$3,509.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,190.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00

STEM COMP PRIMARY STD 12X122MM

Facility

$14,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695586
Hospital Revenue Code	278
Min. Negotiated Rate	$349.45
Max. Negotiated Rate	$7,250.00
Rate for Payer: Aetna Commercial	$5,510.00
Rate for Payer: Aetna Medicare Advantage	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,697.50
Rate for Payer: Cigna Commercial	$7,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,190.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00
Rate for Payer: UnitedHealthcare Community & State	$349.45
Rate for Payer: Wellpoint Medicaid Managed Care	$384.25

STEM COMP PRIMARY STD 9X122MM

Facility

$14,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270694043
Hospital Revenue Code	278
Min. Negotiated Rate	$2,175.00
Max. Negotiated Rate	$3,509.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,190.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00

STEM COMP PRIMARY STD 9X122MM

Facility

$14,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270694043
Hospital Revenue Code	278
Min. Negotiated Rate	$349.45
Max. Negotiated Rate	$7,250.00
Rate for Payer: Aetna Commercial	$5,510.00
Rate for Payer: Aetna Medicare Advantage	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,697.50
Rate for Payer: Cigna Commercial	$7,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,190.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00
Rate for Payer: UnitedHealthcare Community & State	$349.45
Rate for Payer: Wellpoint Medicaid Managed Care	$384.25

STEM COMP STD PRIMARY 7X122MM

Facility

$14,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695499
Hospital Revenue Code	278
Min. Negotiated Rate	$2,175.00
Max. Negotiated Rate	$3,509.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,190.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00

STEM COMP STD PRIMARY 7X122MM

Facility

$14,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270695499
Hospital Revenue Code	278
Min. Negotiated Rate	$349.45
Max. Negotiated Rate	$7,250.00
Rate for Payer: Aetna Commercial	$5,510.00
Rate for Payer: Aetna Medicare Advantage	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,697.50
Rate for Payer: Cigna Commercial	$7,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,190.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00
Rate for Payer: UnitedHealthcare Community & State	$349.45
Rate for Payer: Wellpoint Medicaid Managed Care	$384.25

STEM CTRL INTEGRL 9mm 12162609

Facility

$10,255.00

Hospital Charge Code	270625863
Hospital Revenue Code	278
Min. Negotiated Rate	$247.15
Max. Negotiated Rate	$5,127.50
Rate for Payer: Aetna Commercial	$3,896.90
Rate for Payer: Aetna Medicare Advantage	$3,076.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,615.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,615.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,051.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,615.03
Rate for Payer: Cigna Commercial	$5,127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,481.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,256.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,538.25
Rate for Payer: UnitedHealthcare Community & State	$247.15
Rate for Payer: Wellpoint Medicaid Managed Care	$271.76

Know your out-of-pocket cost for care.

All Charges