Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STEM ELEOS EXT CEMENTED 14 MM

Facility

$5,490.00

Service Code	HCPCS C1776
Hospital Charge Code	2706828402
Hospital Revenue Code	278
Min. Negotiated Rate	$823.50
Max. Negotiated Rate	$1,328.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,098.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,328.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,207.80
Rate for Payer: Qualcare PPO/HMO/WC	$823.50

STEM ELEOS EXT CEMENTED 14 MM

Facility

$5,490.00

Service Code	HCPCS C1776
Hospital Charge Code	2706828402
Hospital Revenue Code	278
Min. Negotiated Rate	$132.31
Max. Negotiated Rate	$2,745.00
Rate for Payer: Aetna Commercial	$2,086.20
Rate for Payer: Aetna Medicare Advantage	$1,647.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,399.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,399.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,098.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,399.95
Rate for Payer: Cigna Commercial	$2,745.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,328.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,207.80
Rate for Payer: Qualcare PPO/HMO/WC	$823.50
Rate for Payer: UnitedHealthcare Community & State	$132.31
Rate for Payer: Wellpoint Medicaid Managed Care	$145.49

STEM EMPLOR 7x26mm 11210062

Facility

$7,480.00

Hospital Charge Code	270644772
Hospital Revenue Code	278
Min. Negotiated Rate	$1,122.00
Max. Negotiated Rate	$1,810.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,496.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,810.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,645.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,122.00

STEM EMPLOR 7x26mm 11210062

Facility

$7,480.00

Hospital Charge Code	270644772
Hospital Revenue Code	278
Min. Negotiated Rate	$180.27
Max. Negotiated Rate	$3,740.00
Rate for Payer: Aetna Commercial	$2,842.40
Rate for Payer: Aetna Medicare Advantage	$2,244.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,907.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,907.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,496.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,907.40
Rate for Payer: Cigna Commercial	$3,740.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,810.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,645.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,122.00
Rate for Payer: UnitedHealthcare Community & State	$180.27
Rate for Payer: Wellpoint Medicaid Managed Care	$198.22

STEM EMPOWER LEFT COATED SZ 7

Facility

$18,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270691776
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 EMPOWER LEFT COATED SZ 7

Facility

$18,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270691776
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 EXPLOR RADIAL 8x28mm

Facility

$15,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680736
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

STEM EXPLOR RADIAL 8x28mm

Facility

$15,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680736
Hospital Revenue Code	278
Min. Negotiated Rate	$361.50
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$361.50
Rate for Payer: Wellpoint Medicaid Managed Care	$397.50

STEM EXT 10 MM

Facility

$19,430.00

Hospital Charge Code	270703332
Hospital Revenue Code	278
Min. Negotiated Rate	$468.26
Max. Negotiated Rate	$9,715.00
Rate for Payer: Aetna Commercial	$7,383.40
Rate for Payer: Aetna Medicare Advantage	$5,829.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,954.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,954.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,886.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,954.65
Rate for Payer: Cigna Commercial	$9,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,702.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,274.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,914.50
Rate for Payer: UnitedHealthcare Community & State	$468.26
Rate for Payer: Wellpoint Medicaid Managed Care	$514.89

STEM EXT 10 MM

Facility

$19,430.00

Hospital Charge Code	270703332
Hospital Revenue Code	278
Min. Negotiated Rate	$2,914.50
Max. Negotiated Rate	$4,702.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,886.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,702.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,274.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,914.50

STEM EXTEN FEM AND TI 14X40MM

Facility

$11,010.00

Service Code	HCPCS C1776
Hospital Charge Code	270683942
Hospital Revenue Code	278
Min. Negotiated Rate	$1,651.50
Max. Negotiated Rate	$2,664.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,422.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50

STEM EXTEN FEM AND TI 14X40MM

Facility

$11,010.00

Service Code	HCPCS C1776
Hospital Charge Code	270683942
Hospital Revenue Code	278
Min. Negotiated Rate	$265.34
Max. Negotiated Rate	$5,505.00
Rate for Payer: Aetna Commercial	$4,183.80
Rate for Payer: Aetna Medicare Advantage	$3,303.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,807.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,807.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,807.55
Rate for Payer: Cigna Commercial	$5,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,422.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50
Rate for Payer: UnitedHealthcare Community & State	$265.34
Rate for Payer: Wellpoint Medicaid Managed Care	$291.76

STEM EXTEN FEM AND TI 14X40MM

Facility

$11,010.00

Service Code	HCPCS C1776
Hospital Charge Code	270683937
Hospital Revenue Code	278
Min. Negotiated Rate	$1,651.50
Max. Negotiated Rate	$2,664.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,422.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50

STEM EXTEN FEM AND TI 14X40MM

Facility

$11,010.00

Service Code	HCPCS C1776
Hospital Charge Code	270683937
Hospital Revenue Code	278
Min. Negotiated Rate	$265.34
Max. Negotiated Rate	$5,505.00
Rate for Payer: Aetna Commercial	$4,183.80
Rate for Payer: Aetna Medicare Advantage	$3,303.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,807.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,807.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,807.55
Rate for Payer: Cigna Commercial	$5,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,422.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50
Rate for Payer: UnitedHealthcare Community & State	$265.34
Rate for Payer: Wellpoint Medicaid Managed Care	$291.76

STEM EXTEN. FEM AND TIB 14X80m

Facility

$11,010.00

Service Code	HCPCS C1776
Hospital Charge Code	270682016
Hospital Revenue Code	278
Min. Negotiated Rate	$265.34
Max. Negotiated Rate	$5,505.00
Rate for Payer: Aetna Commercial	$4,183.80
Rate for Payer: Aetna Medicare Advantage	$3,303.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,807.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,807.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,807.55
Rate for Payer: Cigna Commercial	$5,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,422.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50
Rate for Payer: UnitedHealthcare Community & State	$265.34
Rate for Payer: Wellpoint Medicaid Managed Care	$291.76

STEM EXTEN. FEM AND TIB 14X80m

Facility

$11,010.00

Service Code	HCPCS C1776
Hospital Charge Code	270682016
Hospital Revenue Code	278
Min. Negotiated Rate	$1,651.50
Max. Negotiated Rate	$2,664.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,422.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50

STEM EXTENSION 13 X 155

Facility

$5,245.85

Hospital Charge Code	270657121
Hospital Revenue Code	278
Min. Negotiated Rate	$786.88
Max. Negotiated Rate	$1,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,154.09
Rate for Payer: Qualcare PPO/HMO/WC	$786.88

STEM EXTENSION 13 X 155

Facility

$5,245.85

Hospital Charge Code	270657121
Hospital Revenue Code	278
Min. Negotiated Rate	$126.42
Max. Negotiated Rate	$2,622.93
Rate for Payer: Aetna Commercial	$1,993.42
Rate for Payer: Aetna Medicare Advantage	$1,573.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,337.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,337.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,337.69
Rate for Payer: Cigna Commercial	$2,622.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,154.09
Rate for Payer: Qualcare PPO/HMO/WC	$786.88
Rate for Payer: UnitedHealthcare Community & State	$126.42
Rate for Payer: Wellpoint Medicaid Managed Care	$139.02

STEM EXTENSION 15MM X 30MM

Facility

$5,245.00

Hospital Charge Code	270667171
Hospital Revenue Code	278
Min. Negotiated Rate	$126.40
Max. Negotiated Rate	$2,622.50
Rate for Payer: Aetna Commercial	$1,993.10
Rate for Payer: Aetna Medicare Advantage	$1,573.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,337.47
Rate for Payer: Cigna Commercial	$2,622.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,153.90
Rate for Payer: Qualcare PPO/HMO/WC	$786.75
Rate for Payer: UnitedHealthcare Community & State	$126.40
Rate for Payer: Wellpoint Medicaid Managed Care	$138.99

STEM EXTENSION 15MM X 30MM

Facility

$5,245.00

Hospital Charge Code	270667171
Hospital Revenue Code	278
Min. Negotiated Rate	$786.75
Max. Negotiated Rate	$1,269.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,153.90
Rate for Payer: Qualcare PPO/HMO/WC	$786.75

STEM EXTENSION FEM TIB 12x80MM

Facility

$4,164.75

Hospital Charge Code	270675508
Hospital Revenue Code	278
Min. Negotiated Rate	$624.71
Max. Negotiated Rate	$1,007.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$832.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,007.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$916.25
Rate for Payer: Qualcare PPO/HMO/WC	$624.71

STEM EXTENSION FEM TIB 12x80MM

Facility

$4,164.75

Hospital Charge Code	270675508
Hospital Revenue Code	278
Min. Negotiated Rate	$100.37
Max. Negotiated Rate	$2,082.38
Rate for Payer: Aetna Commercial	$1,582.61
Rate for Payer: Aetna Medicare Advantage	$1,249.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,062.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,062.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$832.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,062.01
Rate for Payer: Cigna Commercial	$2,082.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,007.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$916.25
Rate for Payer: Qualcare PPO/HMO/WC	$624.71
Rate for Payer: UnitedHealthcare Community & State	$100.37
Rate for Payer: Wellpoint Medicaid Managed Care	$110.37

STEM EXTENSION FEM TIB 18X80MM

Facility

$4,164.75

Service Code	HCPCS C1776
Hospital Charge Code	270670651
Hospital Revenue Code	278
Min. Negotiated Rate	$624.71
Max. Negotiated Rate	$1,007.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$832.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,007.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$916.25
Rate for Payer: Qualcare PPO/HMO/WC	$624.71

STEM EXTENSION FEM TIB 18X80MM

Facility

$4,164.75

Service Code	HCPCS C1776
Hospital Charge Code	270670651
Hospital Revenue Code	278
Min. Negotiated Rate	$100.37
Max. Negotiated Rate	$2,082.38
Rate for Payer: Aetna Commercial	$1,582.61
Rate for Payer: Aetna Medicare Advantage	$1,249.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,062.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,062.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$832.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,062.01
Rate for Payer: Cigna Commercial	$2,082.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,007.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$916.25
Rate for Payer: Qualcare PPO/HMO/WC	$624.71
Rate for Payer: UnitedHealthcare Community & State	$100.37
Rate for Payer: Wellpoint Medicaid Managed Care	$110.37

STEM EXTENSION SCREW REPLAC

Facility

$823.33

Hospital Charge Code	270657078
Hospital Revenue Code	278
Min. Negotiated Rate	$19.84
Max. Negotiated Rate	$411.67
Rate for Payer: Aetna Commercial	$312.87
Rate for Payer: Aetna Medicare Advantage	$247.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$164.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.95
Rate for Payer: Cigna Commercial	$411.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$181.13
Rate for Payer: Qualcare PPO/HMO/WC	$123.50
Rate for Payer: UnitedHealthcare Community & State	$19.84
Rate for Payer: Wellpoint Medicaid Managed Care	$21.82

Know your out-of-pocket cost for care.

All Charges