Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STEM FEMORAL SUMMIT SZ4 140MM

Facility

$13,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692423
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$3,146.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,860.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00

STEM FEMORAL SZ3 SN

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677255
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 FEMORAL SZ3 SN

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677255
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 FEMORAL SZ 3 STD 135MM

Facility

$13,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689574
Hospital Revenue Code	278
Min. Negotiated Rate	$313.30
Max. Negotiated Rate	$6,500.00
Rate for Payer: Aetna Commercial	$4,940.00
Rate for Payer: Aetna Medicare Advantage	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,315.00
Rate for Payer: Cigna Commercial	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,860.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00
Rate for Payer: UnitedHealthcare Community & State	$313.30
Rate for Payer: Wellpoint Medicaid Managed Care	$344.50

STEM FEMORAL SZ 3 STD 135MM

Facility

$13,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689574
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$3,146.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,860.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00

STEM FEMORAL SZ4 12/14

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677228
Hospital Revenue Code	278
Min. Negotiated Rate	$204.85
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Community & State	$204.85
Rate for Payer: Wellpoint Medicaid Managed Care	$225.25

STEM FEMORAL SZ4 12/14

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677228
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,870.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

STEM FEMORAL SZ 4 STD COLLAR

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270688630
Hospital Revenue Code	278
Min. Negotiated Rate	$343.43
Max. Negotiated Rate	$7,125.00
Rate for Payer: Aetna Commercial	$5,415.00
Rate for Payer: Aetna Medicare Advantage	$4,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,633.75
Rate for Payer: Cigna Commercial	$7,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,135.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50
Rate for Payer: UnitedHealthcare Community & State	$343.43
Rate for Payer: Wellpoint Medicaid Managed Care	$377.62

STEM FEMORAL SZ 4 STD COLLAR

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270688630
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$3,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,135.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

STEM FEMORAL SZ6 12/14

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676884
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

STEM FEMORAL SZ6 12/14

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676884
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

STEM FEMORAL SZ 8 120MM TAPER

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693324
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 FEMORAL SZ 8 120MM TAPER

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693324
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 FEMORAL SZ 8 12/14 TAPER

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270689572
Hospital Revenue Code	278
Min. Negotiated Rate	$343.43
Max. Negotiated Rate	$7,125.00
Rate for Payer: Aetna Commercial	$5,415.00
Rate for Payer: Aetna Medicare Advantage	$4,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,633.75
Rate for Payer: Cigna Commercial	$7,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,135.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50
Rate for Payer: UnitedHealthcare Community & State	$343.43
Rate for Payer: Wellpoint Medicaid Managed Care	$377.62

STEM FEMORAL SZ 8 12/14 TAPER

Facility

$14,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270689572
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$3,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,135.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

STEM FEMORAL WITH OUT COLLAR

Facility

$12,947.00

Hospital Charge Code	270666933
Hospital Revenue Code	278
Min. Negotiated Rate	$312.02
Max. Negotiated Rate	$6,473.50
Rate for Payer: Aetna Commercial	$4,919.86
Rate for Payer: Aetna Medicare Advantage	$3,884.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,301.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,301.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,589.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,301.49
Rate for Payer: Cigna Commercial	$6,473.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,133.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,848.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,942.05
Rate for Payer: UnitedHealthcare Community & State	$312.02
Rate for Payer: Wellpoint Medicaid Managed Care	$343.10

STEM FEMORAL WITH OUT COLLAR

Facility

$12,947.00

Hospital Charge Code	270666933
Hospital Revenue Code	278
Min. Negotiated Rate	$1,942.05
Max. Negotiated Rate	$3,133.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,589.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,133.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,848.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,942.05

STEM FEMORL MC 15x160 78411520

Facility

$18,618.50

Hospital Charge Code	270635102
Hospital Revenue Code	278
Min. Negotiated Rate	$2,792.78
Max. Negotiated Rate	$4,505.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,723.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,505.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,096.07
Rate for Payer: Qualcare PPO/HMO/WC	$2,792.78

STEM FEMORL MC 15x160 78411520

Facility

$18,618.50

Hospital Charge Code	270635102
Hospital Revenue Code	278
Min. Negotiated Rate	$448.71
Max. Negotiated Rate	$9,309.25
Rate for Payer: Aetna Commercial	$7,075.03
Rate for Payer: Aetna Medicare Advantage	$5,585.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,747.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,747.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,723.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,747.72
Rate for Payer: Cigna Commercial	$9,309.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,505.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,096.07
Rate for Payer: Qualcare PPO/HMO/WC	$2,792.78
Rate for Payer: UnitedHealthcare Community & State	$448.71
Rate for Payer: Wellpoint Medicaid Managed Care	$493.39

STEM FEMORL MC 15x160 78411530

Facility

$17,902.50

Hospital Charge Code	270633225
Hospital Revenue Code	278
Min. Negotiated Rate	$431.45
Max. Negotiated Rate	$8,951.25
Rate for Payer: Aetna Commercial	$6,802.95
Rate for Payer: Aetna Medicare Advantage	$5,370.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,565.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,565.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,580.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,565.14
Rate for Payer: Cigna Commercial	$8,951.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,332.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,938.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,685.38
Rate for Payer: UnitedHealthcare Community & State	$431.45
Rate for Payer: Wellpoint Medicaid Managed Care	$474.42

STEM FEMORL MC 15x160 78411530

Facility

$17,902.50

Hospital Charge Code	270633225
Hospital Revenue Code	278
Min. Negotiated Rate	$2,685.38
Max. Negotiated Rate	$4,332.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,580.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,332.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,938.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,685.38

STEM FEM PS OPEN 57.5RT 183102

Facility

$16,560.00

Hospital Charge Code	270642093
Hospital Revenue Code	278
Min. Negotiated Rate	$399.10
Max. Negotiated Rate	$8,280.00
Rate for Payer: Aetna Commercial	$6,292.80
Rate for Payer: Aetna Medicare Advantage	$4,968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,222.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,222.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,312.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,222.80
Rate for Payer: Cigna Commercial	$8,280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,007.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,643.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,484.00
Rate for Payer: UnitedHealthcare Community & State	$399.10
Rate for Payer: Wellpoint Medicaid Managed Care	$438.84

STEM FEM PS OPEN 57.5RT 183102

Facility

$16,560.00

Hospital Charge Code	270642093
Hospital Revenue Code	278
Min. Negotiated Rate	$2,484.00
Max. Negotiated Rate	$4,007.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,312.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,007.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,643.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,484.00

STEM FEMRL MC16x160 7841-16-20

Facility

$18,768.65

Hospital Charge Code	270631694
Hospital Revenue Code	278
Min. Negotiated Rate	$2,815.30
Max. Negotiated Rate	$4,542.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,753.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,542.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,129.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,815.30

STEM FEMRL MC16x160 7841-16-20

Facility

$18,768.65

Hospital Charge Code	270631694
Hospital Revenue Code	278
Min. Negotiated Rate	$452.32
Max. Negotiated Rate	$9,384.33
Rate for Payer: Aetna Commercial	$7,132.09
Rate for Payer: Aetna Medicare Advantage	$5,630.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,786.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,786.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,753.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,786.01
Rate for Payer: Cigna Commercial	$9,384.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,542.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,129.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,815.30
Rate for Payer: UnitedHealthcare Community & State	$452.32
Rate for Payer: Wellpoint Medicaid Managed Care	$497.37

Know your out-of-pocket cost for care.

All Charges