Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STEM HUMERAL SZ 8

Facility

$33,985.00

Service Code	HCPCS C1776
Hospital Charge Code	270671584
Hospital Revenue Code	278
Min. Negotiated Rate	$819.04
Max. Negotiated Rate	$16,992.50
Rate for Payer: Aetna Commercial	$12,914.30
Rate for Payer: Aetna Medicare Advantage	$10,195.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,666.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,666.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,797.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,666.17
Rate for Payer: Cigna Commercial	$16,992.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,224.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,476.70
Rate for Payer: Qualcare PPO/HMO/WC	$5,097.75
Rate for Payer: UnitedHealthcare Community & State	$819.04
Rate for Payer: Wellpoint Medicaid Managed Care	$900.60

STEM HUMERAL SZ 8

Facility

$33,985.00

Service Code	HCPCS C1776
Hospital Charge Code	270671584
Hospital Revenue Code	278
Min. Negotiated Rate	$5,097.75
Max. Negotiated Rate	$8,224.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,797.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,224.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,476.70
Rate for Payer: Qualcare PPO/HMO/WC	$5,097.75

STEM HUMERAL SZ8

Facility

$23,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270700195
Hospital Revenue Code	278
Min. Negotiated Rate	$554.30
Max. Negotiated Rate	$11,500.00
Rate for Payer: Aetna Commercial	$8,740.00
Rate for Payer: Aetna Medicare Advantage	$6,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,865.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,865.00
Rate for Payer: Cigna Commercial	$11,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,566.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,450.00
Rate for Payer: UnitedHealthcare Community & State	$554.30
Rate for Payer: Wellpoint Medicaid Managed Care	$609.50

STEM HUMERAL SZ8

Facility

$23,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270700195
Hospital Revenue Code	278
Min. Negotiated Rate	$3,450.00
Max. Negotiated Rate	$5,566.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,566.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,450.00

STEM HUMERAL SZ 9

Facility

$33,985.00

Service Code	HCPCS C1776
Hospital Charge Code	270671585
Hospital Revenue Code	278
Min. Negotiated Rate	$5,097.75
Max. Negotiated Rate	$8,224.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,797.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,224.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,476.70
Rate for Payer: Qualcare PPO/HMO/WC	$5,097.75

STEM HUMERAL SZ 9

Facility

$33,985.00

Service Code	HCPCS C1776
Hospital Charge Code	270671585
Hospital Revenue Code	278
Min. Negotiated Rate	$819.04
Max. Negotiated Rate	$16,992.50
Rate for Payer: Aetna Commercial	$12,914.30
Rate for Payer: Aetna Medicare Advantage	$10,195.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,666.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,666.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,797.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,666.17
Rate for Payer: Cigna Commercial	$16,992.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,224.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,476.70
Rate for Payer: Qualcare PPO/HMO/WC	$5,097.75
Rate for Payer: UnitedHealthcare Community & State	$819.04
Rate for Payer: Wellpoint Medicaid Managed Care	$900.60

STEM HUMERAL UNCEMENTED 10.5

Facility

$14,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683029
Hospital Revenue Code	278
Min. Negotiated Rate	$337.40
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$5,320.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,080.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00
Rate for Payer: UnitedHealthcare Community & State	$337.40
Rate for Payer: Wellpoint Medicaid Managed Care	$371.00

STEM HUMERAL UNCEMENTED 10.5

Facility

$14,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683029
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,080.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

STEM HUMERL 8mX130m 43000813

Facility

$12,945.65

Hospital Charge Code	270635865
Hospital Revenue Code	278
Min. Negotiated Rate	$311.99
Max. Negotiated Rate	$6,472.82
Rate for Payer: Aetna Commercial	$4,919.35
Rate for Payer: Aetna Medicare Advantage	$3,883.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,301.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,301.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,589.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,301.14
Rate for Payer: Cigna Commercial	$6,472.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,132.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,848.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,941.85
Rate for Payer: UnitedHealthcare Community & State	$311.99
Rate for Payer: Wellpoint Medicaid Managed Care	$343.06

STEM HUMERL 8mX130m 43000813

Facility

$12,945.65

Hospital Charge Code	270635865
Hospital Revenue Code	278
Min. Negotiated Rate	$1,941.85
Max. Negotiated Rate	$3,132.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,589.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,132.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,848.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,941.85

STEM HUMER PRIMARY MINI 6X83MM

Facility

$14,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697514
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 HUMER PRIMARY MINI 6X83MM

Facility

$14,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697514
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 HUMER TM REVERSE 10X130MM

Facility

$28,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270696094
Hospital Revenue Code	278
Min. Negotiated Rate	$4,346.25
Max. Negotiated Rate	$7,011.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,011.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,374.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,346.25

STEM HUMER TM REVERSE 10X130MM

Facility

$28,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270696094
Hospital Revenue Code	278
Min. Negotiated Rate	$698.30
Max. Negotiated Rate	$14,487.50
Rate for Payer: Aetna Commercial	$11,010.50
Rate for Payer: Aetna Medicare Advantage	$8,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,388.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,388.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,388.62
Rate for Payer: Cigna Commercial	$14,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,011.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,374.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,346.25
Rate for Payer: UnitedHealthcare Community & State	$698.30
Rate for Payer: Wellpoint Medicaid Managed Care	$767.84

STEM IM BOWE 14x150 150368

Facility

$6,480.00

Service Code	HCPCS C1776
Hospital Charge Code	270638567
Hospital Revenue Code	278
Min. Negotiated Rate	$156.17
Max. Negotiated Rate	$3,240.00
Rate for Payer: Aetna Commercial	$2,462.40
Rate for Payer: Aetna Medicare Advantage	$1,944.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,652.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,652.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,652.40
Rate for Payer: Cigna Commercial	$3,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,568.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,425.60
Rate for Payer: Qualcare PPO/HMO/WC	$972.00
Rate for Payer: UnitedHealthcare Community & State	$156.17
Rate for Payer: Wellpoint Medicaid Managed Care	$171.72

STEM IM BOWE 14x150 150368

Facility

$6,480.00

Service Code	HCPCS C1776
Hospital Charge Code	270638567
Hospital Revenue Code	278
Min. Negotiated Rate	$972.00
Max. Negotiated Rate	$1,568.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,296.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,568.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,425.60
Rate for Payer: Qualcare PPO/HMO/WC	$972.00

STEM IM OSS BOWED 12.5x150mm

Facility

$10,530.00

Service Code	HCPCS C1776
Hospital Charge Code	270673538
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.50
Max. Negotiated Rate	$2,548.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,106.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.50

STEM IM OSS BOWED 12.5x150mm

Facility

$10,530.00

Service Code	HCPCS C1776
Hospital Charge Code	270673538
Hospital Revenue Code	278
Min. Negotiated Rate	$253.77
Max. Negotiated Rate	$5,265.00
Rate for Payer: Aetna Commercial	$4,001.40
Rate for Payer: Aetna Medicare Advantage	$3,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,106.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.15
Rate for Payer: Cigna Commercial	$5,265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,316.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.50
Rate for Payer: UnitedHealthcare Community & State	$253.77
Rate for Payer: Wellpoint Medicaid Managed Care	$279.05

STEM IM OSS STR 12.5x150mm

Facility

$5,165.00

Service Code	HCPCS C1776
Hospital Charge Code	270673539
Hospital Revenue Code	278
Min. Negotiated Rate	$774.75
Max. Negotiated Rate	$1,249.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,033.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,249.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,136.30
Rate for Payer: Qualcare PPO/HMO/WC	$774.75

STEM IM OSS STR 12.5x150mm

Facility

$5,165.00

Service Code	HCPCS C1776
Hospital Charge Code	270673539
Hospital Revenue Code	278
Min. Negotiated Rate	$124.48
Max. Negotiated Rate	$2,582.50
Rate for Payer: Aetna Commercial	$1,962.70
Rate for Payer: Aetna Medicare Advantage	$1,549.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,317.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,317.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,033.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,317.08
Rate for Payer: Cigna Commercial	$2,582.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,249.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,136.30
Rate for Payer: Qualcare PPO/HMO/WC	$774.75
Rate for Payer: UnitedHealthcare Community & State	$124.48
Rate for Payer: Wellpoint Medicaid Managed Care	$136.87

STEM INTEG COL POROUS 15x155mm

Facility

$19,180.00

Hospital Charge Code	270645158
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 INTEG COL POROUS 15x155mm

Facility

$19,180.00

Hospital Charge Code	270645158
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 INTEG POROUS 16mm X170316

Facility

$19,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270637574
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 INTEG POROUS 16mm X170316

Facility

$19,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270637574
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 INTEGRAL 11x145MM

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270641366
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,695.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

Know your out-of-pocket cost for care.

All Charges