Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STEM INTEGRAL 11x145MM

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270641366
Hospital Revenue Code	278
Min. Negotiated Rate	$295.23
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$4,655.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
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
Rate for Payer: UnitedHealthcare Community & State	$295.23
Rate for Payer: Wellpoint Medicaid Managed Care	$324.62

STEM INTEGRAL 12x140MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270642105
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 INTEGRAL 12x140MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270642105
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 INTEGRAL 13MM X 145MM PC

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270637437
Hospital Revenue Code	278
Min. Negotiated Rate	$295.23
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$4,655.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
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
Rate for Payer: UnitedHealthcare Community & State	$295.23
Rate for Payer: Wellpoint Medicaid Managed Care	$324.62

STEM INTEGRAL 13MM X 145MM PC

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270637437
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

STEM INTEGRAL 14mm

Facility

$19,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270636663
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 INTEGRAL 14mm

Facility

$19,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270636663
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 7x115 X12-171307

Facility

$19,180.00

Hospital Charge Code	270658432
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 INTEGRAL 7x115 X12-171307

Facility

$19,180.00

Hospital Charge Code	270658432
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 FEM 14 X11170314

Facility

$19,915.00

Hospital Charge Code	270638622
Hospital Revenue Code	278
Min. Negotiated Rate	$479.95
Max. Negotiated Rate	$9,957.50
Rate for Payer: Aetna Commercial	$7,567.70
Rate for Payer: Aetna Medicare Advantage	$5,974.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,078.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,078.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,983.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,078.32
Rate for Payer: Cigna Commercial	$9,957.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,819.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,381.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,987.25
Rate for Payer: UnitedHealthcare Community & State	$479.95
Rate for Payer: Wellpoint Medicaid Managed Care	$527.75

STEM INTEGRAL FEM 14 X11170314

Facility

$19,915.00

Hospital Charge Code	270638622
Hospital Revenue Code	278
Min. Negotiated Rate	$2,987.25
Max. Negotiated Rate	$4,819.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,983.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,819.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,381.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,987.25

STEM INTEGRAL POR0S 13 X170313

Facility

$19,915.00

Hospital Charge Code	270634656
Hospital Revenue Code	278
Min. Negotiated Rate	$2,987.25
Max. Negotiated Rate	$4,819.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,983.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,819.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,381.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,987.25

STEM INTEGRAL POR0S 13 X170313

Facility

$19,915.00

Hospital Charge Code	270634656
Hospital Revenue Code	278
Min. Negotiated Rate	$479.95
Max. Negotiated Rate	$9,957.50
Rate for Payer: Aetna Commercial	$7,567.70
Rate for Payer: Aetna Medicare Advantage	$5,974.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,078.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,078.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,983.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,078.32
Rate for Payer: Cigna Commercial	$9,957.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,819.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,381.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,987.25
Rate for Payer: UnitedHealthcare Community & State	$479.95
Rate for Payer: Wellpoint Medicaid Managed Care	$527.75

STEM INTEGRAL POROUS 11mm

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270637208
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 INTEGRAL POROUS 11mm

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270637208
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 INTEGRAL POROUS 12MM

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270638652
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

STEM INTEGRAL POROUS 12MM

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270638652
Hospital Revenue Code	278
Min. Negotiated Rate	$295.23
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$4,655.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
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
Rate for Payer: UnitedHealthcare Community & State	$295.23
Rate for Payer: Wellpoint Medicaid Managed Care	$324.62

STEM INTEGRAL POROUS 14mm

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270636875
Hospital Revenue Code	278
Min. Negotiated Rate	$295.23
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$4,655.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
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
Rate for Payer: UnitedHealthcare Community & State	$295.23
Rate for Payer: Wellpoint Medicaid Managed Care	$324.62

STEM INTEGRAL POROUS 14mm

Facility

$12,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270636875
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

STEM INTEGRAL POROUS 15mm

Facility

$19,755.75

Hospital Charge Code	270636168
Hospital Revenue Code	278
Min. Negotiated Rate	$2,963.36
Max. Negotiated Rate	$4,780.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,951.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,780.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,346.27
Rate for Payer: Qualcare PPO/HMO/WC	$2,963.36

STEM INTEGRAL POROUS 15mm

Facility

$19,755.75

Hospital Charge Code	270636168
Hospital Revenue Code	278
Min. Negotiated Rate	$476.11
Max. Negotiated Rate	$9,877.88
Rate for Payer: Aetna Commercial	$7,507.19
Rate for Payer: Aetna Medicare Advantage	$5,926.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,037.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,037.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,951.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,037.72
Rate for Payer: Cigna Commercial	$9,877.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,780.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,346.27
Rate for Payer: Qualcare PPO/HMO/WC	$2,963.36
Rate for Payer: UnitedHealthcare Community & State	$476.11
Rate for Payer: Wellpoint Medicaid Managed Care	$523.53

STEM INTEGRAL POROUS 9mm170309

Facility

$19,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270641192
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 POROUS 9mm170309

Facility

$19,180.00

Service Code	HCPCS C1776
Hospital Charge Code	270641192
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 INTEL RP 16x160 X12171316

Facility

$19,915.00

Hospital Charge Code	270642851
Hospital Revenue Code	278
Min. Negotiated Rate	$479.95
Max. Negotiated Rate	$9,957.50
Rate for Payer: Aetna Commercial	$7,567.70
Rate for Payer: Aetna Medicare Advantage	$5,974.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,078.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,078.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,983.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,078.32
Rate for Payer: Cigna Commercial	$9,957.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,819.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,381.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,987.25
Rate for Payer: UnitedHealthcare Community & State	$479.95
Rate for Payer: Wellpoint Medicaid Managed Care	$527.75

STEM INTEL RP 16x160 X12171316

Facility

$19,915.00

Hospital Charge Code	270642851
Hospital Revenue Code	278
Min. Negotiated Rate	$2,987.25
Max. Negotiated Rate	$4,819.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,983.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,819.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,381.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,987.25

Know your out-of-pocket cost for care.

All Charges