Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STEM PROFEMUR TI 127D SZ1

Facility

$16,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270697656
Hospital Revenue Code	278
Min. Negotiated Rate	$390.66
Max. Negotiated Rate	$8,105.00
Rate for Payer: Aetna Commercial	$6,159.80
Rate for Payer: Aetna Medicare Advantage	$4,863.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,133.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,133.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,133.55
Rate for Payer: Cigna Commercial	$8,105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,922.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,566.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,431.50
Rate for Payer: UnitedHealthcare Community & State	$390.66
Rate for Payer: Wellpoint Medicaid Managed Care	$429.56

STEM PROLINE EVOLVE 7.5MM

Facility

$9,225.00

Service Code	HCPCS C1776
Hospital Charge Code	270686806
Hospital Revenue Code	278
Min. Negotiated Rate	$1,383.75
Max. Negotiated Rate	$2,232.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,845.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,232.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,029.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,383.75

STEM PROLINE EVOLVE 7.5MM

Facility

$9,225.00

Service Code	HCPCS C1776
Hospital Charge Code	270686806
Hospital Revenue Code	278
Min. Negotiated Rate	$222.32
Max. Negotiated Rate	$4,612.50
Rate for Payer: Aetna Commercial	$3,505.50
Rate for Payer: Aetna Medicare Advantage	$2,767.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,352.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,352.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,352.38
Rate for Payer: Cigna Commercial	$4,612.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,232.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,029.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,383.75
Rate for Payer: UnitedHealthcare Community & State	$222.32
Rate for Payer: Wellpoint Medicaid Managed Care	$244.46

STEM PROLINE IMPLANT 6.5MM

Facility

$11,720.00

Hospital Charge Code	270669852
Hospital Revenue Code	278
Min. Negotiated Rate	$282.45
Max. Negotiated Rate	$5,860.00
Rate for Payer: Aetna Commercial	$4,453.60
Rate for Payer: Aetna Medicare Advantage	$3,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,988.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,988.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,344.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,988.60
Rate for Payer: Cigna Commercial	$5,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,836.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,578.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,758.00
Rate for Payer: UnitedHealthcare Community & State	$282.45
Rate for Payer: Wellpoint Medicaid Managed Care	$310.58

STEM PROLINE IMPLANT 6.5MM

Facility

$11,720.00

Hospital Charge Code	270669852
Hospital Revenue Code	278
Min. Negotiated Rate	$1,758.00
Max. Negotiated Rate	$2,836.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,344.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,836.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,578.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,758.00

STEM PROLINE IMPLANT 8.5MM

Facility

$11,720.00

Hospital Charge Code	270639548
Hospital Revenue Code	278
Min. Negotiated Rate	$282.45
Max. Negotiated Rate	$5,860.00
Rate for Payer: Aetna Commercial	$4,453.60
Rate for Payer: Aetna Medicare Advantage	$3,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,988.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,988.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,344.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,988.60
Rate for Payer: Cigna Commercial	$5,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,836.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,578.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,758.00
Rate for Payer: UnitedHealthcare Community & State	$282.45
Rate for Payer: Wellpoint Medicaid Managed Care	$310.58

STEM PROLINE IMPLANT 8.5MM

Facility

$11,720.00

Hospital Charge Code	270639548
Hospital Revenue Code	278
Min. Negotiated Rate	$1,758.00
Max. Negotiated Rate	$2,836.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,344.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,836.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,578.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,758.00

STEM PSA STR 14x30MM

Facility

$4,164.75

Service Code	HCPCS C1776
Hospital Charge Code	270677131
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 PSA STR 14x30MM

Facility

$4,164.75

Service Code	HCPCS C1776
Hospital Charge Code	270677131
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 PSA STR 14x75MM

Facility

$4,164.75

Service Code	HCPCS C1776
Hospital Charge Code	270676882
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 PSA STR 14x75MM

Facility

$4,164.75

Service Code	HCPCS C1776
Hospital Charge Code	270676882
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 PSA STR 18x100MM

Facility

$4,164.75

Service Code	HCPCS C1776
Hospital Charge Code	270676875
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 PSA STR 18x100MM

Facility

$4,164.75

Service Code	HCPCS C1776
Hospital Charge Code	270676875
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 PSN LINE 13X135MM

Facility

$12,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270700043
Hospital Revenue Code	278
Min. Negotiated Rate	$311.01
Max. Negotiated Rate	$6,452.50
Rate for Payer: Aetna Commercial	$4,903.90
Rate for Payer: Aetna Medicare Advantage	$3,871.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,290.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,290.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,290.78
Rate for Payer: Cigna Commercial	$6,452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,123.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,839.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,935.75
Rate for Payer: UnitedHealthcare Community & State	$311.01
Rate for Payer: Wellpoint Medicaid Managed Care	$341.98

STEM PSN LINE 13X135MM

Facility

$12,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270700043
Hospital Revenue Code	278
Min. Negotiated Rate	$1,935.75
Max. Negotiated Rate	$3,123.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,581.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,123.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,839.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,935.75

STEM PSN REV 14 X 75 MM EXT

Facility

$11,672.50

Service Code	HCPCS C1776
Hospital Charge Code	270690106
Hospital Revenue Code	278
Min. Negotiated Rate	$281.31
Max. Negotiated Rate	$5,836.25
Rate for Payer: Aetna Commercial	$4,435.55
Rate for Payer: Aetna Medicare Advantage	$3,501.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,976.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,976.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,334.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,976.49
Rate for Payer: Cigna Commercial	$5,836.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,824.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,567.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,750.88
Rate for Payer: UnitedHealthcare Community & State	$281.31
Rate for Payer: Wellpoint Medicaid Managed Care	$309.32

STEM PSN REV 14 X 75 MM EXT

Facility

$11,672.50

Service Code	HCPCS C1776
Hospital Charge Code	270690106
Hospital Revenue Code	278
Min. Negotiated Rate	$1,750.88
Max. Negotiated Rate	$2,824.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,334.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,824.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,567.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,750.88

STEM PSN REV 6MM OFFSET EXT 14

Facility

$18,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270694283
Hospital Revenue Code	278
Min. Negotiated Rate	$454.29
Max. Negotiated Rate	$9,425.00
Rate for Payer: Aetna Commercial	$7,163.00
Rate for Payer: Aetna Medicare Advantage	$5,655.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,806.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,806.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,806.75
Rate for Payer: Cigna Commercial	$9,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,561.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,147.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,827.50
Rate for Payer: UnitedHealthcare Community & State	$454.29
Rate for Payer: Wellpoint Medicaid Managed Care	$499.52

STEM PSN REV 6MM OFFSET EXT 14

Facility

$18,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270694283
Hospital Revenue Code	278
Min. Negotiated Rate	$2,827.50
Max. Negotiated Rate	$4,561.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,561.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,147.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,827.50

STEM PSN REV ST SPLINE

Facility

$15,450.00

Service Code	HCPCS C1776
Hospital Charge Code	270692734
Hospital Revenue Code	278
Min. Negotiated Rate	$2,317.50
Max. Negotiated Rate	$3,738.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,738.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,399.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.50

STEM PSN REV ST SPLINE

Facility

$15,450.00

Service Code	HCPCS C1776
Hospital Charge Code	270692734
Hospital Revenue Code	278
Min. Negotiated Rate	$372.35
Max. Negotiated Rate	$7,725.00
Rate for Payer: Aetna Commercial	$5,871.00
Rate for Payer: Aetna Medicare Advantage	$4,635.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,939.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,939.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,090.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,939.75
Rate for Payer: Cigna Commercial	$7,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,738.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,399.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,317.50
Rate for Payer: UnitedHealthcare Community & State	$372.35
Rate for Payer: Wellpoint Medicaid Managed Care	$409.43

STEM -P STD #1

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688765
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 -P STD #1

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270688765
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 RADIAL ALIGN 8MM 2MM

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680784
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$2,783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,530.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

STEM RADIAL ALIGN 8MM 2MM

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680784
Hospital Revenue Code	278
Min. Negotiated Rate	$277.15
Max. Negotiated Rate	$5,750.00
Rate for Payer: Aetna Commercial	$4,370.00
Rate for Payer: Aetna Medicare Advantage	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,932.50
Rate for Payer: Cigna Commercial	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,530.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00
Rate for Payer: UnitedHealthcare Community & State	$277.15
Rate for Payer: Wellpoint Medicaid Managed Care	$304.75

Know your out-of-pocket cost for care.

All Charges