Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STEM STS DISTAL 15 MM X150MM

Facility

$18,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270683724
Hospital Revenue Code	278
Min. Negotiated Rate	$449.71
Max. Negotiated Rate	$9,330.00
Rate for Payer: Aetna Commercial	$7,090.80
Rate for Payer: Aetna Medicare Advantage	$5,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,758.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,758.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,758.30
Rate for Payer: Cigna Commercial	$9,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,515.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,105.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,799.00
Rate for Payer: UnitedHealthcare Community & State	$449.71
Rate for Payer: Wellpoint Medicaid Managed Care	$494.49

STEM STS DISTAL 15 MM X150MM

Facility

$18,660.00

Service Code	HCPCS C1776
Hospital Charge Code	270683724
Hospital Revenue Code	278
Min. Negotiated Rate	$2,799.00
Max. Negotiated Rate	$4,515.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,515.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,105.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,799.00

STEM SZ 15 TSS PRESS

Facility

$7,914.75

Service Code	HCPCS C1776
Hospital Charge Code	270689617
Hospital Revenue Code	278
Min. Negotiated Rate	$1,187.21
Max. Negotiated Rate	$1,915.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,582.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,915.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,741.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,187.21

STEM SZ 15 TSS PRESS

Facility

$7,914.75

Service Code	HCPCS C1776
Hospital Charge Code	270689617
Hospital Revenue Code	278
Min. Negotiated Rate	$190.75
Max. Negotiated Rate	$3,957.38
Rate for Payer: Aetna Commercial	$3,007.61
Rate for Payer: Aetna Medicare Advantage	$2,374.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,018.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,018.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,582.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,018.26
Rate for Payer: Cigna Commercial	$3,957.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,915.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,741.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,187.21
Rate for Payer: UnitedHealthcare Community & State	$190.75
Rate for Payer: Wellpoint Medicaid Managed Care	$209.74

STEM SZ 2 CEMENTRALIZER 8.5 MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691750
Hospital Revenue Code	278
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

STEM SZ 2 CEMENTRALIZER 8.5 MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691750
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

STEM TALAR 10MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270670887
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

STEM TALAR 10MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270670887
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

STEM TAPER ARCOS SZ A STD 60MM

Facility

$36,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270694443
Hospital Revenue Code	278
Min. Negotiated Rate	$5,431.50
Max. Negotiated Rate	$8,762.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,762.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,966.20
Rate for Payer: Qualcare PPO/HMO/WC	$5,431.50

STEM TAPER ARCOS SZ A STD 60MM

Facility

$36,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270694443
Hospital Revenue Code	278
Min. Negotiated Rate	$872.66
Max. Negotiated Rate	$18,105.00
Rate for Payer: Aetna Commercial	$13,759.80
Rate for Payer: Aetna Medicare Advantage	$10,863.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,233.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,233.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,233.55
Rate for Payer: Cigna Commercial	$18,105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,762.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,966.20
Rate for Payer: Qualcare PPO/HMO/WC	$5,431.50
Rate for Payer: UnitedHealthcare Community & State	$872.66
Rate for Payer: Wellpoint Medicaid Managed Care	$959.57

STEM TAP SMOT EXT 14X75MM

Facility

$11,672.50

Service Code	HCPCS C1776
Hospital Charge Code	270691597
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 TAP SMOT EXT 14X75MM

Facility

$11,672.50

Service Code	HCPCS C1776
Hospital Charge Code	270691597
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 TIBIAL PSN 3 DEG SZ E

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686485
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

STEM TIBIAL PSN 3 DEG SZ E

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686485
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

STEM TIB PSN SZ C L TIBIAL 5D

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692329
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

STEM TIB PSN SZ C L TIBIAL 5D

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692329
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

STEMUBLAST GEL 10CC

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686754
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

STEMUBLAST GEL 10CC

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686754
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

STE MULLIN RX 3.5X23M100784923

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270643219C
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

STE MULLIN RX 3.5X23M100784923

Facility

$4,860.00

Service Code	HCPCS C1894
Hospital Charge Code	270643219N
Hospital Revenue Code	278
Min. Negotiated Rate	$729.00
Max. Negotiated Rate	$1,176.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$972.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,176.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,069.20
Rate for Payer: Qualcare PPO/HMO/WC	$729.00

STE MULLIN RX 3.5X23M100784923

Facility

$4,860.00

Service Code	HCPCS C1894
Hospital Charge Code	270643219N
Hospital Revenue Code	278
Min. Negotiated Rate	$117.13
Max. Negotiated Rate	$2,430.00
Rate for Payer: Aetna Commercial	$1,846.80
Rate for Payer: Aetna Medicare Advantage	$1,458.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,239.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,239.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$972.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,239.30
Rate for Payer: Cigna Commercial	$2,430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,176.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,069.20
Rate for Payer: Qualcare PPO/HMO/WC	$729.00
Rate for Payer: UnitedHealthcare Community & State	$117.13
Rate for Payer: Wellpoint Medicaid Managed Care	$128.79

STE MULLIN RX 3.5X23M100784923

Facility

$3,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270643219C
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

STEM UTF #8 144MM

Facility

$11,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677117
Hospital Revenue Code	278
Min. Negotiated Rate	$265.10
Max. Negotiated Rate	$5,500.00
Rate for Payer: Aetna Commercial	$4,180.00
Rate for Payer: Aetna Medicare Advantage	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,805.00
Rate for Payer: Cigna Commercial	$5,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,662.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00
Rate for Payer: UnitedHealthcare Community & State	$265.10
Rate for Payer: Wellpoint Medicaid Managed Care	$291.50

STEM UTF #8 144MM

Facility

$11,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677117
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$2,662.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,662.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00

STEM V40 132 DEG 30 MM SZ 8

Facility

$11,954.55

Service Code	HCPCS C1776
Hospital Charge Code	270691036
Hospital Revenue Code	278
Min. Negotiated Rate	$288.10
Max. Negotiated Rate	$5,977.27
Rate for Payer: Aetna Commercial	$4,542.73
Rate for Payer: Aetna Medicare Advantage	$3,586.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,048.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,048.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,048.41
Rate for Payer: Cigna Commercial	$5,977.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,893.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,793.18
Rate for Payer: UnitedHealthcare Community & State	$288.10
Rate for Payer: Wellpoint Medicaid Managed Care	$316.80

Know your out-of-pocket cost for care.

All Charges