Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL COMP PSA #4 RIGHT

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676961
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

FEMORAL COMP RT 54CM 102120

Facility

$10,396.25

Hospital Charge Code	270635389
Hospital Revenue Code	278
Min. Negotiated Rate	$250.55
Max. Negotiated Rate	$5,198.12
Rate for Payer: Aetna Commercial	$3,950.57
Rate for Payer: Aetna Medicare Advantage	$3,118.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,651.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,651.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,079.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,651.04
Rate for Payer: Cigna Commercial	$5,198.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,515.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,287.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,559.44
Rate for Payer: UnitedHealthcare Community & State	$250.55
Rate for Payer: Wellpoint Medicaid Managed Care	$275.50

FEMORAL COMP RT 54CM 102120

Facility

$10,396.25

Hospital Charge Code	270635389
Hospital Revenue Code	278
Min. Negotiated Rate	$1,559.44
Max. Negotiated Rate	$2,515.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,079.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,515.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,287.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,559.44

FEMORAL COMP SIZE 4 RIGHT

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680693
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

FEMORAL COMP SIZE 4 RIGHT

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680693
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

FEMORAL COMP SZ 1/1 A/P 53MM

Facility

$21,271.50

Service Code	HCPCS C1776
Hospital Charge Code	270670039
Hospital Revenue Code	278
Min. Negotiated Rate	$3,190.72
Max. Negotiated Rate	$5,147.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,254.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,147.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,679.73
Rate for Payer: Qualcare PPO/HMO/WC	$3,190.72

FEMORAL COMP SZ 1/1 A/P 53MM

Facility

$21,271.50

Service Code	HCPCS C1776
Hospital Charge Code	270670039
Hospital Revenue Code	278
Min. Negotiated Rate	$512.64
Max. Negotiated Rate	$10,635.75
Rate for Payer: Aetna Commercial	$8,083.17
Rate for Payer: Aetna Medicare Advantage	$6,381.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,424.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,424.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,254.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,424.23
Rate for Payer: Cigna Commercial	$10,635.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,147.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,679.73
Rate for Payer: Qualcare PPO/HMO/WC	$3,190.72
Rate for Payer: UnitedHealthcare Community & State	$512.64
Rate for Payer: Wellpoint Medicaid Managed Care	$563.69

FEMORAL COMP SZ2 8MM M/L 60MM

Facility

$21,271.50

Service Code	HCPCS C1776
Hospital Charge Code	270670550
Hospital Revenue Code	278
Min. Negotiated Rate	$3,190.72
Max. Negotiated Rate	$5,147.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,254.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,147.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,679.73
Rate for Payer: Qualcare PPO/HMO/WC	$3,190.72

FEMORAL COMP SZ2 8MM M/L 60MM

Facility

$21,271.50

Service Code	HCPCS C1776
Hospital Charge Code	270670550
Hospital Revenue Code	278
Min. Negotiated Rate	$512.64
Max. Negotiated Rate	$10,635.75
Rate for Payer: Aetna Commercial	$8,083.17
Rate for Payer: Aetna Medicare Advantage	$6,381.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,424.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,424.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,254.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,424.23
Rate for Payer: Cigna Commercial	$10,635.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,147.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,679.73
Rate for Payer: Qualcare PPO/HMO/WC	$3,190.72
Rate for Payer: UnitedHealthcare Community & State	$512.64
Rate for Payer: Wellpoint Medicaid Managed Care	$563.69

FEMORAL COMP SZ3 A/P 76 M/L 70

Facility

$21,271.50

Service Code	HCPCS C1776
Hospital Charge Code	270670650
Hospital Revenue Code	278
Min. Negotiated Rate	$512.64
Max. Negotiated Rate	$10,635.75
Rate for Payer: Aetna Commercial	$8,083.17
Rate for Payer: Aetna Medicare Advantage	$6,381.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,424.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,424.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,254.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,424.23
Rate for Payer: Cigna Commercial	$10,635.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,147.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,679.73
Rate for Payer: Qualcare PPO/HMO/WC	$3,190.72
Rate for Payer: UnitedHealthcare Community & State	$512.64
Rate for Payer: Wellpoint Medicaid Managed Care	$563.69

FEMORAL COMP SZ3 A/P 76 M/L 70

Facility

$21,271.50

Service Code	HCPCS C1776
Hospital Charge Code	270670650
Hospital Revenue Code	278
Min. Negotiated Rate	$3,190.72
Max. Negotiated Rate	$5,147.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,254.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,147.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,679.73
Rate for Payer: Qualcare PPO/HMO/WC	$3,190.72

FEMORAL COMP SZ5 A/P 72 M/L 75

Facility

$21,271.50

Service Code	HCPCS C1776
Hospital Charge Code	270676682
Hospital Revenue Code	278
Min. Negotiated Rate	$512.64
Max. Negotiated Rate	$10,635.75
Rate for Payer: Aetna Commercial	$8,083.17
Rate for Payer: Aetna Medicare Advantage	$6,381.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,424.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,424.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,254.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,424.23
Rate for Payer: Cigna Commercial	$10,635.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,147.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,679.73
Rate for Payer: Qualcare PPO/HMO/WC	$3,190.72
Rate for Payer: UnitedHealthcare Community & State	$512.64
Rate for Payer: Wellpoint Medicaid Managed Care	$563.69

FEMORAL COMP SZ5 A/P 72 M/L 75

Facility

$21,271.50

Service Code	HCPCS C1776
Hospital Charge Code	270676682
Hospital Revenue Code	278
Min. Negotiated Rate	$3,190.72
Max. Negotiated Rate	$5,147.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,254.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,147.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,679.73
Rate for Payer: Qualcare PPO/HMO/WC	$3,190.72

FEMORAL COMP SZE 58421502

Facility

$10,832.70

Hospital Charge Code	270635699
Hospital Revenue Code	278
Min. Negotiated Rate	$1,624.90
Max. Negotiated Rate	$2,621.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,166.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,621.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,383.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,624.90

FEMORAL COMP SZE 58421502

Facility

$10,832.70

Hospital Charge Code	270635699
Hospital Revenue Code	278
Min. Negotiated Rate	$261.07
Max. Negotiated Rate	$5,416.35
Rate for Payer: Aetna Commercial	$4,116.43
Rate for Payer: Aetna Medicare Advantage	$3,249.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,762.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,762.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,166.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,762.34
Rate for Payer: Cigna Commercial	$5,416.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,621.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,383.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,624.90
Rate for Payer: UnitedHealthcare Community & State	$261.07
Rate for Payer: Wellpoint Medicaid Managed Care	$287.07

FEMORAL COMP TRIATHLON PS RT5

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270691997
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.68
Max. Negotiated Rate	$1,751.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,592.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.68

FEMORAL COMP TRIATHLON PS RT5

Facility

$7,237.90

Service Code	HCPCS C1776
Hospital Charge Code	270691997
Hospital Revenue Code	278
Min. Negotiated Rate	$174.43
Max. Negotiated Rate	$3,618.95
Rate for Payer: Aetna Commercial	$2,750.40
Rate for Payer: Aetna Medicare Advantage	$2,171.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,845.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,845.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,447.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,845.66
Rate for Payer: Cigna Commercial	$3,618.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,751.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,592.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.68
Rate for Payer: UnitedHealthcare Community & State	$174.43
Rate for Payer: Wellpoint Medicaid Managed Care	$191.80

FEMORAL CONDYLE HEMI RIGHT

Facility

$59,265.00

Service Code	HCPCS C1776
Hospital Charge Code	270679139
Hospital Revenue Code	278
Min. Negotiated Rate	$8,889.75
Max. Negotiated Rate	$14,342.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,853.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,342.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13,038.30
Rate for Payer: Qualcare PPO/HMO/WC	$8,889.75

FEMORAL CONDYLE HEMI RIGHT

Facility

$59,265.00

Service Code	HCPCS C1776
Hospital Charge Code	270679139
Hospital Revenue Code	278
Min. Negotiated Rate	$1,428.29
Max. Negotiated Rate	$29,632.50
Rate for Payer: Aetna Commercial	$22,520.70
Rate for Payer: Aetna Medicare Advantage	$17,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,112.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,112.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,112.58
Rate for Payer: Cigna Commercial	$29,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,342.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13,038.30
Rate for Payer: Qualcare PPO/HMO/WC	$8,889.75
Rate for Payer: UnitedHealthcare Community & State	$1,428.29
Rate for Payer: Wellpoint Medicaid Managed Care	$1,570.52

FEMORAL CONDYLE LEFT

Facility

$58,350.00

Service Code	HCPCS C1776
Hospital Charge Code	270684836
Hospital Revenue Code	278
Min. Negotiated Rate	$1,406.23
Max. Negotiated Rate	$29,175.00
Rate for Payer: Aetna Commercial	$22,173.00
Rate for Payer: Aetna Medicare Advantage	$17,505.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,879.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,879.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,879.25
Rate for Payer: Cigna Commercial	$29,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,120.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,837.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,752.50
Rate for Payer: UnitedHealthcare Community & State	$1,406.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1,546.28

FEMORAL CONDYLE LEFT

Facility

$58,350.00

Service Code	HCPCS C1776
Hospital Charge Code	270684836
Hospital Revenue Code	278
Min. Negotiated Rate	$8,752.50
Max. Negotiated Rate	$14,120.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,670.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,120.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,837.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,752.50

FEMORAL CR 60 LT POROUS 183064

Facility

$18,295.00

Hospital Charge Code	270641551
Hospital Revenue Code	278
Min. Negotiated Rate	$440.91
Max. Negotiated Rate	$9,147.50
Rate for Payer: Aetna Commercial	$6,952.10
Rate for Payer: Aetna Medicare Advantage	$5,488.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,665.23
Rate for Payer: Cigna Commercial	$9,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25
Rate for Payer: UnitedHealthcare Community & State	$440.91
Rate for Payer: Wellpoint Medicaid Managed Care	$484.82

FEMORAL CR 60 LT POROUS 183064

Facility

$18,295.00

Hospital Charge Code	270641551
Hospital Revenue Code	278
Min. Negotiated Rate	$2,744.25
Max. Negotiated Rate	$4,427.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25

FEMORAL CR 65mm LEFT POROUS

Facility

$18,291.00

Hospital Charge Code	270640442
Hospital Revenue Code	278
Min. Negotiated Rate	$440.81
Max. Negotiated Rate	$9,145.50
Rate for Payer: Aetna Commercial	$6,950.58
Rate for Payer: Aetna Medicare Advantage	$5,487.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,664.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,664.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,658.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,664.20
Rate for Payer: Cigna Commercial	$9,145.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,426.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,743.65
Rate for Payer: UnitedHealthcare Community & State	$440.81
Rate for Payer: Wellpoint Medicaid Managed Care	$484.71

FEMORAL CR 65mm LEFT POROUS

Facility

$18,291.00

Hospital Charge Code	270640442
Hospital Revenue Code	278
Min. Negotiated Rate	$2,743.65
Max. Negotiated Rate	$4,426.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,658.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,426.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,024.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,743.65

Know your out-of-pocket cost for care.

All Charges