Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

KNEE EXCHANGE TRIAL SET COPAL

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690885
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

KNEE FIBERTAK DRILL 2.8MM

Facility

$475.00

Hospital Charge Code	270703164
Hospital Revenue Code	272
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.50
Rate for Payer: Oxford Commercial	$95.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Commercial	$95.00
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

KNEE FIBERTAK DRILL 2.8MM

Facility

$475.00

Hospital Charge Code	270703164
Hospital Revenue Code	272
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$71.25
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

KNEE IMMOBILIZER UNIVERSAL 23

Facility

$67.70

Service Code	HCPCS L1830
Hospital Charge Code	270649884
Hospital Revenue Code	274
Min. Negotiated Rate	$10.15
Max. Negotiated Rate	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14.89
Rate for Payer: Qualcare PPO/HMO/WC	$10.15

KNEE IMMOBILIZER UNIVERSAL 23

Facility

$67.70

Service Code	HCPCS L1830
Hospital Charge Code	270649884
Hospital Revenue Code	274
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$33.85
Rate for Payer: Aetna Commercial	$25.73
Rate for Payer: Aetna Medicare Advantage	$20.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.26
Rate for Payer: Cigna Commercial	$33.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14.89
Rate for Payer: Qualcare PPO/HMO/WC	$10.15
Rate for Payer: UnitedHealthcare Community & State	$1.63
Rate for Payer: Wellpoint Medicaid Managed Care	$1.79

KNEE IMOBILIZER UNIVERSAL 23

Facility

$291.00

Hospital Charge Code	270331551
Hospital Revenue Code	274
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$145.50
Rate for Payer: Aetna Commercial	$110.58
Rate for Payer: Aetna Medicare Advantage	$87.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.20
Rate for Payer: Cigna Commercial	$145.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$64.02
Rate for Payer: Qualcare PPO/HMO/WC	$43.65
Rate for Payer: UnitedHealthcare Community & State	$7.01
Rate for Payer: Wellpoint Medicaid Managed Care	$7.71

KNEE IMOBILIZER UNIVERSAL 23

Facility

$291.00

Hospital Charge Code	270331551
Hospital Revenue Code	274
Min. Negotiated Rate	$43.65
Max. Negotiated Rate	$70.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$64.02
Rate for Payer: Qualcare PPO/HMO/WC	$43.65

KNEE INJECTION

Facility

$1,091.00

Service Code	HCPCS 20610
Hospital Charge Code	84506005
Hospital Revenue Code	361
Min. Negotiated Rate	$163.65
Max. Negotiated Rate	$163.65
Rate for Payer: Qualcare PPO/HMO/WC	$163.65

KNEE INJECTION

Facility

$1,091.00

Service Code	HCPCS 20610
Hospital Charge Code	84506005
Hospital Revenue Code	361
Min. Negotiated Rate	$26.29
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,316.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
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	$1,316.35
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$327.30
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.65
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$26.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$28.91

KNEE KIT SCP

Facility

$23,300.00

Hospital Charge Code	270691618
Hospital Revenue Code	272
Min. Negotiated Rate	$561.53
Max. Negotiated Rate	$11,650.00
Rate for Payer: Aetna Commercial	$8,854.00
Rate for Payer: Aetna Medicare Advantage	$6,990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,941.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,941.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,941.50
Rate for Payer: Cigna Commercial	$11,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,990.00
Rate for Payer: Oxford Commercial	$4,660.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,495.00
Rate for Payer: UnitedHealthcare Commercial	$4,660.00
Rate for Payer: UnitedHealthcare Community & State	$561.53
Rate for Payer: Wellpoint Medicaid Managed Care	$617.45

KNEE KIT SCP

Facility

$23,300.00

Hospital Charge Code	270691618
Hospital Revenue Code	272
Min. Negotiated Rate	$3,495.00
Max. Negotiated Rate	$3,495.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,495.00

KNEE KLASSIC FEMUR SZ 4

Facility

$7,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685970
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

KNEE KLASSIC FEMUR SZ 4

Facility

$7,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685970
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

KNEE M COPAL EXCHANGE

Facility

$20,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690884
Hospital Revenue Code	278
Min. Negotiated Rate	$482.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$482.00
Rate for Payer: Wellpoint Medicaid Managed Care	$530.00

KNEE M COPAL EXCHANGE

Facility

$20,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690884
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

KNEE MIN 3 VIEWS-BILAT

Facility

$6,601.19

Service Code	HCPCS 7356250
Hospital Charge Code	94061239
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,980.36
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$159.09
Rate for Payer: Wellpoint Medicaid Managed Care	$174.93

KNEE MIN 3 VIEWS-BILAT

Facility

$6,601.19

Service Code	HCPCS 7356250
Hospital Charge Code	94061239
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

KNEE MIN 3 VIEWS-LT

Facility

$6,601.19

Service Code	HCPCS 73562LT
Hospital Charge Code	94061369
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

KNEE MIN 3 VIEWS-LT

Facility

$6,601.19

Service Code	HCPCS 73562LT
Hospital Charge Code	94061369
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,980.36
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$159.09
Rate for Payer: Wellpoint Medicaid Managed Care	$174.93

KNEE MIN 3 VIEWS-RT

Facility

$6,601.19

Service Code	HCPCS 73562RT
Hospital Charge Code	94061371
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

KNEE MIN 3 VIEWS-RT

Facility

$6,601.19

Service Code	HCPCS 73562RT
Hospital Charge Code	94061371
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,980.36
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$159.09
Rate for Payer: Wellpoint Medicaid Managed Care	$174.93

KNEE POSITIONER DISP 2ND ASST

Facility

$1,000.00

Hospital Charge Code	270638706
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

KNEE POSITIONER DISP 2ND ASST

Facility

$1,000.00

Hospital Charge Code	270638706
Hospital Revenue Code	272
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC

Facility

$59,307.89

Service Code	MSDRG 488
Min. Negotiated Rate	$18,058.49
Max. Negotiated Rate	$59,307.89
Rate for Payer: Aetna Commercial	$41,008.59
Rate for Payer: Aetna Medicare Advantage	$59,307.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,080.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,080.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,008.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,080.71
Rate for Payer: Cigna Commercial	$28,512.65
Rate for Payer: Cigna Medicare Advantage	$19,008.94
Rate for Payer: Clover Medicare Advantage	$18,058.49
Rate for Payer: EmblemHealth Commercial	$57,026.82
Rate for Payer: Humana Medicare Advantage	$19,579.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,008.94
Rate for Payer: Oxford Commercial	$20,492.42
Rate for Payer: UnitedHealthcare Commercial	$35,934.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,008.94
Rate for Payer: Wellcare Medicare Advantage	$19,008.94

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$38,230.89

Service Code	MSDRG 489
Min. Negotiated Rate	$11,640.82
Max. Negotiated Rate	$38,230.89
Rate for Payer: Aetna Commercial	$26,526.30
Rate for Payer: Aetna Medicare Advantage	$38,230.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,843.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,843.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12,253.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,843.64
Rate for Payer: Cigna Commercial	$20,899.80
Rate for Payer: Cigna Medicare Advantage	$12,253.49
Rate for Payer: Clover Medicare Advantage	$11,640.82
Rate for Payer: EmblemHealth Commercial	$36,760.47
Rate for Payer: Humana Medicare Advantage	$12,621.09
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12,253.49
Rate for Payer: Oxford Commercial	$15,020.96
Rate for Payer: UnitedHealthcare Commercial	$26,339.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,253.49
Rate for Payer: Wellcare Medicare Advantage	$12,253.49

Know your out-of-pocket cost for care.

All Charges