Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

OSS AVL TIB BUSHING SET

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684637
Hospital Revenue Code	278
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

OSS AVL TIBIAL BEARING

Facility

$6,270.00

Service Code	HCPCS C1776
Hospital Charge Code	270684690
Hospital Revenue Code	278
Min. Negotiated Rate	$151.11
Max. Negotiated Rate	$3,135.00
Rate for Payer: Aetna Commercial	$2,382.60
Rate for Payer: Aetna Medicare Advantage	$1,881.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,598.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,598.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,254.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,598.85
Rate for Payer: Cigna Commercial	$3,135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,517.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,379.40
Rate for Payer: Qualcare PPO/HMO/WC	$940.50
Rate for Payer: UnitedHealthcare Community & State	$151.11
Rate for Payer: Wellpoint Medicaid Managed Care	$166.16

OSS AVL TIBIAL BEARING

Facility

$6,270.00

Service Code	HCPCS C1776
Hospital Charge Code	270684690
Hospital Revenue Code	278
Min. Negotiated Rate	$940.50
Max. Negotiated Rate	$1,517.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,254.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,517.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,379.40
Rate for Payer: Qualcare PPO/HMO/WC	$940.50

OSS AVL TI LOCK RING SET

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270684640
Hospital Revenue Code	278
Min. Negotiated Rate	$57.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$528.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Community & State	$57.84
Rate for Payer: Wellpoint Medicaid Managed Care	$63.60

OSS AVL TI LOCK RING SET

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270684640
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$580.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$528.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

OSS AVL TI YOKE SET 12 14 16MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684638
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

OSS AVL TI YOKE SET 12 14 16MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684638
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

OSS BASEPLATE TIBIA 71MM

Facility

$30,343.05

Service Code	HCPCS C1776
Hospital Charge Code	270697108
Hospital Revenue Code	278
Min. Negotiated Rate	$731.27
Max. Negotiated Rate	$15,171.52
Rate for Payer: Aetna Commercial	$11,530.36
Rate for Payer: Aetna Medicare Advantage	$9,102.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,737.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,737.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,068.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,737.48
Rate for Payer: Cigna Commercial	$15,171.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,343.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,675.47
Rate for Payer: Qualcare PPO/HMO/WC	$4,551.46
Rate for Payer: UnitedHealthcare Community & State	$731.27
Rate for Payer: Wellpoint Medicaid Managed Care	$804.09

OSS BASEPLATE TIBIA 71MM

Facility

$30,343.05

Service Code	HCPCS C1776
Hospital Charge Code	270697108
Hospital Revenue Code	278
Min. Negotiated Rate	$4,551.46
Max. Negotiated Rate	$7,343.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,068.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,343.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,675.47
Rate for Payer: Qualcare PPO/HMO/WC	$4,551.46

OSS BASEPLT TIBIA NONMOD 67MM

Facility

$29,804.40

Service Code	HCPCS C1776
Hospital Charge Code	270697106
Hospital Revenue Code	278
Min. Negotiated Rate	$4,470.66
Max. Negotiated Rate	$7,212.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,960.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,212.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,556.97
Rate for Payer: Qualcare PPO/HMO/WC	$4,470.66

OSS BASEPLT TIBIA NONMOD 67MM

Facility

$29,804.40

Service Code	HCPCS C1776
Hospital Charge Code	270697106
Hospital Revenue Code	278
Min. Negotiated Rate	$718.29
Max. Negotiated Rate	$14,902.20
Rate for Payer: Aetna Commercial	$11,325.67
Rate for Payer: Aetna Medicare Advantage	$8,941.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,600.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,600.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,960.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,600.12
Rate for Payer: Cigna Commercial	$14,902.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,212.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,556.97
Rate for Payer: Qualcare PPO/HMO/WC	$4,470.66
Rate for Payer: UnitedHealthcare Community & State	$718.29
Rate for Payer: Wellpoint Medicaid Managed Care	$789.82

OSS BEARING TIBIA ART LS 20MM

Facility

$8,152.25

Service Code	HCPCS C1776
Hospital Charge Code	270697107
Hospital Revenue Code	278
Min. Negotiated Rate	$1,222.84
Max. Negotiated Rate	$1,972.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,630.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,972.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,793.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,222.84

OSS BEARING TIBIA ART LS 20MM

Facility

$8,152.25

Service Code	HCPCS C1776
Hospital Charge Code	270697107
Hospital Revenue Code	278
Min. Negotiated Rate	$196.47
Max. Negotiated Rate	$4,076.12
Rate for Payer: Aetna Commercial	$3,097.86
Rate for Payer: Aetna Medicare Advantage	$2,445.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,078.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,078.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,630.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,078.82
Rate for Payer: Cigna Commercial	$4,076.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,972.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,793.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,222.84
Rate for Payer: UnitedHealthcare Community & State	$196.47
Rate for Payer: Wellpoint Medicaid Managed Care	$216.03

OSS CEMENTED IM STEM 14 X 150

Facility

$9,540.00

Service Code	HCPCS C1776
Hospital Charge Code	270687278
Hospital Revenue Code	278
Min. Negotiated Rate	$1,431.00
Max. Negotiated Rate	$2,308.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,908.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,308.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,098.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,431.00

OSS CEMENTED IM STEM 14 X 150

Facility

$9,540.00

Service Code	HCPCS C1776
Hospital Charge Code	270687278
Hospital Revenue Code	278
Min. Negotiated Rate	$229.91
Max. Negotiated Rate	$4,770.00
Rate for Payer: Aetna Commercial	$3,625.20
Rate for Payer: Aetna Medicare Advantage	$2,862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,432.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,432.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,908.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,432.70
Rate for Payer: Cigna Commercial	$4,770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,308.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,098.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,431.00
Rate for Payer: UnitedHealthcare Community & State	$229.91
Rate for Payer: Wellpoint Medicaid Managed Care	$252.81

OSSEOGEN CELLULAR BONE MATRIX

Facility

$17,750.00

Service Code	HCPCS C1765
Hospital Charge Code	270706026
Hospital Revenue Code	278
Min. Negotiated Rate	$2,662.50
Max. Negotiated Rate	$4,295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,905.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50

OSSEOGEN CELLULAR BONE MATRIX

Facility

$9,750.00

Service Code	HCPCS C1765
Hospital Charge Code	270706025
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$2,359.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,145.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

OSSEOGEN CELLULAR BONE MATRIX

Facility

$9,750.00

Service Code	HCPCS C1765
Hospital Charge Code	270706025
Hospital Revenue Code	278
Min. Negotiated Rate	$234.97
Max. Negotiated Rate	$4,875.00
Rate for Payer: Aetna Commercial	$3,705.00
Rate for Payer: Aetna Medicare Advantage	$2,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,486.25
Rate for Payer: Cigna Commercial	$4,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,145.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50
Rate for Payer: UnitedHealthcare Community & State	$234.97
Rate for Payer: Wellpoint Medicaid Managed Care	$258.38

OSSEOGEN CELLULAR BONE MATRIX

Facility

$17,750.00

Service Code	HCPCS C1765
Hospital Charge Code	270706026
Hospital Revenue Code	278
Min. Negotiated Rate	$427.77
Max. Negotiated Rate	$8,875.00
Rate for Payer: Aetna Commercial	$6,745.00
Rate for Payer: Aetna Medicare Advantage	$5,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,526.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,526.25
Rate for Payer: Cigna Commercial	$8,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,295.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,905.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,662.50
Rate for Payer: UnitedHealthcare Community & State	$427.77
Rate for Payer: Wellpoint Medicaid Managed Care	$470.38

OSSFX

Facility

$7,125.00

Hospital Charge Code	270704259
Hospital Revenue Code	278
Min. Negotiated Rate	$1,068.75
Max. Negotiated Rate	$1,724.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,567.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,068.75

OSSFX

Facility

$7,125.00

Hospital Charge Code	270704259
Hospital Revenue Code	278
Min. Negotiated Rate	$171.71
Max. Negotiated Rate	$3,562.50
Rate for Payer: Aetna Commercial	$2,707.50
Rate for Payer: Aetna Medicare Advantage	$2,137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,816.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,816.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,816.88
Rate for Payer: Cigna Commercial	$3,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,567.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,068.75
Rate for Payer: UnitedHealthcare Community & State	$171.71
Rate for Payer: Wellpoint Medicaid Managed Care	$188.81

OSSFX MOLDABLE 12CC

Facility

$16,375.00

Hospital Charge Code	270702344
Hospital Revenue Code	278
Min. Negotiated Rate	$2,456.25
Max. Negotiated Rate	$3,962.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,962.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,602.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,456.25

OSSFX MOLDABLE 12CC

Facility

$16,375.00

Hospital Charge Code	270702344
Hospital Revenue Code	278
Min. Negotiated Rate	$394.64
Max. Negotiated Rate	$8,187.50
Rate for Payer: Aetna Commercial	$6,222.50
Rate for Payer: Aetna Medicare Advantage	$4,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,175.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,175.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,175.62
Rate for Payer: Cigna Commercial	$8,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,962.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,602.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,456.25
Rate for Payer: UnitedHealthcare Community & State	$394.64
Rate for Payer: Wellpoint Medicaid Managed Care	$433.94

OSSIFUSE FLOWABLE FIBER BONE G

Facility

$7,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270704710
Hospital Revenue Code	278
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$1,808.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,808.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,644.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

OSSIFUSE FLOWABLE FIBER BONE G

Facility

$7,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270704710
Hospital Revenue Code	278
Min. Negotiated Rate	$180.15
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,840.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,808.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,644.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25
Rate for Payer: UnitedHealthcare Community & State	$180.15
Rate for Payer: Wellpoint Medicaid Managed Care	$198.09

Know your out-of-pocket cost for care.

All Charges