Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PATELLA 1 29MM 9MM

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270691041
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

PATELLA 32 MM

Facility

$1,500.00

Hospital Charge Code	270676719
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 32 MM

Facility

$1,500.00

Hospital Charge Code	270676719
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

PATELLA 35MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676628
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

PATELLA 35MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676628
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 35MM ALL POLY NEXGE

Facility

$2,297.50

Hospital Charge Code	270661348
Hospital Revenue Code	278
Min. Negotiated Rate	$55.37
Max. Negotiated Rate	$1,148.75
Rate for Payer: Aetna Commercial	$873.05
Rate for Payer: Aetna Medicare Advantage	$689.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$585.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$585.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$585.86
Rate for Payer: Cigna Commercial	$1,148.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$505.45
Rate for Payer: Qualcare PPO/HMO/WC	$344.62
Rate for Payer: UnitedHealthcare Community & State	$55.37
Rate for Payer: Wellpoint Medicaid Managed Care	$60.88

PATELLA 35MM ALL POLY NEXGE

Facility

$2,297.50

Hospital Charge Code	270661348
Hospital Revenue Code	278
Min. Negotiated Rate	$344.62
Max. Negotiated Rate	$556.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$459.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$505.45
Rate for Payer: Qualcare PPO/HMO/WC	$344.62

PATELLA 3PEG CEMENTED 26MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681295
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 3PEG CEMENTED 26MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681295
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

PATELLA 3PEG CEMENTED 29MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675760
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

PATELLA 3PEG CEMENTED 29MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675760
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 3 PEG STD 28x8.0MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270639116
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

PATELLA 3 PEG STD 28x8.0MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270639116
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 3POST 34mm 11-150842

Facility

$3,530.00

Hospital Charge Code	270636753
Hospital Revenue Code	278
Min. Negotiated Rate	$529.50
Max. Negotiated Rate	$854.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$706.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$854.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$776.60
Rate for Payer: Qualcare PPO/HMO/WC	$529.50

PATELLA 3POST 34mm 11-150842

Facility

$3,530.00

Hospital Charge Code	270636753
Hospital Revenue Code	278
Min. Negotiated Rate	$85.07
Max. Negotiated Rate	$1,765.00
Rate for Payer: Aetna Commercial	$1,341.40
Rate for Payer: Aetna Medicare Advantage	$1,059.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$900.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$900.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$706.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$900.15
Rate for Payer: Cigna Commercial	$1,765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$854.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$776.60
Rate for Payer: Qualcare PPO/HMO/WC	$529.50
Rate for Payer: UnitedHealthcare Community & State	$85.07
Rate for Payer: Wellpoint Medicaid Managed Care	$93.55

PATELLA 3POST 37mm 11150844

Facility

$3,070.00

Hospital Charge Code	270642379
Hospital Revenue Code	278
Min. Negotiated Rate	$73.99
Max. Negotiated Rate	$1,535.00
Rate for Payer: Aetna Commercial	$1,166.60
Rate for Payer: Aetna Medicare Advantage	$921.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$782.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$782.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$782.85
Rate for Payer: Cigna Commercial	$1,535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$742.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$675.40
Rate for Payer: Qualcare PPO/HMO/WC	$460.50
Rate for Payer: UnitedHealthcare Community & State	$73.99
Rate for Payer: Wellpoint Medicaid Managed Care	$81.36

PATELLA 3POST 37mm 11150844

Facility

$3,070.00

Hospital Charge Code	270642379
Hospital Revenue Code	278
Min. Negotiated Rate	$460.50
Max. Negotiated Rate	$742.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$742.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$675.40
Rate for Payer: Qualcare PPO/HMO/WC	$460.50

PATELLA 41MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676728
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PATELLA 41MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676728
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

PATELLA 41MM 10.0MM

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270690961
Hospital Revenue Code	278
Min. Negotiated Rate	$123.63
Max. Negotiated Rate	$2,565.00
Rate for Payer: Aetna Commercial	$1,949.40
Rate for Payer: Aetna Medicare Advantage	$1,539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,308.15
Rate for Payer: Cigna Commercial	$2,565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,128.60
Rate for Payer: Qualcare PPO/HMO/WC	$769.50
Rate for Payer: UnitedHealthcare Community & State	$123.63
Rate for Payer: Wellpoint Medicaid Managed Care	$135.94

PATELLA 41MM 10.0MM

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270690961
Hospital Revenue Code	278
Min. Negotiated Rate	$769.50
Max. Negotiated Rate	$1,241.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,128.60
Rate for Payer: Qualcare PPO/HMO/WC	$769.50

PATELLA 51MM

Facility

$876.65

Service Code	HCPCS C1713
Hospital Charge Code	270656913
Hospital Revenue Code	278
Min. Negotiated Rate	$21.13
Max. Negotiated Rate	$438.32
Rate for Payer: Aetna Commercial	$333.13
Rate for Payer: Aetna Medicare Advantage	$263.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.55
Rate for Payer: Cigna Commercial	$438.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$192.86
Rate for Payer: Qualcare PPO/HMO/WC	$131.50
Rate for Payer: UnitedHealthcare Community & State	$21.13
Rate for Payer: Wellpoint Medicaid Managed Care	$23.23

PATELLA 51MM

Facility

$876.65

Service Code	HCPCS C1713
Hospital Charge Code	270656913
Hospital Revenue Code	278
Min. Negotiated Rate	$131.50
Max. Negotiated Rate	$212.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$192.86
Rate for Payer: Qualcare PPO/HMO/WC	$131.50

PATELLA ADVANCE TRI-PEG 8X32MM

Facility

$0.05

Service Code	HCPCS C1776
Hospital Charge Code	270697718
Hospital Revenue Code	278
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna Commercial	$0.02
Rate for Payer: Aetna Medicare Advantage	$0.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.01
Rate for Payer: Cigna Commercial	$0.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.01
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

PATELLA ADVANCE TRI-PEG 8X32MM

Facility

$0.05

Service Code	HCPCS C1776
Hospital Charge Code	270697718
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.01

Know your out-of-pocket cost for care.

All Charges