Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PATELLA ALL POLY VE 29MM

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270693757
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 ALL POLY VE 29MM

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270693757
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 ASYMMETRIC 10X32

Facility

$2,473.40

Service Code	HCPCS C1776
Hospital Charge Code	270691265
Hospital Revenue Code	278
Min. Negotiated Rate	$59.61
Max. Negotiated Rate	$1,236.70
Rate for Payer: Aetna Commercial	$939.89
Rate for Payer: Aetna Medicare Advantage	$742.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$630.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$630.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$494.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$630.72
Rate for Payer: Cigna Commercial	$1,236.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$544.15
Rate for Payer: Qualcare PPO/HMO/WC	$371.01
Rate for Payer: UnitedHealthcare Community & State	$59.61
Rate for Payer: Wellpoint Medicaid Managed Care	$65.55

PATELLA ASYMMETRIC 10X32

Facility

$2,473.40

Service Code	HCPCS C1776
Hospital Charge Code	270691265
Hospital Revenue Code	278
Min. Negotiated Rate	$371.01
Max. Negotiated Rate	$598.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$494.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$544.15
Rate for Payer: Qualcare PPO/HMO/WC	$371.01

PATELLA ASYMMETRIC A35 MM

Facility

$2,570.60

Service Code	HCPCS C1776
Hospital Charge Code	270691403
Hospital Revenue Code	278
Min. Negotiated Rate	$385.59
Max. Negotiated Rate	$622.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$565.53
Rate for Payer: Qualcare PPO/HMO/WC	$385.59

PATELLA ASYMMETRIC A35 MM

Facility

$2,570.60

Service Code	HCPCS C1776
Hospital Charge Code	270691403
Hospital Revenue Code	278
Min. Negotiated Rate	$61.95
Max. Negotiated Rate	$1,285.30
Rate for Payer: Aetna Commercial	$976.83
Rate for Payer: Aetna Medicare Advantage	$771.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$514.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.50
Rate for Payer: Cigna Commercial	$1,285.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$622.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$565.53
Rate for Payer: Qualcare PPO/HMO/WC	$385.59
Rate for Payer: UnitedHealthcare Community & State	$61.95
Rate for Payer: Wellpoint Medicaid Managed Care	$68.12

PATELLA BMT X-SMALL

Facility

$2,912.00

Hospital Charge Code	270606317
Hospital Revenue Code	272
Min. Negotiated Rate	$436.80
Max. Negotiated Rate	$436.80
Rate for Payer: Qualcare PPO/HMO/WC	$436.80

PATELLA BMT X-SMALL

Facility

$2,912.00

Hospital Charge Code	270606317
Hospital Revenue Code	272
Min. Negotiated Rate	$70.18
Max. Negotiated Rate	$1,456.00
Rate for Payer: Aetna Commercial	$1,106.56
Rate for Payer: Aetna Medicare Advantage	$873.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$742.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$742.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$742.56
Rate for Payer: Cigna Commercial	$1,456.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$873.60
Rate for Payer: Oxford Commercial	$582.40
Rate for Payer: Qualcare PPO/HMO/WC	$436.80
Rate for Payer: UnitedHealthcare Commercial	$582.40
Rate for Payer: UnitedHealthcare Community & State	$70.18
Rate for Payer: Wellpoint Medicaid Managed Care	$77.17

PATELLA BUTTON 31mm 184764

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270639770
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 BUTTON 31mm 184764

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270639770
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 CEMENTED 3 PEG 35MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270668547
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 CEMENTED 3 PEG 35MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270668547
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 CEMENTED 3 PEG 38MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668744
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 CEMENTED 3 PEG 38MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668744
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 COMPONENT

Facility

$6,705.00

Hospital Charge Code	270666806
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.75
Max. Negotiated Rate	$1,622.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,341.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,622.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,475.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.75

PATELLA COMPONENT

Facility

$6,705.00

Hospital Charge Code	270666806
Hospital Revenue Code	278
Min. Negotiated Rate	$161.59
Max. Negotiated Rate	$3,352.50
Rate for Payer: Aetna Commercial	$2,547.90
Rate for Payer: Aetna Medicare Advantage	$2,011.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,709.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,709.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,341.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,709.78
Rate for Payer: Cigna Commercial	$3,352.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,622.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,475.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.75
Rate for Payer: UnitedHealthcare Community & State	$161.59
Rate for Payer: Wellpoint Medicaid Managed Care	$177.68

PATELLA DOMED TRI SZ 35 MM

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270691777
Hospital Revenue Code	278
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$762.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$693.00
Rate for Payer: Qualcare PPO/HMO/WC	$472.50

PATELLA DOMED TRI SZ 35 MM

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270691777
Hospital Revenue Code	278
Min. Negotiated Rate	$75.92
Max. Negotiated Rate	$1,575.00
Rate for Payer: Aetna Commercial	$1,197.00
Rate for Payer: Aetna Medicare Advantage	$945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$803.25
Rate for Payer: Cigna Commercial	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$693.00
Rate for Payer: Qualcare PPO/HMO/WC	$472.50
Rate for Payer: UnitedHealthcare Community & State	$75.92
Rate for Payer: Wellpoint Medicaid Managed Care	$83.47

PATELLA FX FIBERTAPE

Facility

$357.50

Hospital Charge Code	270678376
Hospital Revenue Code	272
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$135.85
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.25
Rate for Payer: Oxford Commercial	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$71.50
Rate for Payer: UnitedHealthcare Community & State	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9.47

PATELLA FX FIBERTAPE

Facility

$357.50

Hospital Charge Code	270678266
Hospital Revenue Code	272
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$178.75
Rate for Payer: Aetna Commercial	$135.85
Rate for Payer: Aetna Medicare Advantage	$107.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.16
Rate for Payer: Cigna Commercial	$178.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.25
Rate for Payer: Oxford Commercial	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$53.62
Rate for Payer: UnitedHealthcare Commercial	$71.50
Rate for Payer: UnitedHealthcare Community & State	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9.47

PATELLA FX FIBERTAPE

Facility

$357.50

Hospital Charge Code	270678376
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

PATELLA FX FIBERTAPE

Facility

$357.50

Hospital Charge Code	270678266
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$53.62
Rate for Payer: Qualcare PPO/HMO/WC	$53.62

PATELLA INSTRUMENT SET

Facility

$500.00

Hospital Charge Code	270687769
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

PATELLA INSTRUMENT SET

Facility

$500.00

Hospital Charge Code	270687769
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

PATELLA LAT VAL 2.4 /2.7 SS

Facility

$10,836.80

Service Code	HCPCS C1713
Hospital Charge Code	270694000
Hospital Revenue Code	278
Min. Negotiated Rate	$1,625.52
Max. Negotiated Rate	$2,622.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,167.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,622.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,384.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,625.52

Know your out-of-pocket cost for care.

All Charges