Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$261.17
Max. Negotiated Rate	$5,418.40
Rate for Payer: Aetna Commercial	$4,117.98
Rate for Payer: Aetna Medicare Advantage	$3,251.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,763.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,763.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,167.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,763.38
Rate for Payer: Cigna Commercial	$5,418.40
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
Rate for Payer: UnitedHealthcare Community & State	$261.17
Rate for Payer: Wellpoint Medicaid Managed Care	$287.18

PATELLA LIGAMENT 10MM PRECUT

Facility

$17,777.50

Hospital Charge Code	270670447
Hospital Revenue Code	278
Min. Negotiated Rate	$2,666.62
Max. Negotiated Rate	$4,302.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,555.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,302.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,911.05
Rate for Payer: Qualcare PPO/HMO/WC	$2,666.62

PATELLA LIGAMENT 10MM PRECUT

Facility

$17,777.50

Hospital Charge Code	270670447
Hospital Revenue Code	278
Min. Negotiated Rate	$428.44
Max. Negotiated Rate	$8,888.75
Rate for Payer: Aetna Commercial	$6,755.45
Rate for Payer: Aetna Medicare Advantage	$5,333.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,533.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,533.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,555.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,533.26
Rate for Payer: Cigna Commercial	$8,888.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,302.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,911.05
Rate for Payer: Qualcare PPO/HMO/WC	$2,666.62
Rate for Payer: UnitedHealthcare Community & State	$428.44
Rate for Payer: Wellpoint Medicaid Managed Care	$471.10

PATELLA MEDIALIZED DOME 29 MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685561
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

PATELLA MEDIALIZED DOME 29 MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685561
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

PATELLA MEDIALIZED DOME 32MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685507
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

PATELLA MEDIALIZED DOME 32MM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685507
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

PATELLA NEXGEN POROUS TM 10X

Facility

$9,360.00

Service Code	HCPCS C1776
Hospital Charge Code	270698908
Hospital Revenue Code	278
Min. Negotiated Rate	$225.58
Max. Negotiated Rate	$4,680.00
Rate for Payer: Aetna Commercial	$3,556.80
Rate for Payer: Aetna Medicare Advantage	$2,808.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,386.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,386.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,386.80
Rate for Payer: Cigna Commercial	$4,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,265.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,059.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,404.00
Rate for Payer: UnitedHealthcare Community & State	$225.58
Rate for Payer: Wellpoint Medicaid Managed Care	$248.04

PATELLA NEXGEN POROUS TM 10X

Facility

$9,360.00

Service Code	HCPCS C1776
Hospital Charge Code	270698908
Hospital Revenue Code	278
Min. Negotiated Rate	$1,404.00
Max. Negotiated Rate	$2,265.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,872.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,265.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,059.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,404.00

PATELLA NEX MICRO 26m 59726126

Facility

$3,118.15

Hospital Charge Code	270630185
Hospital Revenue Code	278
Min. Negotiated Rate	$467.72
Max. Negotiated Rate	$754.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$623.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$754.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$685.99
Rate for Payer: Qualcare PPO/HMO/WC	$467.72

PATELLA NEX MICRO 26m 59726126

Facility

$3,118.15

Hospital Charge Code	270630185
Hospital Revenue Code	278
Min. Negotiated Rate	$75.15
Max. Negotiated Rate	$1,559.08
Rate for Payer: Aetna Commercial	$1,184.90
Rate for Payer: Aetna Medicare Advantage	$935.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$795.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$795.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$623.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$795.13
Rate for Payer: Cigna Commercial	$1,559.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$754.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$685.99
Rate for Payer: Qualcare PPO/HMO/WC	$467.72
Rate for Payer: UnitedHealthcare Community & State	$75.15
Rate for Payer: Wellpoint Medicaid Managed Care	$82.63

PATELLA ON SET 3 PEGS 38MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676679
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 ON SET 3 PEGS 38MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676679
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 PEG 3 CEMENT 41MM DIA

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270670648
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 PEG 3 CEMENT 41MM DIA

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270670648
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 PLUSDOMED TRI PEG 32

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270692522
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 PLUSDOMED TRI PEG 32

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270692522
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, POLY 29MM NEXGEN A

Facility

$2,300.00

Hospital Charge Code	270665752
Hospital Revenue Code	278
Min. Negotiated Rate	$55.43
Max. Negotiated Rate	$1,150.00
Rate for Payer: Aetna Commercial	$874.00
Rate for Payer: Aetna Medicare Advantage	$690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$586.50
Rate for Payer: Cigna Commercial	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$506.00
Rate for Payer: Qualcare PPO/HMO/WC	$345.00
Rate for Payer: UnitedHealthcare Community & State	$55.43
Rate for Payer: Wellpoint Medicaid Managed Care	$60.95

PATELLA, POLY 29MM NEXGEN A

Facility

$2,300.00

Hospital Charge Code	270665752
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$556.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$506.00
Rate for Payer: Qualcare PPO/HMO/WC	$345.00

PATELLA POROUS 10X38 587806538

Facility

$6,750.00

Hospital Charge Code	270637705
Hospital Revenue Code	272
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,012.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

PATELLA POROUS 10X38 587806538

Facility

$6,750.00

Hospital Charge Code	270637705
Hospital Revenue Code	272
Min. Negotiated Rate	$162.68
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,025.00
Rate for Payer: Oxford Commercial	$1,350.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Commercial	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$162.68
Rate for Payer: Wellpoint Medicaid Managed Care	$178.88

PATELLA PRIMARY 34mm SERIES A

Facility

$4,865.00

Hospital Charge Code	270646500
Hospital Revenue Code	278
Min. Negotiated Rate	$729.75
Max. Negotiated Rate	$1,177.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$973.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,177.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,070.30
Rate for Payer: Qualcare PPO/HMO/WC	$729.75

PATELLA PRIMARY 34mm SERIES A

Facility

$4,865.00

Hospital Charge Code	270646500
Hospital Revenue Code	278
Min. Negotiated Rate	$117.25
Max. Negotiated Rate	$2,432.50
Rate for Payer: Aetna Commercial	$1,848.70
Rate for Payer: Aetna Medicare Advantage	$1,459.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,240.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,240.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$973.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,240.58
Rate for Payer: Cigna Commercial	$2,432.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,177.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,070.30
Rate for Payer: Qualcare PPO/HMO/WC	$729.75
Rate for Payer: UnitedHealthcare Community & State	$117.25
Rate for Payer: Wellpoint Medicaid Managed Care	$128.92

PATELLA PRIMARY REGENEREX 3PEG

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270655089
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

PATELLA PRIMARY REGENEREX 3PEG

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270655089
Hospital Revenue Code	278
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

Know your out-of-pocket cost for care.

All Charges