Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PATELLA PSN ALL POLY 32 MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686544
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 PSN ALL POLY 32 MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686544
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 PSN ALL POLY 32MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689503
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 PSN ALL POLY 32MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689503
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

PATELLAR BUTTON STD AGC

Facility

$1,870.00

Hospital Charge Code	270654366
Hospital Revenue Code	278
Min. Negotiated Rate	$280.50
Max. Negotiated Rate	$452.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$374.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$452.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$411.40
Rate for Payer: Qualcare PPO/HMO/WC	$280.50

PATELLAR BUTTON STD AGC

Facility

$1,870.00

Hospital Charge Code	270654366
Hospital Revenue Code	278
Min. Negotiated Rate	$45.07
Max. Negotiated Rate	$935.00
Rate for Payer: Aetna Commercial	$710.60
Rate for Payer: Aetna Medicare Advantage	$561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$476.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$476.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$476.85
Rate for Payer: Cigna Commercial	$935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$452.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$411.40
Rate for Payer: Qualcare PPO/HMO/WC	$280.50
Rate for Payer: UnitedHealthcare Community & State	$45.07
Rate for Payer: Wellpoint Medicaid Managed Care	$49.55

PATELLAR COMPONENT OVAL SZ

Facility

$2,750.00

Hospital Charge Code	270667534
Hospital Revenue Code	278
Min. Negotiated Rate	$66.28
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$1,045.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.50
Rate for Payer: UnitedHealthcare Community & State	$66.28
Rate for Payer: Wellpoint Medicaid Managed Care	$72.88

PATELLAR COMPONENT OVAL SZ

Facility

$2,750.00

Hospital Charge Code	270667534
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$665.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

PATELLAR COMP OVAL SZ 1 10MM

Facility

$3,750.00

Hospital Charge Code	270669292
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

PATELLAR COMP OVAL SZ 1 10MM

Facility

$3,750.00

Hospital Charge Code	270669292
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

PATELLAR COMP. OVAL SZ 2 7.5

Facility

$2,976.25

Hospital Charge Code	270671357
Hospital Revenue Code	278
Min. Negotiated Rate	$71.73
Max. Negotiated Rate	$1,488.12
Rate for Payer: Aetna Commercial	$1,130.97
Rate for Payer: Aetna Medicare Advantage	$892.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$595.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.94
Rate for Payer: Cigna Commercial	$1,488.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$720.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$654.77
Rate for Payer: Qualcare PPO/HMO/WC	$446.44
Rate for Payer: UnitedHealthcare Community & State	$71.73
Rate for Payer: Wellpoint Medicaid Managed Care	$78.87

PATELLAR COMP. OVAL SZ 2 7.5

Facility

$2,976.25

Hospital Charge Code	270671357
Hospital Revenue Code	278
Min. Negotiated Rate	$446.44
Max. Negotiated Rate	$720.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$595.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$720.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$654.77
Rate for Payer: Qualcare PPO/HMO/WC	$446.44

PATELLA REAMER BLADE W/

Facility

$876.65

Hospital Charge Code	270657855
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 REAMER BLADE W/

Facility

$876.65

Hospital Charge Code	270657857
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 REAMER BLADE W/

Facility

$876.65

Hospital Charge Code	270657857
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 REAMER BLADE W/

Facility

$876.65

Hospital Charge Code	270657855
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, REAMER BLADE W/ PI

Facility

$875.00

Hospital Charge Code	270665753
Hospital Revenue Code	272
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$21.09
Rate for Payer: Wellpoint Medicaid Managed Care	$23.19

PATELLA, REAMER BLADE W/ PI

Facility

$875.00

Hospital Charge Code	270665753
Hospital Revenue Code	272
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

PATELLA REAMER BLADE W/ PILOT

Facility

$6,000.00

Hospital Charge Code	270661349
Hospital Revenue Code	272
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$900.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PATELLA REAMER BLADE W/ PILOT

Facility

$6,000.00

Hospital Charge Code	270661349
Hospital Revenue Code	272
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,800.00
Rate for Payer: Oxford Commercial	$1,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Commercial	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

PATELLA REAMER BLADE W PILOT H

Facility

$876.55

Hospital Charge Code	270657054
Hospital Revenue Code	278
Min. Negotiated Rate	$21.12
Max. Negotiated Rate	$438.27
Rate for Payer: Aetna Commercial	$333.09
Rate for Payer: Aetna Medicare Advantage	$262.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.52
Rate for Payer: Cigna Commercial	$438.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$192.84
Rate for Payer: Qualcare PPO/HMO/WC	$131.48
Rate for Payer: UnitedHealthcare Community & State	$21.12
Rate for Payer: Wellpoint Medicaid Managed Care	$23.23

PATELLA REAMER BLADE W PILOT H

Facility

$876.65

Hospital Charge Code	270657052
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 REAMER BLADE W PILOT H

Facility

$876.65

Hospital Charge Code	270657052
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 REAMER BLADE W PILOT H

Facility

$876.55

Hospital Charge Code	270657054
Hospital Revenue Code	278
Min. Negotiated Rate	$131.48
Max. Negotiated Rate	$212.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$192.84
Rate for Payer: Qualcare PPO/HMO/WC	$131.48

PATELLA REAMING SYSTEM 35MM

Facility

$700.00

Hospital Charge Code	270703499
Hospital Revenue Code	278
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Community & State	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$18.55

Know your out-of-pocket cost for care.

All Charges