Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PATELLA REAMING SYSTEM 35MM

Facility

$700.00

Hospital Charge Code	270703499
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
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

PATELLA REAMING SYSTEM 38MM

Facility

$700.00

Hospital Charge Code	270703498
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
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

PATELLA REAMING SYSTEM 38MM

Facility

$700.00

Hospital Charge Code	270703498
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

PATELLA REGENEREX SZ31

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270646611
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 REGENEREX SZ31

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270646611
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

PATELLA RESURFACE RD DOME 29MM

Facility

$3,770.00

Hospital Charge Code	270668848
Hospital Revenue Code	278
Min. Negotiated Rate	$90.86
Max. Negotiated Rate	$1,885.00
Rate for Payer: Aetna Commercial	$1,432.60
Rate for Payer: Aetna Medicare Advantage	$1,131.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$961.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$961.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$961.35
Rate for Payer: Cigna Commercial	$1,885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$829.40
Rate for Payer: Qualcare PPO/HMO/WC	$565.50
Rate for Payer: UnitedHealthcare Community & State	$90.86
Rate for Payer: Wellpoint Medicaid Managed Care	$99.91

PATELLA RESURFACE RD DOME 29MM

Facility

$3,770.00

Hospital Charge Code	270668848
Hospital Revenue Code	278
Min. Negotiated Rate	$565.50
Max. Negotiated Rate	$912.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$829.40
Rate for Payer: Qualcare PPO/HMO/WC	$565.50

PATELLA RESURFACE RD DOME 32MM

Facility

$3,770.00

Hospital Charge Code	270668849
Hospital Revenue Code	278
Min. Negotiated Rate	$90.86
Max. Negotiated Rate	$1,885.00
Rate for Payer: Aetna Commercial	$1,432.60
Rate for Payer: Aetna Medicare Advantage	$1,131.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$961.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$961.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$961.35
Rate for Payer: Cigna Commercial	$1,885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$829.40
Rate for Payer: Qualcare PPO/HMO/WC	$565.50
Rate for Payer: UnitedHealthcare Community & State	$90.86
Rate for Payer: Wellpoint Medicaid Managed Care	$99.91

PATELLA RESURFACE RD DOME 32MM

Facility

$3,770.00

Hospital Charge Code	270668849
Hospital Revenue Code	278
Min. Negotiated Rate	$565.50
Max. Negotiated Rate	$912.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$829.40
Rate for Payer: Qualcare PPO/HMO/WC	$565.50

PATELLA RESURFACE RD DOME 35MM

Facility

$3,770.00

Hospital Charge Code	270668850
Hospital Revenue Code	278
Min. Negotiated Rate	$565.50
Max. Negotiated Rate	$912.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$829.40
Rate for Payer: Qualcare PPO/HMO/WC	$565.50

PATELLA RESURFACE RD DOME 35MM

Facility

$3,770.00

Hospital Charge Code	270668850
Hospital Revenue Code	278
Min. Negotiated Rate	$90.86
Max. Negotiated Rate	$1,885.00
Rate for Payer: Aetna Commercial	$1,432.60
Rate for Payer: Aetna Medicare Advantage	$1,131.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$961.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$961.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$961.35
Rate for Payer: Cigna Commercial	$1,885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$829.40
Rate for Payer: Qualcare PPO/HMO/WC	$565.50
Rate for Payer: UnitedHealthcare Community & State	$90.86
Rate for Payer: Wellpoint Medicaid Managed Care	$99.91

PATELLA RESURFACE RD DOME 38MM

Facility

$3,770.00

Hospital Charge Code	270668851
Hospital Revenue Code	278
Min. Negotiated Rate	$90.86
Max. Negotiated Rate	$1,885.00
Rate for Payer: Aetna Commercial	$1,432.60
Rate for Payer: Aetna Medicare Advantage	$1,131.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$961.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$961.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$961.35
Rate for Payer: Cigna Commercial	$1,885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$829.40
Rate for Payer: Qualcare PPO/HMO/WC	$565.50
Rate for Payer: UnitedHealthcare Community & State	$90.86
Rate for Payer: Wellpoint Medicaid Managed Care	$99.91

PATELLA RESURFACE RD DOME 38MM

Facility

$3,770.00

Hospital Charge Code	270668851
Hospital Revenue Code	278
Min. Negotiated Rate	$565.50
Max. Negotiated Rate	$912.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$829.40
Rate for Payer: Qualcare PPO/HMO/WC	$565.50

PATELLA RESURFACE RD DOME 41MM

Facility

$3,770.00

Hospital Charge Code	270668852
Hospital Revenue Code	278
Min. Negotiated Rate	$565.50
Max. Negotiated Rate	$912.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$829.40
Rate for Payer: Qualcare PPO/HMO/WC	$565.50

PATELLA RESURFACE RD DOME 41MM

Facility

$3,770.00

Hospital Charge Code	270668852
Hospital Revenue Code	278
Min. Negotiated Rate	$90.86
Max. Negotiated Rate	$1,885.00
Rate for Payer: Aetna Commercial	$1,432.60
Rate for Payer: Aetna Medicare Advantage	$1,131.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$961.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$961.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$961.35
Rate for Payer: Cigna Commercial	$1,885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$912.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$829.40
Rate for Payer: Qualcare PPO/HMO/WC	$565.50
Rate for Payer: UnitedHealthcare Community & State	$90.86
Rate for Payer: Wellpoint Medicaid Managed Care	$99.91

PATELLA RESURFACING S2

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270667708
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 RESURFACING S2

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270667708
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 RESURFACING SZ1

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672251
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 RESURFACING SZ1

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672251
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 RESURFACING SZ3

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677521
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 RESURFACING SZ3

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677521
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 RESURFACING TRIAL

Facility

$326.25

Service Code	HCPCS C1776
Hospital Charge Code	270688384
Hospital Revenue Code	278
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$163.12
Rate for Payer: Aetna Commercial	$123.97
Rate for Payer: Aetna Medicare Advantage	$97.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.19
Rate for Payer: Cigna Commercial	$163.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$71.78
Rate for Payer: Qualcare PPO/HMO/WC	$48.94
Rate for Payer: UnitedHealthcare Community & State	$7.86
Rate for Payer: Wellpoint Medicaid Managed Care	$8.65

PATELLA RESURFACING TRIAL

Facility

$326.25

Service Code	HCPCS C1776
Hospital Charge Code	270688384
Hospital Revenue Code	278
Min. Negotiated Rate	$48.94
Max. Negotiated Rate	$78.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$71.78
Rate for Payer: Qualcare PPO/HMO/WC	$48.94

PATELLA RGX 3 PEG 28MM

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270677861
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 RGX 3 PEG 28MM

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270677861
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