Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PATELLA RIM LAT 2.4/2.7

Facility

$10,836.80

Service Code	HCPCS C1776
Hospital Charge Code	270693887
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

PATELLA RIM LAT 2.4/2.7

Facility

$10,836.80

Service Code	HCPCS C1776
Hospital Charge Code	270693887
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 SAIPH 38mm CEMENTED

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270680034
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 SAIPH 38mm CEMENTED

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270680034
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 SOMBRERO SZ1 7MM

Facility

$1,500.00

Hospital Charge Code	270677277
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 SOMBRERO SZ1 7MM

Facility

$1,500.00

Hospital Charge Code	270677277
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 SOMBRERO SZ 2 7MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675544
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 SOMBRERO SZ 2 7MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675544
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 SOMBRERO SZ 2 7x31MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675282
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 SOMBRERO SZ 2 7x31MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675282
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 ST ALLPOLY 38MM 9.5MM

Facility

$450.00

Service Code	HCPCS C1776
Hospital Charge Code	270694197
Hospital Revenue Code	278
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

PATELLA ST ALLPOLY 38MM 9.5MM

Facility

$450.00

Service Code	HCPCS C1776
Hospital Charge Code	270694197
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

PATELLA STD 37x10MM 3-PEG

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270640765
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 STD 37x10MM 3-PEG

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270640765
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 STD ALL POLY 8.0X29MM

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696278
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

PATELLA STD ALL POLY 8.0X29MM

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696278
Hospital Revenue Code	278
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) NJ Health	$100.00
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	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

PATELLA SYMMERIC S31 9 MM

Facility

$2,550.50

Service Code	HCPCS C1776
Hospital Charge Code	270691025
Hospital Revenue Code	278
Min. Negotiated Rate	$382.57
Max. Negotiated Rate	$617.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$561.11
Rate for Payer: Qualcare PPO/HMO/WC	$382.57

PATELLA SYMMERIC S31 9 MM

Facility

$2,550.50

Service Code	HCPCS C1776
Hospital Charge Code	270691025
Hospital Revenue Code	278
Min. Negotiated Rate	$61.47
Max. Negotiated Rate	$1,275.25
Rate for Payer: Aetna Commercial	$969.19
Rate for Payer: Aetna Medicare Advantage	$765.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$650.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$650.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$650.38
Rate for Payer: Cigna Commercial	$1,275.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$561.11
Rate for Payer: Qualcare PPO/HMO/WC	$382.57
Rate for Payer: UnitedHealthcare Community & State	$61.47
Rate for Payer: Wellpoint Medicaid Managed Care	$67.59

PATELLA SYMMETRIC X3 36MMx10MM

Facility

$2,569.35

Service Code	HCPCS C1776
Hospital Charge Code	270681039
Hospital Revenue Code	278
Min. Negotiated Rate	$385.40
Max. Negotiated Rate	$621.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$513.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$565.26
Rate for Payer: Qualcare PPO/HMO/WC	$385.40

PATELLA SYMMETRIC X3 36MMx10MM

Facility

$2,569.35

Service Code	HCPCS C1776
Hospital Charge Code	270681039
Hospital Revenue Code	278
Min. Negotiated Rate	$61.92
Max. Negotiated Rate	$1,284.67
Rate for Payer: Aetna Commercial	$976.35
Rate for Payer: Aetna Medicare Advantage	$770.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$513.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.18
Rate for Payer: Cigna Commercial	$1,284.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$565.26
Rate for Payer: Qualcare PPO/HMO/WC	$385.40
Rate for Payer: UnitedHealthcare Community & State	$61.92
Rate for Payer: Wellpoint Medicaid Managed Care	$68.09

PATELLA SYSTEM 11MM

Facility

$825.00

Service Code	HCPCS C1776
Hospital Charge Code	270692772
Hospital Revenue Code	278
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$199.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$123.75

PATELLA SYSTEM 11MM

Facility

$825.00

Service Code	HCPCS C1776
Hospital Charge Code	270692772
Hospital Revenue Code	278
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$412.50
Rate for Payer: Aetna Commercial	$313.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Community & State	$19.88
Rate for Payer: Wellpoint Medicaid Managed Care	$21.86

PATELLA SZ 38 MM 9 MM

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270692718
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 SZ 38 MM 9 MM

Facility

$3,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270692718
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 TM STD NEXGEN 10X35MM

Facility

$9,360.00

Service Code	HCPCS C1776
Hospital Charge Code	270699475
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

Know your out-of-pocket cost for care.

All Charges