Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PATELLA TM STD NEXGEN 10X35MM

Facility

$9,360.00

Service Code	HCPCS C1776
Hospital Charge Code	270699475
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 TRIATHALON SYM 9x31MM

Facility

$3,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270672929
Hospital Revenue Code	278
Min. Negotiated Rate	$92.78
Max. Negotiated Rate	$1,925.00
Rate for Payer: Aetna Commercial	$1,463.00
Rate for Payer: Aetna Medicare Advantage	$1,155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$981.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$981.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$981.75
Rate for Payer: Cigna Commercial	$1,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$931.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$577.50
Rate for Payer: UnitedHealthcare Community & State	$92.78
Rate for Payer: Wellpoint Medicaid Managed Care	$102.03

PATELLA TRIATHALON SYM 9x31MM

Facility

$3,850.00

Service Code	HCPCS C1776
Hospital Charge Code	270672929
Hospital Revenue Code	278
Min. Negotiated Rate	$577.50
Max. Negotiated Rate	$931.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$931.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$577.50

PATELLA TRIATHLON X 3

Facility

$2,708.80

Service Code	HCPCS C1776
Hospital Charge Code	270691407
Hospital Revenue Code	278
Min. Negotiated Rate	$65.28
Max. Negotiated Rate	$1,354.40
Rate for Payer: Aetna Commercial	$1,029.34
Rate for Payer: Aetna Medicare Advantage	$812.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$690.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$690.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$541.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$690.74
Rate for Payer: Cigna Commercial	$1,354.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$655.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$595.94
Rate for Payer: Qualcare PPO/HMO/WC	$406.32
Rate for Payer: UnitedHealthcare Community & State	$65.28
Rate for Payer: Wellpoint Medicaid Managed Care	$71.78

PATELLA TRIATHLON X 3

Facility

$2,708.80

Service Code	HCPCS C1776
Hospital Charge Code	270691407
Hospital Revenue Code	278
Min. Negotiated Rate	$406.32
Max. Negotiated Rate	$655.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$541.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$655.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$595.94
Rate for Payer: Qualcare PPO/HMO/WC	$406.32

PATELLA TRITHLON X3 S 29MM 8MM

Facility

$2,569.35

Service Code	HCPCS C1776
Hospital Charge Code	270682132
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 TRITHLON X3 S 29MM 8MM

Facility

$2,569.35

Service Code	HCPCS C1776
Hospital Charge Code	270682132
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 VANGRD STD 28MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692926
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 VANGRD STD 28MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692926
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 X3

Facility

$5,609.50

Service Code	HCPCS C1776
Hospital Charge Code	270677998
Hospital Revenue Code	278
Min. Negotiated Rate	$841.42
Max. Negotiated Rate	$1,357.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,121.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,357.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,234.09
Rate for Payer: Qualcare PPO/HMO/WC	$841.42

PATELLA X3

Facility

$5,609.50

Service Code	HCPCS C1776
Hospital Charge Code	270677998
Hospital Revenue Code	278
Min. Negotiated Rate	$135.19
Max. Negotiated Rate	$2,804.75
Rate for Payer: Aetna Commercial	$2,131.61
Rate for Payer: Aetna Medicare Advantage	$1,682.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,430.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,430.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,121.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,430.42
Rate for Payer: Cigna Commercial	$2,804.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,357.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,234.09
Rate for Payer: Qualcare PPO/HMO/WC	$841.42
Rate for Payer: UnitedHealthcare Community & State	$135.19
Rate for Payer: Wellpoint Medicaid Managed Care	$148.65

PATELLA X3 TRIATHLON 11X40

Facility

$2,473.40

Service Code	HCPCS C1776
Hospital Charge Code	270691995
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 X3 TRIATHLON 11X40

Facility

$2,473.40

Service Code	HCPCS C1776
Hospital Charge Code	270691995
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 X3 TRIATHLON A20 11MM

Facility

$9,635.00

Service Code	HCPCS C1776
Hospital Charge Code	270691992
Hospital Revenue Code	278
Min. Negotiated Rate	$1,445.25
Max. Negotiated Rate	$2,331.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,927.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,331.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,119.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,445.25

PATELLA X3 TRIATHLON A20 11MM

Facility

$9,635.00

Service Code	HCPCS C1776
Hospital Charge Code	270691992
Hospital Revenue Code	278
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$4,817.50
Rate for Payer: Aetna Commercial	$3,661.30
Rate for Payer: Aetna Medicare Advantage	$2,890.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,456.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,456.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,927.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,456.93
Rate for Payer: Cigna Commercial	$4,817.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,331.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,119.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,445.25
Rate for Payer: UnitedHealthcare Community & State	$232.20
Rate for Payer: Wellpoint Medicaid Managed Care	$255.33

PATELLA ZIM POLY 29MM 59726529

Facility

$3,242.90

Hospital Charge Code	270607658
Hospital Revenue Code	278
Min. Negotiated Rate	$486.44
Max. Negotiated Rate	$784.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$648.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$784.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$713.44
Rate for Payer: Qualcare PPO/HMO/WC	$486.44

PATELLA ZIM POLY 29MM 59726529

Facility

$3,242.90

Hospital Charge Code	270607658
Hospital Revenue Code	278
Min. Negotiated Rate	$78.15
Max. Negotiated Rate	$1,621.45
Rate for Payer: Aetna Commercial	$1,232.30
Rate for Payer: Aetna Medicare Advantage	$972.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$826.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$826.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$648.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$826.94
Rate for Payer: Cigna Commercial	$1,621.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$784.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$713.44
Rate for Payer: Qualcare PPO/HMO/WC	$486.44
Rate for Payer: UnitedHealthcare Community & State	$78.15
Rate for Payer: Wellpoint Medicaid Managed Care	$85.94

PATELLA ZIM POLY 32MM 59726532

Facility

$2,998.20

Hospital Charge Code	270607475
Hospital Revenue Code	278
Min. Negotiated Rate	$72.26
Max. Negotiated Rate	$1,499.10
Rate for Payer: Aetna Commercial	$1,139.32
Rate for Payer: Aetna Medicare Advantage	$899.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$599.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.54
Rate for Payer: Cigna Commercial	$1,499.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$725.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$659.60
Rate for Payer: Qualcare PPO/HMO/WC	$449.73
Rate for Payer: UnitedHealthcare Community & State	$72.26
Rate for Payer: Wellpoint Medicaid Managed Care	$79.45

PATELLA ZIM POLY 32MM 59726532

Facility

$2,998.20

Hospital Charge Code	270607475
Hospital Revenue Code	278
Min. Negotiated Rate	$449.73
Max. Negotiated Rate	$725.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$599.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$725.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$659.60
Rate for Payer: Qualcare PPO/HMO/WC	$449.73

PATELLA ZIM POLY 35MM 59726535

Facility

$3,242.45

Service Code	HCPCS C1776
Hospital Charge Code	270606757
Hospital Revenue Code	278
Min. Negotiated Rate	$78.14
Max. Negotiated Rate	$1,621.22
Rate for Payer: Aetna Commercial	$1,232.13
Rate for Payer: Aetna Medicare Advantage	$972.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$826.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$826.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$648.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$826.82
Rate for Payer: Cigna Commercial	$1,621.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$784.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$713.34
Rate for Payer: Qualcare PPO/HMO/WC	$486.37
Rate for Payer: UnitedHealthcare Community & State	$78.14
Rate for Payer: Wellpoint Medicaid Managed Care	$85.92

PATELLA ZIM POLY 35MM 59726535

Facility

$3,242.45

Service Code	HCPCS C1776
Hospital Charge Code	270606757
Hospital Revenue Code	278
Min. Negotiated Rate	$486.37
Max. Negotiated Rate	$784.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$648.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$784.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$713.34
Rate for Payer: Qualcare PPO/HMO/WC	$486.37

PATELLA ZIM POLY 38MM 59726538

Facility

$3,432.85

Hospital Charge Code	270606474
Hospital Revenue Code	278
Min. Negotiated Rate	$82.73
Max. Negotiated Rate	$1,716.42
Rate for Payer: Aetna Commercial	$1,304.48
Rate for Payer: Aetna Medicare Advantage	$1,029.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$875.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$875.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$686.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$875.38
Rate for Payer: Cigna Commercial	$1,716.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$830.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$755.23
Rate for Payer: Qualcare PPO/HMO/WC	$514.93
Rate for Payer: UnitedHealthcare Community & State	$82.73
Rate for Payer: Wellpoint Medicaid Managed Care	$90.97

PATELLA ZIM POLY 38MM 59726538

Facility

$3,432.85

Hospital Charge Code	270606474
Hospital Revenue Code	278
Min. Negotiated Rate	$514.93
Max. Negotiated Rate	$830.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$686.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$830.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$755.23
Rate for Payer: Qualcare PPO/HMO/WC	$514.93

PATELLOFEMORAL COMPON SZ4 LEFT

Facility

$12,580.00

Service Code	HCPCS C1776
Hospital Charge Code	270668855
Hospital Revenue Code	278
Min. Negotiated Rate	$303.18
Max. Negotiated Rate	$6,290.00
Rate for Payer: Aetna Commercial	$4,780.40
Rate for Payer: Aetna Medicare Advantage	$3,774.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,207.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,207.90
Rate for Payer: Cigna Commercial	$6,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,767.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00
Rate for Payer: UnitedHealthcare Community & State	$303.18
Rate for Payer: Wellpoint Medicaid Managed Care	$333.37

PATELLOFEMORAL COMPON SZ4 LEFT

Facility

$12,580.00

Service Code	HCPCS C1776
Hospital Charge Code	270668855
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$3,044.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,516.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,044.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,767.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,887.00

Know your out-of-pocket cost for care.

All Charges