Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE TIBIA 4 HOLE 3.5MM RIGHT

Facility

$6,440.00

Hospital Charge Code	270637379
Hospital Revenue Code	278
Min. Negotiated Rate	$155.20
Max. Negotiated Rate	$3,220.00
Rate for Payer: Aetna Commercial	$2,447.20
Rate for Payer: Aetna Medicare Advantage	$1,932.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,642.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,642.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,288.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,642.20
Rate for Payer: Cigna Commercial	$3,220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,558.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,416.80
Rate for Payer: Qualcare PPO/HMO/WC	$966.00
Rate for Payer: UnitedHealthcare Community & State	$155.20
Rate for Payer: Wellpoint Medicaid Managed Care	$170.66

PLATE TIBIA 6HOLE 123MM LEFT

Facility

$9,671.00

Service Code	HCPCS C1713
Hospital Charge Code	270675653
Hospital Revenue Code	278
Min. Negotiated Rate	$233.07
Max. Negotiated Rate	$4,835.50
Rate for Payer: Aetna Commercial	$3,674.98
Rate for Payer: Aetna Medicare Advantage	$2,901.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,466.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,466.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,934.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,466.11
Rate for Payer: Cigna Commercial	$4,835.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,340.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,127.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,450.65
Rate for Payer: UnitedHealthcare Community & State	$233.07
Rate for Payer: Wellpoint Medicaid Managed Care	$256.28

PLATE TIBIA 6HOLE 123MM LEFT

Facility

$9,671.00

Service Code	HCPCS C1713
Hospital Charge Code	270675653
Hospital Revenue Code	278
Min. Negotiated Rate	$1,450.65
Max. Negotiated Rate	$2,340.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,934.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,340.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,127.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,450.65

PLATE TIBIA 8-H 3.5 RT 239908

Facility

$6,066.15

Hospital Charge Code	270634849
Hospital Revenue Code	278
Min. Negotiated Rate	$146.19
Max. Negotiated Rate	$3,033.07
Rate for Payer: Aetna Commercial	$2,305.14
Rate for Payer: Aetna Medicare Advantage	$1,819.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,546.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,546.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,213.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,546.87
Rate for Payer: Cigna Commercial	$3,033.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,468.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,334.55
Rate for Payer: Qualcare PPO/HMO/WC	$909.92
Rate for Payer: UnitedHealthcare Community & State	$146.19
Rate for Payer: Wellpoint Medicaid Managed Care	$160.75

PLATE TIBIA 8-H 3.5 RT 239908

Facility

$6,066.15

Hospital Charge Code	270634849
Hospital Revenue Code	278
Min. Negotiated Rate	$909.92
Max. Negotiated Rate	$1,468.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,213.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,468.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,334.55
Rate for Payer: Qualcare PPO/HMO/WC	$909.92

PLATE TIBIA 8HOL 3.5 LT 239909

Facility

$5,624.70

Hospital Charge Code	270633831
Hospital Revenue Code	278
Min. Negotiated Rate	$843.71
Max. Negotiated Rate	$1,361.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,124.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.43
Rate for Payer: Qualcare PPO/HMO/WC	$843.71

PLATE TIBIA 8HOL 3.5 LT 239909

Facility

$5,624.70

Hospital Charge Code	270633831
Hospital Revenue Code	278
Min. Negotiated Rate	$135.56
Max. Negotiated Rate	$2,812.35
Rate for Payer: Aetna Commercial	$2,137.39
Rate for Payer: Aetna Medicare Advantage	$1,687.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,124.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.30
Rate for Payer: Cigna Commercial	$2,812.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.43
Rate for Payer: Qualcare PPO/HMO/WC	$843.71
Rate for Payer: UnitedHealthcare Community & State	$135.56
Rate for Payer: Wellpoint Medicaid Managed Care	$149.05

PLATE TIBIAL 3.5LCP 10HOLES

Facility

$6,448.85

Service Code	HCPCS C1713
Hospital Charge Code	270645819
Hospital Revenue Code	278
Min. Negotiated Rate	$967.33
Max. Negotiated Rate	$1,560.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,418.75
Rate for Payer: Qualcare PPO/HMO/WC	$967.33

PLATE TIBIAL 3.5LCP 10HOLES

Facility

$6,448.85

Service Code	HCPCS C1713
Hospital Charge Code	270645819
Hospital Revenue Code	278
Min. Negotiated Rate	$155.42
Max. Negotiated Rate	$3,224.43
Rate for Payer: Aetna Commercial	$2,450.56
Rate for Payer: Aetna Medicare Advantage	$1,934.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,644.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,644.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,644.46
Rate for Payer: Cigna Commercial	$3,224.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,418.75
Rate for Payer: Qualcare PPO/HMO/WC	$967.33
Rate for Payer: UnitedHealthcare Community & State	$155.42
Rate for Payer: Wellpoint Medicaid Managed Care	$170.89

PLATE TIBIAL 5-HOLE STD LEFT

Facility

$8,100.00

Hospital Charge Code	270648240
Hospital Revenue Code	278
Min. Negotiated Rate	$195.21
Max. Negotiated Rate	$4,050.00
Rate for Payer: Aetna Commercial	$3,078.00
Rate for Payer: Aetna Medicare Advantage	$2,430.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,065.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,065.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,065.50
Rate for Payer: Cigna Commercial	$4,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,960.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,782.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,215.00
Rate for Payer: UnitedHealthcare Community & State	$195.21
Rate for Payer: Wellpoint Medicaid Managed Care	$214.65

PLATE TIBIAL 5-HOLE STD LEFT

Facility

$8,100.00

Hospital Charge Code	270648240
Hospital Revenue Code	278
Min. Negotiated Rate	$1,215.00
Max. Negotiated Rate	$1,960.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,620.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,960.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,782.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,215.00

PLATE TIBIAL 67 OSS 150420

Facility

$12,480.00

Service Code	HCPCS C1713
Hospital Charge Code	270638563
Hospital Revenue Code	278
Min. Negotiated Rate	$1,872.00
Max. Negotiated Rate	$3,020.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,496.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,020.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,745.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,872.00

PLATE TIBIAL 67 OSS 150420

Facility

$12,480.00

Service Code	HCPCS C1713
Hospital Charge Code	270638563
Hospital Revenue Code	278
Min. Negotiated Rate	$300.77
Max. Negotiated Rate	$6,240.00
Rate for Payer: Aetna Commercial	$4,742.40
Rate for Payer: Aetna Medicare Advantage	$3,744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,182.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,182.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,496.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,182.40
Rate for Payer: Cigna Commercial	$6,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,020.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,745.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,872.00
Rate for Payer: UnitedHealthcare Community & State	$300.77
Rate for Payer: Wellpoint Medicaid Managed Care	$330.72

PLATE TIBIAL 6-HOLE/118mm RT

Facility

$5,485.85

Hospital Charge Code	270636087
Hospital Revenue Code	278
Min. Negotiated Rate	$132.21
Max. Negotiated Rate	$2,742.93
Rate for Payer: Aetna Commercial	$2,084.62
Rate for Payer: Aetna Medicare Advantage	$1,645.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,398.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,398.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,097.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,398.89
Rate for Payer: Cigna Commercial	$2,742.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,327.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,206.89
Rate for Payer: Qualcare PPO/HMO/WC	$822.88
Rate for Payer: UnitedHealthcare Community & State	$132.21
Rate for Payer: Wellpoint Medicaid Managed Care	$145.38

PLATE TIBIAL 6-HOLE/118mm RT

Facility

$5,485.85

Hospital Charge Code	270636087
Hospital Revenue Code	278
Min. Negotiated Rate	$822.88
Max. Negotiated Rate	$1,327.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,097.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,327.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,206.89
Rate for Payer: Qualcare PPO/HMO/WC	$822.88

PLATE TIBIAL 6HOLE 130mm LEFT

Facility

$5,020.00

Hospital Charge Code	270643715
Hospital Revenue Code	278
Min. Negotiated Rate	$753.00
Max. Negotiated Rate	$1,214.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,004.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,214.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,104.40
Rate for Payer: Qualcare PPO/HMO/WC	$753.00

PLATE TIBIAL 6HOLE 130mm LEFT

Facility

$5,020.00

Hospital Charge Code	270643715
Hospital Revenue Code	278
Min. Negotiated Rate	$120.98
Max. Negotiated Rate	$2,510.00
Rate for Payer: Aetna Commercial	$1,907.60
Rate for Payer: Aetna Medicare Advantage	$1,506.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,280.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,280.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,004.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,280.10
Rate for Payer: Cigna Commercial	$2,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,214.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,104.40
Rate for Payer: Qualcare PPO/HMO/WC	$753.00
Rate for Payer: UnitedHealthcare Community & State	$120.98
Rate for Payer: Wellpoint Medicaid Managed Care	$133.03

PLATE TIBIAL 75mm CRU T 141234

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270636752
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

PLATE TIBIAL 75mm CRU T 141234

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270636752
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PLATE TIBIAL 83mm 141226

Facility

$7,890.00

Hospital Charge Code	270637544
Hospital Revenue Code	278
Min. Negotiated Rate	$1,183.50
Max. Negotiated Rate	$1,909.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,578.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,909.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,735.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,183.50

PLATE TIBIAL 83mm 141226

Facility

$7,890.00

Hospital Charge Code	270637544
Hospital Revenue Code	278
Min. Negotiated Rate	$190.15
Max. Negotiated Rate	$3,945.00
Rate for Payer: Aetna Commercial	$2,998.20
Rate for Payer: Aetna Medicare Advantage	$2,367.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,011.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,011.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,578.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,011.95
Rate for Payer: Cigna Commercial	$3,945.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,909.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,735.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,183.50
Rate for Payer: UnitedHealthcare Community & State	$190.15
Rate for Payer: Wellpoint Medicaid Managed Care	$209.09

PLATE TIBIAL 8-HOLE 4.5 240041

Facility

$4,682.25

Hospital Charge Code	270632183
Hospital Revenue Code	278
Min. Negotiated Rate	$702.34
Max. Negotiated Rate	$1,133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$936.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,030.10
Rate for Payer: Qualcare PPO/HMO/WC	$702.34

PLATE TIBIAL 8-HOLE 4.5 240041

Facility

$4,682.25

Hospital Charge Code	270632183
Hospital Revenue Code	278
Min. Negotiated Rate	$112.84
Max. Negotiated Rate	$2,341.12
Rate for Payer: Aetna Commercial	$1,779.26
Rate for Payer: Aetna Medicare Advantage	$1,404.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,193.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,193.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$936.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,193.97
Rate for Payer: Cigna Commercial	$2,341.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,030.10
Rate for Payer: Qualcare PPO/HMO/WC	$702.34
Rate for Payer: UnitedHealthcare Community & State	$112.84
Rate for Payer: Wellpoint Medicaid Managed Care	$124.08

PLATE TIBIAL BEARING 12x71/75

Facility

$5,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270638582
Hospital Revenue Code	278
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$2,567.50
Rate for Payer: Aetna Commercial	$1,951.30
Rate for Payer: Aetna Medicare Advantage	$1,540.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,309.42
Rate for Payer: Cigna Commercial	$2,567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,129.70
Rate for Payer: Qualcare PPO/HMO/WC	$770.25
Rate for Payer: UnitedHealthcare Community & State	$123.75
Rate for Payer: Wellpoint Medicaid Managed Care	$136.08

PLATE TIBIAL BEARING 12x71/75

Facility

$5,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270638582
Hospital Revenue Code	278
Min. Negotiated Rate	$770.25
Max. Negotiated Rate	$1,242.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,129.70
Rate for Payer: Qualcare PPO/HMO/WC	$770.25

Know your out-of-pocket cost for care.

All Charges