Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE TIBIAL CRUCIATE 71mm

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270639680
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 CRUCIATE 71mm

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270639680
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 TIBIA LF 2 HOLE 95MM

Facility

$12,236.15

Service Code	HCPCS C1713
Hospital Charge Code	270699118
Hospital Revenue Code	278
Min. Negotiated Rate	$294.89
Max. Negotiated Rate	$6,118.07
Rate for Payer: Aetna Commercial	$4,649.74
Rate for Payer: Aetna Medicare Advantage	$3,670.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,120.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,120.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,447.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,120.22
Rate for Payer: Cigna Commercial	$6,118.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,961.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,691.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,835.42
Rate for Payer: UnitedHealthcare Community & State	$294.89
Rate for Payer: Wellpoint Medicaid Managed Care	$324.26

PLATE TIBIA LF 2 HOLE 95MM

Facility

$12,236.15

Service Code	HCPCS C1713
Hospital Charge Code	270699118
Hospital Revenue Code	278
Min. Negotiated Rate	$1,835.42
Max. Negotiated Rate	$2,961.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,447.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,961.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,691.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,835.42

PLATE TIBIAL LCP 3.5 8HOLE LT

Facility

$7,464.00

Hospital Charge Code	270671109
Hospital Revenue Code	278
Min. Negotiated Rate	$1,119.60
Max. Negotiated Rate	$1,806.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,492.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,806.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,642.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,119.60

PLATE TIBIAL LCP 3.5 8HOLE LT

Facility

$7,464.00

Hospital Charge Code	270671109
Hospital Revenue Code	278
Min. Negotiated Rate	$179.88
Max. Negotiated Rate	$3,732.00
Rate for Payer: Aetna Commercial	$2,836.32
Rate for Payer: Aetna Medicare Advantage	$2,239.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,903.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,903.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,492.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,903.32
Rate for Payer: Cigna Commercial	$3,732.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,806.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,642.08
Rate for Payer: Qualcare PPO/HMO/WC	$1,119.60
Rate for Payer: UnitedHealthcare Community & State	$179.88
Rate for Payer: Wellpoint Medicaid Managed Care	$197.80

PLATE TIBIAL PROX 6-HOLE

Facility

$10,020.00

Hospital Charge Code	270651345
Hospital Revenue Code	278
Min. Negotiated Rate	$1,503.00
Max. Negotiated Rate	$2,424.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,004.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,424.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,204.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,503.00

PLATE TIBIAL PROX 6-HOLE

Facility

$10,020.00

Hospital Charge Code	270651345
Hospital Revenue Code	278
Min. Negotiated Rate	$241.48
Max. Negotiated Rate	$5,010.00
Rate for Payer: Aetna Commercial	$3,807.60
Rate for Payer: Aetna Medicare Advantage	$3,006.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,555.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,555.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,004.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,555.10
Rate for Payer: Cigna Commercial	$5,010.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,424.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,204.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,503.00
Rate for Payer: UnitedHealthcare Community & State	$241.48
Rate for Payer: Wellpoint Medicaid Managed Care	$265.53

PLATE TIBIAL STEM 71MM 141513

Facility

$13,265.00

Hospital Charge Code	270647562
Hospital Revenue Code	278
Min. Negotiated Rate	$1,989.75
Max. Negotiated Rate	$3,210.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,653.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,210.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,918.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,989.75

PLATE TIBIAL STEM 71MM 141513

Facility

$13,265.00

Hospital Charge Code	270647562
Hospital Revenue Code	278
Min. Negotiated Rate	$319.69
Max. Negotiated Rate	$6,632.50
Rate for Payer: Aetna Commercial	$5,040.70
Rate for Payer: Aetna Medicare Advantage	$3,979.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,382.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,382.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,653.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,382.57
Rate for Payer: Cigna Commercial	$6,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,210.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,918.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,989.75
Rate for Payer: UnitedHealthcare Community & State	$319.69
Rate for Payer: Wellpoint Medicaid Managed Care	$351.52

PLATE TIBIAL STEMMED 67mm

Facility

$15,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270638752
Hospital Revenue Code	278
Min. Negotiated Rate	$371.86
Max. Negotiated Rate	$7,715.00
Rate for Payer: Aetna Commercial	$5,863.40
Rate for Payer: Aetna Medicare Advantage	$4,629.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,934.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,934.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,086.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,934.65
Rate for Payer: Cigna Commercial	$7,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,734.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,394.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,314.50
Rate for Payer: UnitedHealthcare Community & State	$371.86
Rate for Payer: Wellpoint Medicaid Managed Care	$408.89

PLATE TIBIAL STEMMED 67mm

Facility

$15,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270638752
Hospital Revenue Code	278
Min. Negotiated Rate	$2,314.50
Max. Negotiated Rate	$3,734.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,086.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,734.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,394.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,314.50

PLATE TIBIAL STEMMED 83mm

Facility

$15,430.00

Hospital Charge Code	270669904
Hospital Revenue Code	278
Min. Negotiated Rate	$2,314.50
Max. Negotiated Rate	$3,734.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,086.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,734.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,394.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,314.50

PLATE TIBIAL STEMMED 83mm

Facility

$15,430.00

Hospital Charge Code	270669904
Hospital Revenue Code	278
Min. Negotiated Rate	$371.86
Max. Negotiated Rate	$7,715.00
Rate for Payer: Aetna Commercial	$5,863.40
Rate for Payer: Aetna Medicare Advantage	$4,629.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,934.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,934.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,086.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,934.65
Rate for Payer: Cigna Commercial	$7,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,734.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,394.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,314.50
Rate for Payer: UnitedHealthcare Community & State	$371.86
Rate for Payer: Wellpoint Medicaid Managed Care	$408.89

PLATE TIBIAL SZ 8 NEXGEN PRE-

Facility

$6,405.90

Hospital Charge Code	270632060
Hospital Revenue Code	278
Min. Negotiated Rate	$960.88
Max. Negotiated Rate	$1,550.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,281.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,550.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,409.30
Rate for Payer: Qualcare PPO/HMO/WC	$960.88

PLATE TIBIAL SZ 8 NEXGEN PRE-

Facility

$6,405.90

Hospital Charge Code	270632060
Hospital Revenue Code	278
Min. Negotiated Rate	$154.38
Max. Negotiated Rate	$3,202.95
Rate for Payer: Aetna Commercial	$2,434.24
Rate for Payer: Aetna Medicare Advantage	$1,921.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,281.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,633.50
Rate for Payer: Cigna Commercial	$3,202.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,550.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,409.30
Rate for Payer: Qualcare PPO/HMO/WC	$960.88
Rate for Payer: UnitedHealthcare Community & State	$154.38
Rate for Payer: Wellpoint Medicaid Managed Care	$169.76

PLATE TIBIA MED DIST SS LEFT4

Facility

$8,858.00

Service Code	HCPCS C1713
Hospital Charge Code	270704607
Hospital Revenue Code	278
Min. Negotiated Rate	$1,328.70
Max. Negotiated Rate	$2,143.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,771.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,143.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,948.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,328.70

PLATE TIBIA MED DIST SS LEFT4

Facility

$8,858.00

Service Code	HCPCS C1713
Hospital Charge Code	270704607
Hospital Revenue Code	278
Min. Negotiated Rate	$213.48
Max. Negotiated Rate	$4,429.00
Rate for Payer: Aetna Commercial	$3,366.04
Rate for Payer: Aetna Medicare Advantage	$2,657.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,258.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,258.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,771.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,258.79
Rate for Payer: Cigna Commercial	$4,429.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,143.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,948.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,328.70
Rate for Payer: UnitedHealthcare Community & State	$213.48
Rate for Payer: Wellpoint Medicaid Managed Care	$234.74

PLATE TIBIA MED DIST SS LT 6H

Facility

$9,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270699402
Hospital Revenue Code	278
Min. Negotiated Rate	$227.14
Max. Negotiated Rate	$4,712.50
Rate for Payer: Aetna Commercial	$3,581.50
Rate for Payer: Aetna Medicare Advantage	$2,827.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,403.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,403.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,403.38
Rate for Payer: Cigna Commercial	$4,712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,280.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,073.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.75
Rate for Payer: UnitedHealthcare Community & State	$227.14
Rate for Payer: Wellpoint Medicaid Managed Care	$249.76

PLATE TIBIA MED DIST SS LT 6H

Facility

$9,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270699402
Hospital Revenue Code	278
Min. Negotiated Rate	$1,413.75
Max. Negotiated Rate	$2,280.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,280.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,073.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.75

PLATE TIBIA PROX 3.5x119 6H RT

Facility

$6,489.50

Service Code	HCPCS C1713
Hospital Charge Code	270681562
Hospital Revenue Code	278
Min. Negotiated Rate	$156.40
Max. Negotiated Rate	$3,244.75
Rate for Payer: Aetna Commercial	$2,466.01
Rate for Payer: Aetna Medicare Advantage	$1,946.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,654.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,654.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,297.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,654.82
Rate for Payer: Cigna Commercial	$3,244.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,570.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,427.69
Rate for Payer: Qualcare PPO/HMO/WC	$973.42
Rate for Payer: UnitedHealthcare Community & State	$156.40
Rate for Payer: Wellpoint Medicaid Managed Care	$171.97

PLATE TIBIA PROX 3.5x119 6H RT

Facility

$6,489.50

Service Code	HCPCS C1713
Hospital Charge Code	270681562
Hospital Revenue Code	278
Min. Negotiated Rate	$973.42
Max. Negotiated Rate	$1,570.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,297.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,570.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,427.69
Rate for Payer: Qualcare PPO/HMO/WC	$973.42

PLATE TIBIA PROX VA-LCP 3.5MM

Facility

$6,912.85

Service Code	HCPCS C1713
Hospital Charge Code	270681178
Hospital Revenue Code	278
Min. Negotiated Rate	$1,036.93
Max. Negotiated Rate	$1,672.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,382.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,672.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,520.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,036.93

PLATE TIBIA PROX VA-LCP 3.5MM

Facility

$6,912.85

Service Code	HCPCS C1713
Hospital Charge Code	270681178
Hospital Revenue Code	278
Min. Negotiated Rate	$166.60
Max. Negotiated Rate	$3,456.43
Rate for Payer: Aetna Commercial	$2,626.88
Rate for Payer: Aetna Medicare Advantage	$2,073.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,762.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,762.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,382.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,762.78
Rate for Payer: Cigna Commercial	$3,456.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,672.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,520.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,036.93
Rate for Payer: UnitedHealthcare Community & State	$166.60
Rate for Payer: Wellpoint Medicaid Managed Care	$183.19

PLATE TIBIA VA LCP 3.5 X147 MM

Facility

$93.35

Service Code	HCPCS C1713
Hospital Charge Code	270691497
Hospital Revenue Code	278
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$46.67
Rate for Payer: Aetna Commercial	$35.47
Rate for Payer: Aetna Medicare Advantage	$28.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.80
Rate for Payer: Cigna Commercial	$46.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20.54
Rate for Payer: Qualcare PPO/HMO/WC	$14.00
Rate for Payer: UnitedHealthcare Community & State	$2.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.47

Know your out-of-pocket cost for care.

All Charges