Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BASEPLATE GLENOID RSS

Facility

$12,057.50

Service Code	HCPCS C1713
Hospital Charge Code	270689178
Hospital Revenue Code	278
Min. Negotiated Rate	$290.59
Max. Negotiated Rate	$6,028.75
Rate for Payer: Aetna Commercial	$4,581.85
Rate for Payer: Aetna Medicare Advantage	$3,617.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,074.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,411.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,074.66
Rate for Payer: Cigna Commercial	$6,028.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,917.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,652.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,808.62
Rate for Payer: UnitedHealthcare Community & State	$290.59
Rate for Payer: Wellpoint Medicaid Managed Care	$319.52

BASEPLATE GLENOID RVRS 10X28MM

Facility

$23,385.00

Service Code	HCPCS C1713
Hospital Charge Code	270700596
Hospital Revenue Code	278
Min. Negotiated Rate	$3,507.75
Max. Negotiated Rate	$5,659.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,677.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,659.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,144.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,507.75

BASEPLATE GLENOID RVRS 10X28MM

Facility

$23,385.00

Service Code	HCPCS C1713
Hospital Charge Code	270700596
Hospital Revenue Code	278
Min. Negotiated Rate	$563.58
Max. Negotiated Rate	$11,692.50
Rate for Payer: Aetna Commercial	$8,886.30
Rate for Payer: Aetna Medicare Advantage	$7,015.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,963.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,963.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,677.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,963.18
Rate for Payer: Cigna Commercial	$11,692.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,659.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,144.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,507.75
Rate for Payer: UnitedHealthcare Community & State	$563.58
Rate for Payer: Wellpoint Medicaid Managed Care	$619.70

BASEPLATE GLENOID S

Facility

$8,575.00

Hospital Charge Code	270672413
Hospital Revenue Code	278
Min. Negotiated Rate	$1,286.25
Max. Negotiated Rate	$2,075.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,886.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25

BASEPLATE GLENOID S

Facility

$8,575.00

Hospital Charge Code	270672413
Hospital Revenue Code	278
Min. Negotiated Rate	$206.66
Max. Negotiated Rate	$4,287.50
Rate for Payer: Aetna Commercial	$3,258.50
Rate for Payer: Aetna Medicare Advantage	$2,572.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,186.62
Rate for Payer: Cigna Commercial	$4,287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,886.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25
Rate for Payer: UnitedHealthcare Community & State	$206.66
Rate for Payer: Wellpoint Medicaid Managed Care	$227.24

BASEPLATE GLENOID THR 24.5X30

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696980
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

BASEPLATE GLENOID THR 24.5X30

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696980
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

BASEPLATE GLENOID THRD 027X30

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699524
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

BASEPLATE GLENOID THRD 027X30

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699524
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

BASEPLATE GLEN REVII 25X15MM4H

Facility

$8,645.00

Service Code	HCPCS C1776
Hospital Charge Code	270657914
Hospital Revenue Code	278
Min. Negotiated Rate	$208.34
Max. Negotiated Rate	$4,322.50
Rate for Payer: Aetna Commercial	$3,285.10
Rate for Payer: Aetna Medicare Advantage	$2,593.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,204.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,204.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,729.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,204.47
Rate for Payer: Cigna Commercial	$4,322.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,092.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,901.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,296.75
Rate for Payer: UnitedHealthcare Community & State	$208.34
Rate for Payer: Wellpoint Medicaid Managed Care	$229.09

BASEPLATE GLEN REVII 25X15MM4H

Facility

$8,645.00

Service Code	HCPCS C1776
Hospital Charge Code	270657914
Hospital Revenue Code	278
Min. Negotiated Rate	$1,296.75
Max. Negotiated Rate	$2,092.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,729.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,092.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,901.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,296.75

BASEPLATE KNEE SZ 2

Facility

$6,303.45

Service Code	HCPCS C1776
Hospital Charge Code	270691993
Hospital Revenue Code	278
Min. Negotiated Rate	$151.91
Max. Negotiated Rate	$3,151.72
Rate for Payer: Aetna Commercial	$2,395.31
Rate for Payer: Aetna Medicare Advantage	$1,891.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,607.38
Rate for Payer: Cigna Commercial	$3,151.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,525.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,386.76
Rate for Payer: Qualcare PPO/HMO/WC	$945.52
Rate for Payer: UnitedHealthcare Community & State	$151.91
Rate for Payer: Wellpoint Medicaid Managed Care	$167.04

BASEPLATE KNEE SZ 2

Facility

$6,303.45

Service Code	HCPCS C1776
Hospital Charge Code	270691993
Hospital Revenue Code	278
Min. Negotiated Rate	$945.52
Max. Negotiated Rate	$1,525.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,525.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,386.76
Rate for Payer: Qualcare PPO/HMO/WC	$945.52

BASEPLATE MINI W ADP 25MM

Facility

$11,585.00

Hospital Charge Code	270668582
Hospital Revenue Code	278
Min. Negotiated Rate	$279.20
Max. Negotiated Rate	$5,792.50
Rate for Payer: Aetna Commercial	$4,402.30
Rate for Payer: Aetna Medicare Advantage	$3,475.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,954.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,954.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,317.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,954.18
Rate for Payer: Cigna Commercial	$5,792.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,803.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,548.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,737.75
Rate for Payer: UnitedHealthcare Community & State	$279.20
Rate for Payer: Wellpoint Medicaid Managed Care	$307.00

BASEPLATE MINI W ADP 25MM

Facility

$11,585.00

Hospital Charge Code	270668582
Hospital Revenue Code	278
Min. Negotiated Rate	$1,737.75
Max. Negotiated Rate	$2,803.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,317.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,803.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,548.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,737.75

BASEPLATE REVERSE COMP 25MM

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270669244
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

BASEPLATE REVERSE COMP 25MM

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270669244
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

BASEPLATE RSA GLENOID SZ 28MM

Facility

$7,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270671578
Hospital Revenue Code	278
Min. Negotiated Rate	$1,072.50
Max. Negotiated Rate	$1,730.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,730.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,072.50

BASEPLATE RSA GLENOID SZ 28MM

Facility

$7,150.00

Service Code	HCPCS C1776
Hospital Charge Code	270671578
Hospital Revenue Code	278
Min. Negotiated Rate	$172.31
Max. Negotiated Rate	$3,575.00
Rate for Payer: Aetna Commercial	$2,717.00
Rate for Payer: Aetna Medicare Advantage	$2,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,823.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,823.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,430.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,823.25
Rate for Payer: Cigna Commercial	$3,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,730.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,072.50
Rate for Payer: UnitedHealthcare Community & State	$172.31
Rate for Payer: Wellpoint Medicaid Managed Care	$189.47

BASEPLATE SZ 3 UNIVERIAL

Facility

$6,243.95

Service Code	HCPCS C1776
Hospital Charge Code	270691043
Hospital Revenue Code	278
Min. Negotiated Rate	$150.48
Max. Negotiated Rate	$3,121.97
Rate for Payer: Aetna Commercial	$2,372.70
Rate for Payer: Aetna Medicare Advantage	$1,873.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,592.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,592.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,248.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,592.21
Rate for Payer: Cigna Commercial	$3,121.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,511.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,373.67
Rate for Payer: Qualcare PPO/HMO/WC	$936.59
Rate for Payer: UnitedHealthcare Community & State	$150.48
Rate for Payer: Wellpoint Medicaid Managed Care	$165.46

BASEPLATE SZ 3 UNIVERIAL

Facility

$6,243.95

Service Code	HCPCS C1776
Hospital Charge Code	270691043
Hospital Revenue Code	278
Min. Negotiated Rate	$936.59
Max. Negotiated Rate	$1,511.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,248.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,511.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,373.67
Rate for Payer: Qualcare PPO/HMO/WC	$936.59

BASEPLATE THREADED 24.5X25

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691235
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

BASEPLATE THREADED 24.5X25

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691235
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

BASEPLATE TIBIA EVOL15MMSZ5SZ6

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697691
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

BASEPLATE TIBIA EVOL15MMSZ5SZ6

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697691
Hospital Revenue Code	278
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

Know your out-of-pocket cost for care.

All Charges