Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BASE PLATE TIBIAL

Facility

$4,470.00

Service Code	HCPCS C1776
Hospital Charge Code	270692081
Hospital Revenue Code	278
Min. Negotiated Rate	$670.50
Max. Negotiated Rate	$1,081.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$894.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,081.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$983.40
Rate for Payer: Qualcare PPO/HMO/WC	$670.50

BASE PLATE TIBIAL

Facility

$4,470.00

Service Code	HCPCS C1776
Hospital Charge Code	270692081
Hospital Revenue Code	278
Min. Negotiated Rate	$107.73
Max. Negotiated Rate	$2,235.00
Rate for Payer: Aetna Commercial	$1,698.60
Rate for Payer: Aetna Medicare Advantage	$1,341.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,139.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,139.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$894.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,139.85
Rate for Payer: Cigna Commercial	$2,235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,081.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$983.40
Rate for Payer: Qualcare PPO/HMO/WC	$670.50
Rate for Payer: UnitedHealthcare Community & State	$107.73
Rate for Payer: Wellpoint Medicaid Managed Care	$118.45

BASEPLATE TIBIAL 63MM LNG

Facility

$18,655.00

Service Code	HCPCS C1776
Hospital Charge Code	270673720
Hospital Revenue Code	278
Min. Negotiated Rate	$2,798.25
Max. Negotiated Rate	$4,514.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,731.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,514.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,104.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,798.25

BASEPLATE TIBIAL 63MM LNG

Facility

$18,655.00

Service Code	HCPCS C1776
Hospital Charge Code	270673720
Hospital Revenue Code	278
Min. Negotiated Rate	$449.59
Max. Negotiated Rate	$9,327.50
Rate for Payer: Aetna Commercial	$7,088.90
Rate for Payer: Aetna Medicare Advantage	$5,596.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,757.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,757.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,731.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,757.02
Rate for Payer: Cigna Commercial	$9,327.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,514.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,104.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,798.25
Rate for Payer: UnitedHealthcare Community & State	$449.59
Rate for Payer: Wellpoint Medicaid Managed Care	$494.36

BASEPLATE TIBIAL CMA #1

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679702
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 TIBIAL CMA #1

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679702
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

BASEPLATE TIBIAL CMA #2

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676753
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 TIBIAL CMA #2

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676753
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

BASEPLATE TIBIAL CMA #3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676624
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

BASEPLATE TIBIAL CMA #3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676624
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 TIBIAL CMA #4

Facility

$4,500.00

Hospital Charge Code	270676674
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

BASEPLATE TIBIAL CMA #4

Facility

$4,500.00

Hospital Charge Code	270676674
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 TIBIAL CMA #6

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676726
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

BASEPLATE TIBIAL CMA #6

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676726
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 TIBIAL LM/RL SZ 1

Facility

$6,445.00

Hospital Charge Code	270668767
Hospital Revenue Code	278
Min. Negotiated Rate	$966.75
Max. Negotiated Rate	$1,559.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,417.90
Rate for Payer: Qualcare PPO/HMO/WC	$966.75

BASEPLATE TIBIAL LM/RL SZ 1

Facility

$6,445.00

Hospital Charge Code	270668767
Hospital Revenue Code	278
Min. Negotiated Rate	$155.32
Max. Negotiated Rate	$3,222.50
Rate for Payer: Aetna Commercial	$2,449.10
Rate for Payer: Aetna Medicare Advantage	$1,933.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,643.47
Rate for Payer: Cigna Commercial	$3,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,417.90
Rate for Payer: Qualcare PPO/HMO/WC	$966.75
Rate for Payer: UnitedHealthcare Community & State	$155.32
Rate for Payer: Wellpoint Medicaid Managed Care	$170.79

BASEPLATE TIBIAL LM/RL SZ 2

Facility

$6,445.00

Hospital Charge Code	270668727
Hospital Revenue Code	278
Min. Negotiated Rate	$155.32
Max. Negotiated Rate	$3,222.50
Rate for Payer: Aetna Commercial	$2,449.10
Rate for Payer: Aetna Medicare Advantage	$1,933.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,643.47
Rate for Payer: Cigna Commercial	$3,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,417.90
Rate for Payer: Qualcare PPO/HMO/WC	$966.75
Rate for Payer: UnitedHealthcare Community & State	$155.32
Rate for Payer: Wellpoint Medicaid Managed Care	$170.79

BASEPLATE TIBIAL LM/RL SZ 2

Facility

$6,445.00

Hospital Charge Code	270668727
Hospital Revenue Code	278
Min. Negotiated Rate	$966.75
Max. Negotiated Rate	$1,559.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,417.90
Rate for Payer: Qualcare PPO/HMO/WC	$966.75

BASEPLATE TIBIAL LM/RL SZ 3

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668768
Hospital Revenue Code	278
Min. Negotiated Rate	$155.32
Max. Negotiated Rate	$3,222.50
Rate for Payer: Aetna Commercial	$2,449.10
Rate for Payer: Aetna Medicare Advantage	$1,933.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,643.47
Rate for Payer: Cigna Commercial	$3,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,417.90
Rate for Payer: Qualcare PPO/HMO/WC	$966.75
Rate for Payer: UnitedHealthcare Community & State	$155.32
Rate for Payer: Wellpoint Medicaid Managed Care	$170.79

BASEPLATE TIBIAL LM/RL SZ 3

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668768
Hospital Revenue Code	278
Min. Negotiated Rate	$966.75
Max. Negotiated Rate	$1,559.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,417.90
Rate for Payer: Qualcare PPO/HMO/WC	$966.75

BASEPLATE TIBIAL LM/RL SZ 4

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668488
Hospital Revenue Code	278
Min. Negotiated Rate	$966.75
Max. Negotiated Rate	$1,559.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,417.90
Rate for Payer: Qualcare PPO/HMO/WC	$966.75

BASEPLATE TIBIAL LM/RL SZ 4

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668488
Hospital Revenue Code	278
Min. Negotiated Rate	$155.32
Max. Negotiated Rate	$3,222.50
Rate for Payer: Aetna Commercial	$2,449.10
Rate for Payer: Aetna Medicare Advantage	$1,933.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,643.47
Rate for Payer: Cigna Commercial	$3,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,417.90
Rate for Payer: Qualcare PPO/HMO/WC	$966.75
Rate for Payer: UnitedHealthcare Community & State	$155.32
Rate for Payer: Wellpoint Medicaid Managed Care	$170.79

BASEPLATE TIBIAL LM/RL SZ 5

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668769
Hospital Revenue Code	278
Min. Negotiated Rate	$966.75
Max. Negotiated Rate	$1,559.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,417.90
Rate for Payer: Qualcare PPO/HMO/WC	$966.75

BASEPLATE TIBIAL LM/RL SZ 5

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668769
Hospital Revenue Code	278
Min. Negotiated Rate	$155.32
Max. Negotiated Rate	$3,222.50
Rate for Payer: Aetna Commercial	$2,449.10
Rate for Payer: Aetna Medicare Advantage	$1,933.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,643.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,643.47
Rate for Payer: Cigna Commercial	$3,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,417.90
Rate for Payer: Qualcare PPO/HMO/WC	$966.75
Rate for Payer: UnitedHealthcare Community & State	$155.32
Rate for Payer: Wellpoint Medicaid Managed Care	$170.79

BASEPLATE TIBIAL LM/RL SZ 6

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668770
Hospital Revenue Code	278
Min. Negotiated Rate	$966.75
Max. Negotiated Rate	$1,559.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,559.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,417.90
Rate for Payer: Qualcare PPO/HMO/WC	$966.75

Know your out-of-pocket cost for care.

All Charges