Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 7

Facility

$6,445.00

Hospital Charge Code	270668771
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 7

Facility

$6,445.00

Hospital Charge Code	270668771
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 8

Facility

$6,445.00

Hospital Charge Code	270668772
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 8

Facility

$6,445.00

Hospital Charge Code	270668772
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 N/POROUS SZ 1

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672553
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 N/POROUS SZ 1

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672553
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 N/POROUS SZ 2

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672554
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 N/POROUS SZ 2

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672554
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 N/POROUS SZ 3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672555
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 N/POROUS SZ 3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672555
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 N/POROUS SZ 4

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672556
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 N/POROUS SZ 4

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672556
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 N/POROUS SZ 5

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672557
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 N/POROUS SZ 5

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672557
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 N/POROUS SZ 6

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672558
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 N/POROUS SZ 6

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672558
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 PSA #5

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270676879
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

BASEPLATE TIBIAL PSA #5

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270676879
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

BASEPLATE TIBIAL RM/LL SZ 1

Facility

$6,445.00

Hospital Charge Code	270668773
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 RM/LL SZ 1

Facility

$6,445.00

Hospital Charge Code	270668773
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 RM/LL SZ 2

Facility

$6,445.00

Hospital Charge Code	270668774
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 RM/LL SZ 2

Facility

$6,445.00

Hospital Charge Code	270668774
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 RM/LL SZ 3

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668775
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 RM/LL SZ 3

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668775
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

Know your out-of-pocket cost for care.

All Charges