Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BASEPLATE TIBIAL RM/LL SZ 4

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668776
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 4

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668776
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 5

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668777
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 5

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668777
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 6

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668778
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 6

Facility

$6,445.00

Service Code	HCPCS C1776
Hospital Charge Code	270668778
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 7

Facility

$6,445.00

Hospital Charge Code	270668779
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 7

Facility

$6,445.00

Hospital Charge Code	270668779
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 8

Facility

$6,445.00

Hospital Charge Code	270668780
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 8

Facility

$6,445.00

Hospital Charge Code	270668780
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 STEMMED SZ

Facility

$7,125.00

Hospital Charge Code	270667532
Hospital Revenue Code	278
Min. Negotiated Rate	$171.71
Max. Negotiated Rate	$3,562.50
Rate for Payer: Aetna Commercial	$2,707.50
Rate for Payer: Aetna Medicare Advantage	$2,137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,816.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,816.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,816.88
Rate for Payer: Cigna Commercial	$3,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,567.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,068.75
Rate for Payer: UnitedHealthcare Community & State	$171.71
Rate for Payer: Wellpoint Medicaid Managed Care	$188.81

BASEPLATE TIBIAL STEMMED SZ

Facility

$7,125.00

Hospital Charge Code	270667532
Hospital Revenue Code	278
Min. Negotiated Rate	$1,068.75
Max. Negotiated Rate	$1,724.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,567.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,068.75

BASEPLATE TIBIAL STEMMED SZ 2

Facility

$7,125.00

Hospital Charge Code	270671019
Hospital Revenue Code	278
Min. Negotiated Rate	$1,068.75
Max. Negotiated Rate	$1,724.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,567.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,068.75

BASEPLATE TIBIAL STEMMED SZ 2

Facility

$7,125.00

Hospital Charge Code	270671019
Hospital Revenue Code	278
Min. Negotiated Rate	$171.71
Max. Negotiated Rate	$3,562.50
Rate for Payer: Aetna Commercial	$2,707.50
Rate for Payer: Aetna Medicare Advantage	$2,137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,816.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,816.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,816.88
Rate for Payer: Cigna Commercial	$3,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,724.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,567.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,068.75
Rate for Payer: UnitedHealthcare Community & State	$171.71
Rate for Payer: Wellpoint Medicaid Managed Care	$188.81

BASEPLATE TIBIAL SZ 2

Facility

$4,446.55

Service Code	HCPCS C1776
Hospital Charge Code	270682131
Hospital Revenue Code	278
Min. Negotiated Rate	$666.98
Max. Negotiated Rate	$1,076.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$889.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$978.24
Rate for Payer: Qualcare PPO/HMO/WC	$666.98

BASEPLATE TIBIAL SZ 2

Facility

$4,446.55

Service Code	HCPCS C1776
Hospital Charge Code	270682131
Hospital Revenue Code	278
Min. Negotiated Rate	$107.16
Max. Negotiated Rate	$2,223.28
Rate for Payer: Aetna Commercial	$1,689.69
Rate for Payer: Aetna Medicare Advantage	$1,333.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,133.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,133.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$889.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,133.87
Rate for Payer: Cigna Commercial	$2,223.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,076.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$978.24
Rate for Payer: Qualcare PPO/HMO/WC	$666.98
Rate for Payer: UnitedHealthcare Community & State	$107.16
Rate for Payer: Wellpoint Medicaid Managed Care	$117.83

BASEPLATE TIBIAL SZ 6

Facility

$4,685.25

Service Code	HCPCS C1713
Hospital Charge Code	270691405
Hospital Revenue Code	278
Min. Negotiated Rate	$702.79
Max. Negotiated Rate	$1,133.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$937.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,133.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,030.76
Rate for Payer: Qualcare PPO/HMO/WC	$702.79

BASEPLATE TIBIAL SZ 6

Facility

$4,685.25

Service Code	HCPCS C1713
Hospital Charge Code	270691405
Hospital Revenue Code	278
Min. Negotiated Rate	$112.91
Max. Negotiated Rate	$2,342.62
Rate for Payer: Aetna Commercial	$1,780.39
Rate for Payer: Aetna Medicare Advantage	$1,405.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,194.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,194.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$937.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,194.74
Rate for Payer: Cigna Commercial	$2,342.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,133.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,030.76
Rate for Payer: Qualcare PPO/HMO/WC	$702.79
Rate for Payer: UnitedHealthcare Community & State	$112.91
Rate for Payer: Wellpoint Medicaid Managed Care	$124.16

BASE PLATE TIBIAL UNIVERSAL #3

Facility

$6,303.45

Service Code	HCPCS C1776
Hospital Charge Code	270672930
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

BASE PLATE TIBIAL UNIVERSAL #3

Facility

$6,303.45

Service Code	HCPCS C1776
Hospital Charge Code	270672930
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 TRIATHLN PRIMRY TIB

Facility

$4,171.75

Service Code	HCPCS C1776
Hospital Charge Code	270693031
Hospital Revenue Code	278
Min. Negotiated Rate	$100.54
Max. Negotiated Rate	$2,085.88
Rate for Payer: Aetna Commercial	$1,585.27
Rate for Payer: Aetna Medicare Advantage	$1,251.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,063.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,063.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$834.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,063.80
Rate for Payer: Cigna Commercial	$2,085.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,009.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$917.78
Rate for Payer: Qualcare PPO/HMO/WC	$625.76
Rate for Payer: UnitedHealthcare Community & State	$100.54
Rate for Payer: Wellpoint Medicaid Managed Care	$110.55

BASEPLATE TRIATHLN PRIMRY TIB

Facility

$4,171.75

Service Code	HCPCS C1776
Hospital Charge Code	270693031
Hospital Revenue Code	278
Min. Negotiated Rate	$625.76
Max. Negotiated Rate	$1,009.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$834.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,009.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$917.78
Rate for Payer: Qualcare PPO/HMO/WC	$625.76

BASEPLATE TRIATHLON TIBIA SZ6

Facility

$6,835.00

Service Code	HCPCS C1776
Hospital Charge Code	270692258
Hospital Revenue Code	278
Min. Negotiated Rate	$164.72
Max. Negotiated Rate	$3,417.50
Rate for Payer: Aetna Commercial	$2,597.30
Rate for Payer: Aetna Medicare Advantage	$2,050.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,742.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,742.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,742.92
Rate for Payer: Cigna Commercial	$3,417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,503.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.25
Rate for Payer: UnitedHealthcare Community & State	$164.72
Rate for Payer: Wellpoint Medicaid Managed Care	$181.13

BASEPLATE TRIATHLON TIBIA SZ6

Facility

$6,835.00

Service Code	HCPCS C1776
Hospital Charge Code	270692258
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.25
Max. Negotiated Rate	$1,654.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,503.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.25

BASEPLATE UNIVERSAL TIBIAL SZ4

Facility

$4,870.00

Service Code	HCPCS C1776
Hospital Charge Code	270691262
Hospital Revenue Code	278
Min. Negotiated Rate	$730.50
Max. Negotiated Rate	$1,178.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$974.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,178.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,071.40
Rate for Payer: Qualcare PPO/HMO/WC	$730.50

Know your out-of-pocket cost for care.

All Charges