Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BEARING TIBIAL 14mm 63/6mm

Facility

$5,135.00

Hospital Charge Code	270646587
Hospital Revenue Code	278
Min. Negotiated Rate	$770.25
Max. Negotiated Rate	$1,242.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,129.70
Rate for Payer: Qualcare PPO/HMO/WC	$770.25

BEARING TIBIAL 14mm 63/6mm

Facility

$5,135.00

Hospital Charge Code	270646587
Hospital Revenue Code	278
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$2,567.50
Rate for Payer: Aetna Commercial	$1,951.30
Rate for Payer: Aetna Medicare Advantage	$1,540.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,309.42
Rate for Payer: Cigna Commercial	$2,567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,129.70
Rate for Payer: Qualcare PPO/HMO/WC	$770.25
Rate for Payer: UnitedHealthcare Community & State	$123.75
Rate for Payer: Wellpoint Medicaid Managed Care	$136.08

BEARING TIBIAL 14mm X 79/83mm

Facility

$4,885.00

Hospital Charge Code	270637462
Hospital Revenue Code	278
Min. Negotiated Rate	$117.73
Max. Negotiated Rate	$2,442.50
Rate for Payer: Aetna Commercial	$1,856.30
Rate for Payer: Aetna Medicare Advantage	$1,465.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,245.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,245.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,245.67
Rate for Payer: Cigna Commercial	$2,442.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,074.70
Rate for Payer: Qualcare PPO/HMO/WC	$732.75
Rate for Payer: UnitedHealthcare Community & State	$117.73
Rate for Payer: Wellpoint Medicaid Managed Care	$129.45

BEARING TIBIAL 14mm X 79/83mm

Facility

$4,885.00

Hospital Charge Code	270637462
Hospital Revenue Code	278
Min. Negotiated Rate	$732.75
Max. Negotiated Rate	$1,182.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,074.70
Rate for Payer: Qualcare PPO/HMO/WC	$732.75

BEARING TIBIAL 14x79/83MM

Facility

$4,000.00

Hospital Charge Code	270676549
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

BEARING TIBIAL 14x79/83MM

Facility

$4,000.00

Hospital Charge Code	270676549
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

BEARING TIBIAL 16x59mm SMALL

Facility

$12,565.00

Hospital Charge Code	270665690
Hospital Revenue Code	278
Min. Negotiated Rate	$302.82
Max. Negotiated Rate	$6,282.50
Rate for Payer: Aetna Commercial	$4,774.70
Rate for Payer: Aetna Medicare Advantage	$3,769.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,513.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,204.07
Rate for Payer: Cigna Commercial	$6,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,040.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,764.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,884.75
Rate for Payer: UnitedHealthcare Community & State	$302.82
Rate for Payer: Wellpoint Medicaid Managed Care	$332.97

BEARING TIBIAL 16x59mm SMALL

Facility

$12,565.00

Hospital Charge Code	270665690
Hospital Revenue Code	278
Min. Negotiated Rate	$1,884.75
Max. Negotiated Rate	$3,040.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,513.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,040.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,764.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,884.75

BEARING TIBIAL 16x63/67MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270666325
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

BEARING TIBIAL 16x63/67MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270666325
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

BEARING TIBIAL 16x71/75 146556

Facility

$3,085.20

Hospital Charge Code	270619031
Hospital Revenue Code	278
Min. Negotiated Rate	$462.78
Max. Negotiated Rate	$746.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$617.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$746.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$678.74
Rate for Payer: Qualcare PPO/HMO/WC	$462.78

BEARING TIBIAL 16x71/75 146556

Facility

$3,085.20

Hospital Charge Code	270619031
Hospital Revenue Code	278
Min. Negotiated Rate	$74.35
Max. Negotiated Rate	$1,542.60
Rate for Payer: Aetna Commercial	$1,172.38
Rate for Payer: Aetna Medicare Advantage	$925.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$786.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$786.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$617.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$786.73
Rate for Payer: Cigna Commercial	$1,542.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$746.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$678.74
Rate for Payer: Qualcare PPO/HMO/WC	$462.78
Rate for Payer: UnitedHealthcare Community & State	$74.35
Rate for Payer: Wellpoint Medicaid Managed Care	$81.76

BEARING TIBIAL 18mm x63/67mm

Facility

$5,135.00

Service Code	HCPCS C1776
Hospital Charge Code	270665997
Hospital Revenue Code	278
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$2,567.50
Rate for Payer: Aetna Commercial	$1,951.30
Rate for Payer: Aetna Medicare Advantage	$1,540.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,309.42
Rate for Payer: Cigna Commercial	$2,567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,129.70
Rate for Payer: Qualcare PPO/HMO/WC	$770.25
Rate for Payer: UnitedHealthcare Community & State	$123.75
Rate for Payer: Wellpoint Medicaid Managed Care	$136.08

BEARING TIBIAL 18mm x63/67mm

Facility

$5,135.00

Service Code	HCPCS C1776
Hospital Charge Code	270665997
Hospital Revenue Code	278
Min. Negotiated Rate	$770.25
Max. Negotiated Rate	$1,242.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,129.70
Rate for Payer: Qualcare PPO/HMO/WC	$770.25

BEARING TIBIAL 18x63/67MM

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270679529
Hospital Revenue Code	278
Min. Negotiated Rate	$1,782.00
Max. Negotiated Rate	$2,874.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,613.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00

BEARING TIBIAL 18x63/67MM

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270679529
Hospital Revenue Code	278
Min. Negotiated Rate	$286.31
Max. Negotiated Rate	$5,940.00
Rate for Payer: Aetna Commercial	$4,514.40
Rate for Payer: Aetna Medicare Advantage	$3,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,029.40
Rate for Payer: Cigna Commercial	$5,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,613.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00
Rate for Payer: UnitedHealthcare Community & State	$286.31
Rate for Payer: Wellpoint Medicaid Managed Care	$314.82

BEARING TIBIAL 7MM SMALL RIGHT

Facility

$7,200.00

Service Code	HCPCS C1776
Hospital Charge Code	270684005
Hospital Revenue Code	278
Min. Negotiated Rate	$173.52
Max. Negotiated Rate	$3,600.00
Rate for Payer: Aetna Commercial	$2,736.00
Rate for Payer: Aetna Medicare Advantage	$2,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,836.00
Rate for Payer: Cigna Commercial	$3,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,584.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,080.00
Rate for Payer: UnitedHealthcare Community & State	$173.52
Rate for Payer: Wellpoint Medicaid Managed Care	$190.80

BEARING TIBIAL 7MM SMALL RIGHT

Facility

$7,200.00

Service Code	HCPCS C1776
Hospital Charge Code	270684005
Hospital Revenue Code	278
Min. Negotiated Rate	$1,080.00
Max. Negotiated Rate	$1,742.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,584.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,080.00

BEARING TIBIAL INSERT 13 MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270691023
Hospital Revenue Code	278
Min. Negotiated Rate	$122.48
Max. Negotiated Rate	$2,541.18
Rate for Payer: Aetna Commercial	$1,931.29
Rate for Payer: Aetna Medicare Advantage	$1,524.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,296.00
Rate for Payer: Cigna Commercial	$2,541.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,118.12
Rate for Payer: Qualcare PPO/HMO/WC	$762.35
Rate for Payer: UnitedHealthcare Community & State	$122.48
Rate for Payer: Wellpoint Medicaid Managed Care	$134.68

BEARING TIBIAL INSERT 13 MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270691023
Hospital Revenue Code	278
Min. Negotiated Rate	$762.35
Max. Negotiated Rate	$1,229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,229.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,118.12
Rate for Payer: Qualcare PPO/HMO/WC	$762.35

BEARING TIBIAL OSS 22mm

Facility

$6,085.00

Service Code	HCPCS C1776
Hospital Charge Code	270673542
Hospital Revenue Code	278
Min. Negotiated Rate	$146.65
Max. Negotiated Rate	$3,042.50
Rate for Payer: Aetna Commercial	$2,312.30
Rate for Payer: Aetna Medicare Advantage	$1,825.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,551.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,551.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,217.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,551.67
Rate for Payer: Cigna Commercial	$3,042.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,472.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,338.70
Rate for Payer: Qualcare PPO/HMO/WC	$912.75
Rate for Payer: UnitedHealthcare Community & State	$146.65
Rate for Payer: Wellpoint Medicaid Managed Care	$161.25

BEARING TIBIAL OSS 22mm

Facility

$6,085.00

Service Code	HCPCS C1776
Hospital Charge Code	270673542
Hospital Revenue Code	278
Min. Negotiated Rate	$912.75
Max. Negotiated Rate	$1,472.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,217.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,472.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,338.70
Rate for Payer: Qualcare PPO/HMO/WC	$912.75

BEARING TIBIAL PS + 63/67 10MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270641842
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

BEARING TIBIAL PS + 63/67 10MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270641842
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

BEARING TIBIAL TRIAT X3 10MM

Facility

$5,659.85

Service Code	HCPCS C1776
Hospital Charge Code	270700354
Hospital Revenue Code	278
Min. Negotiated Rate	$136.40
Max. Negotiated Rate	$2,829.93
Rate for Payer: Aetna Commercial	$2,150.74
Rate for Payer: Aetna Medicare Advantage	$1,697.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,443.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,443.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,131.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,443.26
Rate for Payer: Cigna Commercial	$2,829.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,369.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,245.17
Rate for Payer: Qualcare PPO/HMO/WC	$848.98
Rate for Payer: UnitedHealthcare Community & State	$136.40
Rate for Payer: Wellpoint Medicaid Managed Care	$149.99

Know your out-of-pocket cost for care.

All Charges