Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BEARING TIBIAL TRIAT X3 10MM

Facility

$5,659.85

Service Code	HCPCS C1776
Hospital Charge Code	270700354
Hospital Revenue Code	278
Min. Negotiated Rate	$848.98
Max. Negotiated Rate	$1,369.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,131.97
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

BEARING TIBIAL VANGUARD+ 14MM

Facility

$5,000.00

Hospital Charge Code	270677027
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

BEARING TIBIAL VANGUARD+ 14MM

Facility

$5,000.00

Hospital Charge Code	270677027
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

BEARING TIBIA VANG 14MM 63/67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270694500
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 TIBIA VANG 14MM 63/67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270694500
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 TIBL 10x71/75 11146550

Facility

$4,682.25

Hospital Charge Code	270633019
Hospital Revenue Code	278
Min. Negotiated Rate	$112.84
Max. Negotiated Rate	$2,341.12
Rate for Payer: Aetna Commercial	$1,779.26
Rate for Payer: Aetna Medicare Advantage	$1,404.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,193.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,193.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$936.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,193.97
Rate for Payer: Cigna Commercial	$2,341.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,030.10
Rate for Payer: Qualcare PPO/HMO/WC	$702.34
Rate for Payer: UnitedHealthcare Community & State	$112.84
Rate for Payer: Wellpoint Medicaid Managed Care	$124.08

BEARING TIBL 10x71/75 11146550

Facility

$4,682.25

Hospital Charge Code	270633019
Hospital Revenue Code	278
Min. Negotiated Rate	$702.34
Max. Negotiated Rate	$1,133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$936.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,030.10
Rate for Payer: Qualcare PPO/HMO/WC	$702.34

BEARING TIBL 12x71/75 11146552

Facility

$4,720.00

Hospital Charge Code	270628235
Hospital Revenue Code	278
Min. Negotiated Rate	$708.00
Max. Negotiated Rate	$1,142.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$944.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,142.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,038.40
Rate for Payer: Qualcare PPO/HMO/WC	$708.00

BEARING TIBL 12x71/75 11146552

Facility

$4,720.00

Hospital Charge Code	270628235
Hospital Revenue Code	278
Min. Negotiated Rate	$113.75
Max. Negotiated Rate	$2,360.00
Rate for Payer: Aetna Commercial	$1,793.60
Rate for Payer: Aetna Medicare Advantage	$1,416.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,203.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,203.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$944.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,203.60
Rate for Payer: Cigna Commercial	$2,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,142.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,038.40
Rate for Payer: Qualcare PPO/HMO/WC	$708.00
Rate for Payer: UnitedHealthcare Community & State	$113.75
Rate for Payer: Wellpoint Medicaid Managed Care	$125.08

BEARING TIBL 14x71/75 11146554

Facility

$4,720.00

Hospital Charge Code	270621066
Hospital Revenue Code	278
Min. Negotiated Rate	$113.75
Max. Negotiated Rate	$2,360.00
Rate for Payer: Aetna Commercial	$1,793.60
Rate for Payer: Aetna Medicare Advantage	$1,416.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,203.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,203.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$944.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,203.60
Rate for Payer: Cigna Commercial	$2,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,142.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,038.40
Rate for Payer: Qualcare PPO/HMO/WC	$708.00
Rate for Payer: UnitedHealthcare Community & State	$113.75
Rate for Payer: Wellpoint Medicaid Managed Care	$125.08

BEARING TIBL 14x71/75 11146554

Facility

$4,720.00

Hospital Charge Code	270621066
Hospital Revenue Code	278
Min. Negotiated Rate	$708.00
Max. Negotiated Rate	$1,142.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$944.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,142.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,038.40
Rate for Payer: Qualcare PPO/HMO/WC	$708.00

BEARING TIB LG SIZE 4 Z000243

Facility

$3,350.00

Hospital Charge Code	270638797
Hospital Revenue Code	278
Min. Negotiated Rate	$502.50
Max. Negotiated Rate	$810.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$670.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$737.00
Rate for Payer: Qualcare PPO/HMO/WC	$502.50

BEARING TIB LG SIZE 4 Z000243

Facility

$3,350.00

Hospital Charge Code	270638797
Hospital Revenue Code	278
Min. Negotiated Rate	$80.73
Max. Negotiated Rate	$1,675.00
Rate for Payer: Aetna Commercial	$1,273.00
Rate for Payer: Aetna Medicare Advantage	$1,005.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$854.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$854.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$854.25
Rate for Payer: Cigna Commercial	$1,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$810.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$737.00
Rate for Payer: Qualcare PPO/HMO/WC	$502.50
Rate for Payer: UnitedHealthcare Community & State	$80.73
Rate for Payer: Wellpoint Medicaid Managed Care	$88.78

BEARING TIB SIAPH C LEFT 16MM

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680032
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

BEARING TIB SIAPH C LEFT 16MM

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680032
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

BEARING TIB SSK 12X 63 67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270692328
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 TIB SSK 12X 63 67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270692328
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 TIB SSK 16X63/67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270692340
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 TIB SSK 16X63/67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270692340
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 VIVACIT-E DM 28X38MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693270
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

BEARING VIVACIT-E DM 28X38MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270693270
Hospital Revenue Code	278
Min. Negotiated Rate	$325.35
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,970.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Community & State	$325.35
Rate for Payer: Wellpoint Medicaid Managed Care	$357.75

BEARING VNGD SSK PSC TIB 18X71

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270687241
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 VNGD SSK PSC TIB 18X71

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270687241
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 VNGD TIB 16X71/75 MM

Facility

$3,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270683980
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

BEARING VNGD TIB 16X71/75 MM

Facility

$3,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270683980
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

Know your out-of-pocket cost for care.

All Charges