Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TIBAL KNEE BASE FX BEARING SZ

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685508
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

TIBAL MODULAR

Facility

$5,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270679530
Hospital Revenue Code	278
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$1,343.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,221.00
Rate for Payer: Qualcare PPO/HMO/WC	$832.50

TIBAL MODULAR

Facility

$5,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270679530
Hospital Revenue Code	278
Min. Negotiated Rate	$133.75
Max. Negotiated Rate	$2,775.00
Rate for Payer: Aetna Commercial	$2,109.00
Rate for Payer: Aetna Medicare Advantage	$1,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,415.25
Rate for Payer: Cigna Commercial	$2,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,221.00
Rate for Payer: Qualcare PPO/HMO/WC	$832.50
Rate for Payer: UnitedHealthcare Community & State	$133.75
Rate for Payer: Wellpoint Medicaid Managed Care	$147.07

TIB BEARING INSERT CS 11MM SZ4

Facility

$5,209.00

Service Code	HCPCS C1776
Hospital Charge Code	270692376
Hospital Revenue Code	278
Min. Negotiated Rate	$125.54
Max. Negotiated Rate	$2,604.50
Rate for Payer: Aetna Commercial	$1,979.42
Rate for Payer: Aetna Medicare Advantage	$1,562.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,328.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,328.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,041.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,328.30
Rate for Payer: Cigna Commercial	$2,604.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,260.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,145.98
Rate for Payer: Qualcare PPO/HMO/WC	$781.35
Rate for Payer: UnitedHealthcare Community & State	$125.54
Rate for Payer: Wellpoint Medicaid Managed Care	$138.04

TIB BEARING INSERT CS 11MM SZ4

Facility

$5,209.00

Service Code	HCPCS C1776
Hospital Charge Code	270692376
Hospital Revenue Code	278
Min. Negotiated Rate	$781.35
Max. Negotiated Rate	$1,260.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,041.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,260.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,145.98
Rate for Payer: Qualcare PPO/HMO/WC	$781.35

TIB BEARING INSET CS SZ 4 13MM

Facility

$5,336.50

Service Code	HCPCS C1776
Hospital Charge Code	270690855
Hospital Revenue Code	278
Min. Negotiated Rate	$128.61
Max. Negotiated Rate	$2,668.25
Rate for Payer: Aetna Commercial	$2,027.87
Rate for Payer: Aetna Medicare Advantage	$1,600.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,360.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,360.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,067.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,360.81
Rate for Payer: Cigna Commercial	$2,668.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,291.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,174.03
Rate for Payer: Qualcare PPO/HMO/WC	$800.48
Rate for Payer: UnitedHealthcare Community & State	$128.61
Rate for Payer: Wellpoint Medicaid Managed Care	$141.42

TIB BEARING INSET CS SZ 4 13MM

Facility

$5,336.50

Service Code	HCPCS C1776
Hospital Charge Code	270690855
Hospital Revenue Code	278
Min. Negotiated Rate	$800.48
Max. Negotiated Rate	$1,291.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,067.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,291.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,174.03
Rate for Payer: Qualcare PPO/HMO/WC	$800.48

TIB BEARING VNGRD PS 63/67X10

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270679834
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

TIB BEARING VNGRD PS 63/67X10

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270679834
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

TIB BEARNG E1 VANGARD 71/75/10

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270679849
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

TIB BEARNG E1 VANGARD 71/75/10

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270679849
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

TIB BRG VNGRD SSK PSC20X71/75

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270679831
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

TIB BRG VNGRD SSK PSC20X71/75

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270679831
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

TIBETRACH SZ 4 LOW PR C

Facility

$573.65

Hospital Charge Code	270302380
Hospital Revenue Code	272
Min. Negotiated Rate	$86.05
Max. Negotiated Rate	$86.05
Rate for Payer: Qualcare PPO/HMO/WC	$86.05

TIBETRACH SZ 4 LOW PR C

Facility

$573.65

Hospital Charge Code	270302380
Hospital Revenue Code	272
Min. Negotiated Rate	$13.82
Max. Negotiated Rate	$286.82
Rate for Payer: Aetna Commercial	$217.99
Rate for Payer: Aetna Medicare Advantage	$172.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.28
Rate for Payer: Cigna Commercial	$286.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.09
Rate for Payer: Oxford Commercial	$114.73
Rate for Payer: Qualcare PPO/HMO/WC	$86.05
Rate for Payer: UnitedHealthcare Commercial	$114.73
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: Wellpoint Medicaid Managed Care	$15.20

TIB/FIB 2 VWS-BILAT

Facility

$6,601.19

Service Code	HCPCS 7359050
Hospital Charge Code	94061243
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,980.36
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$159.09
Rate for Payer: Wellpoint Medicaid Managed Care	$174.93

TIB/FIB 2 VWS-BILAT

Facility

$6,601.19

Service Code	HCPCS 7359050
Hospital Charge Code	94061243
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

TIB/FIB 2 VWS-LT

Facility

$6,601.19

Service Code	HCPCS 73590LT
Hospital Charge Code	94061377
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

TIB/FIB 2 VWS-LT

Facility

$6,601.19

Service Code	HCPCS 73590LT
Hospital Charge Code	94061377
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,980.36
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$159.09
Rate for Payer: Wellpoint Medicaid Managed Care	$174.93

TIB/FIB 2 VWS-RT

Facility

$6,601.19

Service Code	HCPCS 73590RT
Hospital Charge Code	94061379
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

TIB/FIB 2 VWS-RT

Facility

$6,601.19

Service Code	HCPCS 73590RT
Hospital Charge Code	94061379
Hospital Revenue Code	320
Min. Negotiated Rate	$159.09
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,980.36
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$159.09
Rate for Payer: Wellpoint Medicaid Managed Care	$174.93

TIB/HUM CALI DRILL- 4.3MM

Facility

$1,116.00

Hospital Charge Code	270665469
Hospital Revenue Code	272
Min. Negotiated Rate	$26.90
Max. Negotiated Rate	$558.00
Rate for Payer: Aetna Commercial	$424.08
Rate for Payer: Aetna Medicare Advantage	$334.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.58
Rate for Payer: Cigna Commercial	$558.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$334.80
Rate for Payer: Oxford Commercial	$223.20
Rate for Payer: Qualcare PPO/HMO/WC	$167.40
Rate for Payer: UnitedHealthcare Commercial	$223.20
Rate for Payer: UnitedHealthcare Community & State	$26.90
Rate for Payer: Wellpoint Medicaid Managed Care	$29.57

TIB/HUM CALI DRILL- 4.3MM

Facility

$1,116.00

Hospital Charge Code	270665469
Hospital Revenue Code	272
Min. Negotiated Rate	$167.40
Max. Negotiated Rate	$167.40
Rate for Payer: Qualcare PPO/HMO/WC	$167.40

TIBIA

Facility

$6,156.70

Hospital Charge Code	270657129
Hospital Revenue Code	278
Min. Negotiated Rate	$148.38
Max. Negotiated Rate	$3,078.35
Rate for Payer: Aetna Commercial	$2,339.55
Rate for Payer: Aetna Medicare Advantage	$1,847.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,569.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,569.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,231.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,569.96
Rate for Payer: Cigna Commercial	$3,078.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,489.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,354.47
Rate for Payer: Qualcare PPO/HMO/WC	$923.50
Rate for Payer: UnitedHealthcare Community & State	$148.38
Rate for Payer: Wellpoint Medicaid Managed Care	$163.15

TIBIA

Facility

$6,156.70

Hospital Charge Code	270657129
Hospital Revenue Code	278
Min. Negotiated Rate	$923.50
Max. Negotiated Rate	$1,489.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,231.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,489.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,354.47
Rate for Payer: Qualcare PPO/HMO/WC	$923.50

Know your out-of-pocket cost for care.

All Charges