Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL BASEPLATE SZ 1 ELEOS

Facility

$20,235.00

Service Code	HCPCS C1776
Hospital Charge Code	270682847
Hospital Revenue Code	278
Min. Negotiated Rate	$3,035.25
Max. Negotiated Rate	$4,896.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,047.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,896.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,451.70
Rate for Payer: Qualcare PPO/HMO/WC	$3,035.25

TIBIAL BASEPLATE SZ 2

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678878
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

TIBIAL BASEPLATE SZ 2

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678878
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

TIBIAL BASEPLATE SZ 3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678829
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

TIBIAL BASEPLATE SZ 3

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678829
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

TIBIAL BASEPLATE SZ 4

Facility

$8,488.25

Hospital Charge Code	270671355
Hospital Revenue Code	278
Min. Negotiated Rate	$1,273.24
Max. Negotiated Rate	$2,054.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,697.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,054.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,867.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,273.24

TIBIAL BASEPLATE SZ 4

Facility

$8,488.25

Hospital Charge Code	270671355
Hospital Revenue Code	278
Min. Negotiated Rate	$204.57
Max. Negotiated Rate	$4,244.12
Rate for Payer: Aetna Commercial	$3,225.53
Rate for Payer: Aetna Medicare Advantage	$2,546.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,164.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,164.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,697.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,164.50
Rate for Payer: Cigna Commercial	$4,244.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,054.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,867.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,273.24
Rate for Payer: UnitedHealthcare Community & State	$204.57
Rate for Payer: Wellpoint Medicaid Managed Care	$224.94

TIBIAL BASEPLATE SZ4 KLASSIC

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680134
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

TIBIAL BASEPLATE SZ4 KLASSIC

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680134
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

TIBIAL BASEPLATE SZ5 KLASSIC

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680135
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

TIBIAL BASEPLATE SZ5 KLASSIC

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680135
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

TIBIAL BEARING

Facility

$12,315.00

Service Code	HCPCS C1776
Hospital Charge Code	270672775
Hospital Revenue Code	278
Min. Negotiated Rate	$296.79
Max. Negotiated Rate	$6,157.50
Rate for Payer: Aetna Commercial	$4,679.70
Rate for Payer: Aetna Medicare Advantage	$3,694.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,140.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,140.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,463.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,140.32
Rate for Payer: Cigna Commercial	$6,157.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,980.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,709.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,847.25
Rate for Payer: UnitedHealthcare Community & State	$296.79
Rate for Payer: Wellpoint Medicaid Managed Care	$326.35

TIBIAL BEARING

Facility

$12,315.00

Service Code	HCPCS C1776
Hospital Charge Code	270672775
Hospital Revenue Code	278
Min. Negotiated Rate	$1,847.25
Max. Negotiated Rate	$2,980.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,463.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,980.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,709.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,847.25

TIBIAL BEARING 12MM X 63/67MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681314
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

TIBIAL BEARING 12MM X 63/67MM

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681314
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

TIBIAL BEARING 18MM

Facility

$6,085.00

Service Code	HCPCS C1776
Hospital Charge Code	270673718
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

TIBIAL BEARING 18MM

Facility

$6,085.00

Service Code	HCPCS C1776
Hospital Charge Code	270673718
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

TIBIAL BEARING INS CS4 9.0MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270692202
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

TIBIAL BEARING INS CS4 9.0MM

Facility

$5,082.35

Service Code	HCPCS C1776
Hospital Charge Code	270692202
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

TIBIAL BEARING INSERT 11MM

Facility

$5,182.10

Service Code	HCPCS C1776
Hospital Charge Code	270681037
Hospital Revenue Code	278
Min. Negotiated Rate	$124.89
Max. Negotiated Rate	$2,591.05
Rate for Payer: Aetna Commercial	$1,969.20
Rate for Payer: Aetna Medicare Advantage	$1,554.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,321.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,321.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,321.44
Rate for Payer: Cigna Commercial	$2,591.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,254.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,140.06
Rate for Payer: Qualcare PPO/HMO/WC	$777.32
Rate for Payer: UnitedHealthcare Community & State	$124.89
Rate for Payer: Wellpoint Medicaid Managed Care	$137.33

TIBIAL BEARING INSERT 11MM

Facility

$5,182.10

Service Code	HCPCS C1776
Hospital Charge Code	270681037
Hospital Revenue Code	278
Min. Negotiated Rate	$777.32
Max. Negotiated Rate	$1,254.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,254.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,140.06
Rate for Payer: Qualcare PPO/HMO/WC	$777.32

TIBIAL BEARING INSERT 13MM

Facility

$5,209.00

Service Code	HCPCS C1776
Hospital Charge Code	270691037
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

TIBIAL BEARING INSERT 13MM

Facility

$5,209.00

Service Code	HCPCS C1776
Hospital Charge Code	270691037
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

TIBIAL BEARING INSERT SZ 1

Facility

$5,233.60

Service Code	HCPCS C1713
Hospital Charge Code	270705094
Hospital Revenue Code	278
Min. Negotiated Rate	$126.13
Max. Negotiated Rate	$2,616.80
Rate for Payer: Aetna Commercial	$1,988.77
Rate for Payer: Aetna Medicare Advantage	$1,570.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,334.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,334.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,046.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,334.57
Rate for Payer: Cigna Commercial	$2,616.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,266.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,151.39
Rate for Payer: Qualcare PPO/HMO/WC	$785.04
Rate for Payer: UnitedHealthcare Community & State	$126.13
Rate for Payer: Wellpoint Medicaid Managed Care	$138.69

TIBIAL BEARING INSERT SZ 1

Facility

$5,233.60

Service Code	HCPCS C1713
Hospital Charge Code	270705094
Hospital Revenue Code	278
Min. Negotiated Rate	$785.04
Max. Negotiated Rate	$1,266.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,046.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,266.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,151.39
Rate for Payer: Qualcare PPO/HMO/WC	$785.04

Know your out-of-pocket cost for care.

All Charges