Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL BEARING INSERT SZ 2

Facility

$5,208.30

Service Code	HCPCS C1713
Hospital Charge Code	270705127
Hospital Revenue Code	278
Min. Negotiated Rate	$125.52
Max. Negotiated Rate	$2,604.15
Rate for Payer: Aetna Commercial	$1,979.15
Rate for Payer: Aetna Medicare Advantage	$1,562.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,328.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,328.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,041.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,328.12
Rate for Payer: Cigna Commercial	$2,604.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,260.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,145.83
Rate for Payer: Qualcare PPO/HMO/WC	$781.25
Rate for Payer: UnitedHealthcare Community & State	$125.52
Rate for Payer: Wellpoint Medicaid Managed Care	$138.02

TIBIAL BEARING INSERT SZ 2

Facility

$5,208.30

Service Code	HCPCS C1713
Hospital Charge Code	270705127
Hospital Revenue Code	278
Min. Negotiated Rate	$781.25
Max. Negotiated Rate	$1,260.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,041.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,260.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,145.83
Rate for Payer: Qualcare PPO/HMO/WC	$781.25

TIBIAL BEARING INSERT SZ4 13MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270697649
Hospital Revenue Code	278
Min. Negotiated Rate	$747.79
Max. Negotiated Rate	$1,206.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,096.77
Rate for Payer: Qualcare PPO/HMO/WC	$747.79

TIBIAL BEARING INSERT SZ4 13MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270697649
Hospital Revenue Code	278
Min. Negotiated Rate	$120.15
Max. Negotiated Rate	$2,492.65
Rate for Payer: Aetna Commercial	$1,894.41
Rate for Payer: Aetna Medicare Advantage	$1,495.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,271.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$997.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,271.25
Rate for Payer: Cigna Commercial	$2,492.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,206.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,096.77
Rate for Payer: Qualcare PPO/HMO/WC	$747.79
Rate for Payer: UnitedHealthcare Community & State	$120.15
Rate for Payer: Wellpoint Medicaid Managed Care	$132.11

TIBIAL BEARING INSRT PS 5/11MM

Facility

$6,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270672933
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,663.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

TIBIAL BEARING INSRT PS 5/11MM

Facility

$6,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270672933
Hospital Revenue Code	278
Min. Negotiated Rate	$165.69
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,612.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25
Rate for Payer: UnitedHealthcare Community & State	$165.69
Rate for Payer: Wellpoint Medicaid Managed Care	$182.19

TIBIAL BEARING INSRT PS 5/16MM

Facility

$6,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270672932
Hospital Revenue Code	278
Min. Negotiated Rate	$165.69
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,612.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25
Rate for Payer: UnitedHealthcare Community & State	$165.69
Rate for Payer: Wellpoint Medicaid Managed Care	$182.19

TIBIAL BEARING INSRT PS 5/16MM

Facility

$6,875.00

Service Code	HCPCS C1776
Hospital Charge Code	270672932
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,663.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

TIBIAL BONE MODEL

Facility

$500.00

Hospital Charge Code	270672254
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

TIBIAL BONE MODEL

Facility

$500.00

Hospital Charge Code	270672254
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

TIBIAL BONE MODEL 4.9020

Facility

$500.00

Hospital Charge Code	270672255
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

TIBIAL BONE MODEL 4.9020

Facility

$500.00

Hospital Charge Code	270672255
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

TIBIAL BUSHING

Facility

$1,605.00

Service Code	HCPCS C1713
Hospital Charge Code	270664277
Hospital Revenue Code	278
Min. Negotiated Rate	$38.68
Max. Negotiated Rate	$802.50
Rate for Payer: Aetna Commercial	$609.90
Rate for Payer: Aetna Medicare Advantage	$481.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$409.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$409.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$321.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$409.27
Rate for Payer: Cigna Commercial	$802.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$353.10
Rate for Payer: Qualcare PPO/HMO/WC	$240.75
Rate for Payer: UnitedHealthcare Community & State	$38.68
Rate for Payer: Wellpoint Medicaid Managed Care	$42.53

TIBIAL BUSHING

Facility

$1,605.00

Service Code	HCPCS C1713
Hospital Charge Code	270664277
Hospital Revenue Code	278
Min. Negotiated Rate	$240.75
Max. Negotiated Rate	$388.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$321.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$353.10
Rate for Payer: Qualcare PPO/HMO/WC	$240.75

TIBIAL CHECKPOINT STERILE

Facility

$270.00

Hospital Charge Code	270668097
Hospital Revenue Code	272
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.00
Rate for Payer: Oxford Commercial	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Commercial	$54.00
Rate for Payer: UnitedHealthcare Community & State	$6.51
Rate for Payer: Wellpoint Medicaid Managed Care	$7.16

TIBIAL CHECKPOINT STERILE

Facility

$270.00

Hospital Charge Code	270668097
Hospital Revenue Code	272
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

TIBIAL COMPENT 32x6.5 102140

Facility

$3,774.65

Hospital Charge Code	270631693
Hospital Revenue Code	278
Min. Negotiated Rate	$566.20
Max. Negotiated Rate	$913.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$913.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$830.42
Rate for Payer: Qualcare PPO/HMO/WC	$566.20

TIBIAL COMPENT 32x6.5 102140

Facility

$3,774.65

Hospital Charge Code	270631693
Hospital Revenue Code	278
Min. Negotiated Rate	$90.97
Max. Negotiated Rate	$1,887.33
Rate for Payer: Aetna Commercial	$1,434.37
Rate for Payer: Aetna Medicare Advantage	$1,132.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$962.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$962.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$962.54
Rate for Payer: Cigna Commercial	$1,887.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$913.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$830.42
Rate for Payer: Qualcare PPO/HMO/WC	$566.20
Rate for Payer: UnitedHealthcare Community & State	$90.97
Rate for Payer: Wellpoint Medicaid Managed Care	$100.03

TIBIAL COMPONENT 12MM

Facility

$14,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270672591
Hospital Revenue Code	278
Min. Negotiated Rate	$2,160.00
Max. Negotiated Rate	$3,484.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,484.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,168.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,160.00

TIBIAL COMPONENT 12MM

Facility

$14,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270672591
Hospital Revenue Code	278
Min. Negotiated Rate	$347.04
Max. Negotiated Rate	$7,200.00
Rate for Payer: Aetna Commercial	$5,472.00
Rate for Payer: Aetna Medicare Advantage	$4,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,672.00
Rate for Payer: Cigna Commercial	$7,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,484.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,168.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,160.00
Rate for Payer: UnitedHealthcare Community & State	$347.04
Rate for Payer: Wellpoint Medicaid Managed Care	$381.60

TIBIAL COMPONENT 37x65 102150

Facility

$3,774.65

Hospital Charge Code	270630491
Hospital Revenue Code	278
Min. Negotiated Rate	$90.97
Max. Negotiated Rate	$1,887.33
Rate for Payer: Aetna Commercial	$1,434.37
Rate for Payer: Aetna Medicare Advantage	$1,132.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$962.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$962.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$962.54
Rate for Payer: Cigna Commercial	$1,887.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$913.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$830.42
Rate for Payer: Qualcare PPO/HMO/WC	$566.20
Rate for Payer: UnitedHealthcare Community & State	$90.97
Rate for Payer: Wellpoint Medicaid Managed Care	$100.03

TIBIAL COMPONENT 37x65 102150

Facility

$3,774.65

Hospital Charge Code	270630491
Hospital Revenue Code	278
Min. Negotiated Rate	$566.20
Max. Negotiated Rate	$913.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$754.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$913.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$830.42
Rate for Payer: Qualcare PPO/HMO/WC	$566.20

TIBIAL COMPONENT 37x7.5 102152

Facility

$3,278.45

Hospital Charge Code	270631518
Hospital Revenue Code	278
Min. Negotiated Rate	$79.01
Max. Negotiated Rate	$1,639.22
Rate for Payer: Aetna Commercial	$1,245.81
Rate for Payer: Aetna Medicare Advantage	$983.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$836.00
Rate for Payer: Cigna Commercial	$1,639.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$721.26
Rate for Payer: Qualcare PPO/HMO/WC	$491.77
Rate for Payer: UnitedHealthcare Community & State	$79.01
Rate for Payer: Wellpoint Medicaid Managed Care	$86.88

TIBIAL COMPONENT 37x7.5 102152

Facility

$3,278.45

Hospital Charge Code	270631518
Hospital Revenue Code	278
Min. Negotiated Rate	$491.77
Max. Negotiated Rate	$793.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$721.26
Rate for Payer: Qualcare PPO/HMO/WC	$491.77

TIBIAL COMPONENT 37X7.5 102154

Facility

$3,278.45

Hospital Charge Code	270631773
Hospital Revenue Code	278
Min. Negotiated Rate	$491.77
Max. Negotiated Rate	$793.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$721.26
Rate for Payer: Qualcare PPO/HMO/WC	$491.77

Know your out-of-pocket cost for care.

All Charges