Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL COMPONENT 37X7.5 102154

Facility

$3,278.45

Hospital Charge Code	270631773
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 # 5

Facility

$6,837.70

Service Code	HCPCS C1776
Hospital Charge Code	270691024
Hospital Revenue Code	278
Min. Negotiated Rate	$164.79
Max. Negotiated Rate	$3,418.85
Rate for Payer: Aetna Commercial	$2,598.33
Rate for Payer: Aetna Medicare Advantage	$2,051.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,743.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,743.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,743.61
Rate for Payer: Cigna Commercial	$3,418.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,504.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.65
Rate for Payer: UnitedHealthcare Community & State	$164.79
Rate for Payer: Wellpoint Medicaid Managed Care	$181.20

TIBIAL COMPONENT # 5

Facility

$6,837.70

Service Code	HCPCS C1776
Hospital Charge Code	270691024
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.65
Max. Negotiated Rate	$1,654.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,367.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,654.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,504.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.65

TIBIAL COMPONENT 80MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676066
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

TIBIAL COMPONENT 80MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676066
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

TIBIAL COMPONENT MEDIUM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686974
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

TIBIAL COMPONENT MEDIUM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686974
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

TIBIAL COMPONENT SIZE 3 12MM

Facility

$5,695.00

Hospital Charge Code	270673197
Hospital Revenue Code	278
Min. Negotiated Rate	$854.25
Max. Negotiated Rate	$1,378.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,139.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,252.90
Rate for Payer: Qualcare PPO/HMO/WC	$854.25

TIBIAL COMPONENT SIZE 3 12MM

Facility

$5,695.00

Hospital Charge Code	270673197
Hospital Revenue Code	278
Min. Negotiated Rate	$137.25
Max. Negotiated Rate	$2,847.50
Rate for Payer: Aetna Commercial	$2,164.10
Rate for Payer: Aetna Medicare Advantage	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,452.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,452.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,139.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,452.22
Rate for Payer: Cigna Commercial	$2,847.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,252.90
Rate for Payer: Qualcare PPO/HMO/WC	$854.25
Rate for Payer: UnitedHealthcare Community & State	$137.25
Rate for Payer: Wellpoint Medicaid Managed Care	$150.92

TIBIAL COMPONENT SIZE #4

Facility

$7,179.60

Service Code	HCPCS C1776
Hospital Charge Code	270690853
Hospital Revenue Code	278
Min. Negotiated Rate	$173.03
Max. Negotiated Rate	$3,589.80
Rate for Payer: Aetna Commercial	$2,728.25
Rate for Payer: Aetna Medicare Advantage	$2,153.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,830.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,830.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,435.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,830.80
Rate for Payer: Cigna Commercial	$3,589.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,737.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,579.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,076.94
Rate for Payer: UnitedHealthcare Community & State	$173.03
Rate for Payer: Wellpoint Medicaid Managed Care	$190.26

TIBIAL COMPONENT SIZE #4

Facility

$7,179.60

Service Code	HCPCS C1776
Hospital Charge Code	270690853
Hospital Revenue Code	278
Min. Negotiated Rate	$1,076.94
Max. Negotiated Rate	$1,737.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,435.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,737.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,579.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,076.94

TIBIAL COMPONENT SMALL

Facility

$8,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270680960
Hospital Revenue Code	278
Min. Negotiated Rate	$210.88
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$3,325.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50
Rate for Payer: UnitedHealthcare Community & State	$210.88
Rate for Payer: Wellpoint Medicaid Managed Care	$231.88

TIBIAL COMPONENT SMALL

Facility

$8,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270680960
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

TIBIAL CUTTING BLOCK RT SZ3

Facility

$1,625.00

Hospital Charge Code	270673641
Hospital Revenue Code	272
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$243.75
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

TIBIAL CUTTING BLOCK RT SZ3

Facility

$1,625.00

Hospital Charge Code	270673641
Hospital Revenue Code	272
Min. Negotiated Rate	$39.16
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.50
Rate for Payer: Oxford Commercial	$325.00
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Commercial	$325.00
Rate for Payer: UnitedHealthcare Community & State	$39.16
Rate for Payer: Wellpoint Medicaid Managed Care	$43.06

TIBIAL CUTTING BLOCK RT SZ4

Facility

$2,625.00

Hospital Charge Code	270675307
Hospital Revenue Code	272
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$393.75
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

TIBIAL CUTTING BLOCK RT SZ4

Facility

$2,625.00

Hospital Charge Code	270675307
Hospital Revenue Code	272
Min. Negotiated Rate	$63.26
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.50
Rate for Payer: Oxford Commercial	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Commercial	$525.00
Rate for Payer: UnitedHealthcare Community & State	$63.26
Rate for Payer: Wellpoint Medicaid Managed Care	$69.56

TIBIAL CUTTING BLOCK SZ2 LEFT

Facility

$625.00

Hospital Charge Code	270676450
Hospital Revenue Code	272
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

TIBIAL CUTTING BLOCK SZ2 LEFT

Facility

$625.00

Hospital Charge Code	270676450
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

TIBIAL CUTTING BLOCK SZ2 RIGHT

Facility

$2,625.00

Hospital Charge Code	270672252
Hospital Revenue Code	272
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$393.75
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

TIBIAL CUTTING BLOCK SZ2 RIGHT

Facility

$2,625.00

Hospital Charge Code	270672252
Hospital Revenue Code	272
Min. Negotiated Rate	$63.26
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.50
Rate for Payer: Oxford Commercial	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Commercial	$525.00
Rate for Payer: UnitedHealthcare Community & State	$63.26
Rate for Payer: Wellpoint Medicaid Managed Care	$69.56

TIBIAL CUTTING BLOCK SZ 4 LEFT

Facility

$625.00

Hospital Charge Code	270671996
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

TIBIAL CUTTING BLOCK SZ 4 LEFT

Facility

$625.00

Hospital Charge Code	270671996
Hospital Revenue Code	272
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

TIBIAL CUTTING BLOCK UNIVERAL

Facility

$4,200.00

Hospital Charge Code	270686931
Hospital Revenue Code	272
Min. Negotiated Rate	$101.22
Max. Negotiated Rate	$2,100.00
Rate for Payer: Aetna Commercial	$1,596.00
Rate for Payer: Aetna Medicare Advantage	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,071.00
Rate for Payer: Cigna Commercial	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,260.00
Rate for Payer: Oxford Commercial	$840.00
Rate for Payer: Qualcare PPO/HMO/WC	$630.00
Rate for Payer: UnitedHealthcare Commercial	$840.00
Rate for Payer: UnitedHealthcare Community & State	$101.22
Rate for Payer: Wellpoint Medicaid Managed Care	$111.30

TIBIAL CUTTING BLOCK UNIVERAL

Facility

$4,200.00

Hospital Charge Code	270686931
Hospital Revenue Code	272
Min. Negotiated Rate	$630.00
Max. Negotiated Rate	$630.00
Rate for Payer: Qualcare PPO/HMO/WC	$630.00

Know your out-of-pocket cost for care.

All Charges