Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL ELEOS MODUL CAP ONE SZ

Facility

$850.00

Service Code	HCPCS C1776
Hospital Charge Code	270682848
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

TIBIAL ELEOS MODUL CAP ONE SZ

Facility

$850.00

Service Code	HCPCS C1776
Hospital Charge Code	270682848
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

TIBIAL FIXED KEEL CMT SZ D L

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270690105
Hospital Revenue Code	278
Min. Negotiated Rate	$445.55
Max. Negotiated Rate	$9,243.75
Rate for Payer: Aetna Commercial	$7,025.25
Rate for Payer: Aetna Medicare Advantage	$5,546.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,714.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,714.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,714.31
Rate for Payer: Cigna Commercial	$9,243.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,067.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,773.12
Rate for Payer: UnitedHealthcare Community & State	$445.55
Rate for Payer: Wellpoint Medicaid Managed Care	$489.92

TIBIAL FIXED KEEL CMT SZ D L

Facility

$18,487.50

Service Code	HCPCS C1776
Hospital Charge Code	270690105
Hospital Revenue Code	278
Min. Negotiated Rate	$2,773.12
Max. Negotiated Rate	$4,473.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,473.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,067.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,773.12

TIBIAL GMK TRAY HINGE 20 MM S

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687685
Hospital Revenue Code	278
Min. Negotiated Rate	$2,235.75
Max. Negotiated Rate	$3,607.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,279.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,235.75

TIBIAL GMK TRAY HINGE 20 MM S

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687685
Hospital Revenue Code	278
Min. Negotiated Rate	$359.21
Max. Negotiated Rate	$7,452.50
Rate for Payer: Aetna Commercial	$5,663.90
Rate for Payer: Aetna Medicare Advantage	$4,471.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,800.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,800.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,800.78
Rate for Payer: Cigna Commercial	$7,452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,279.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,235.75
Rate for Payer: UnitedHealthcare Community & State	$359.21
Rate for Payer: Wellpoint Medicaid Managed Care	$394.98

TIBIAL GMK TRAY HINGE 2 20MM

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687695
Hospital Revenue Code	278
Min. Negotiated Rate	$2,235.75
Max. Negotiated Rate	$3,607.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,279.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,235.75

TIBIAL GMK TRAY HINGE 2 20MM

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687695
Hospital Revenue Code	278
Min. Negotiated Rate	$359.21
Max. Negotiated Rate	$7,452.50
Rate for Payer: Aetna Commercial	$5,663.90
Rate for Payer: Aetna Medicare Advantage	$4,471.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,800.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,800.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,800.78
Rate for Payer: Cigna Commercial	$7,452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,279.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,235.75
Rate for Payer: UnitedHealthcare Community & State	$359.21
Rate for Payer: Wellpoint Medicaid Managed Care	$394.98

TIBIAL GMK TRAY HINGE RIGHT S4

Facility

$24,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270687949
Hospital Revenue Code	278
Min. Negotiated Rate	$3,651.75
Max. Negotiated Rate	$5,891.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,869.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,891.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,355.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,651.75

TIBIAL GMK TRAY HINGE RIGHT S4

Facility

$24,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270687949
Hospital Revenue Code	278
Min. Negotiated Rate	$586.71
Max. Negotiated Rate	$12,172.50
Rate for Payer: Aetna Commercial	$9,251.10
Rate for Payer: Aetna Medicare Advantage	$7,303.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,207.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,207.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,869.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,207.98
Rate for Payer: Cigna Commercial	$12,172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,891.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,355.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,651.75
Rate for Payer: UnitedHealthcare Community & State	$586.71
Rate for Payer: Wellpoint Medicaid Managed Care	$645.14

TIBIAL HINGE ELEOS ROTIONAL ST

Facility

$11,645.00

Service Code	HCPCS C1776
Hospital Charge Code	270682843
Hospital Revenue Code	278
Min. Negotiated Rate	$1,746.75
Max. Negotiated Rate	$2,818.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,329.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,818.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,561.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,746.75

TIBIAL HINGE ELEOS ROTIONAL ST

Facility

$11,645.00

Service Code	HCPCS C1776
Hospital Charge Code	270682843
Hospital Revenue Code	278
Min. Negotiated Rate	$280.64
Max. Negotiated Rate	$5,822.50
Rate for Payer: Aetna Commercial	$4,425.10
Rate for Payer: Aetna Medicare Advantage	$3,493.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,969.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,969.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,329.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,969.47
Rate for Payer: Cigna Commercial	$5,822.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,818.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,561.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,746.75
Rate for Payer: UnitedHealthcare Community & State	$280.64
Rate for Payer: Wellpoint Medicaid Managed Care	$308.59

TIBIAL INLAY POLY SZ 1 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668679
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$870.10
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 1 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668679
Hospital Revenue Code	278
Min. Negotiated Rate	$95.32
Max. Negotiated Rate	$1,977.50
Rate for Payer: Aetna Commercial	$1,502.90
Rate for Payer: Aetna Medicare Advantage	$1,186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.52
Rate for Payer: Cigna Commercial	$1,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$870.10
Rate for Payer: Qualcare PPO/HMO/WC	$593.25
Rate for Payer: UnitedHealthcare Community & State	$95.32
Rate for Payer: Wellpoint Medicaid Managed Care	$104.81

TIBIAL INLAY POLY SZ 1 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668680
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$870.10
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 1 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668680
Hospital Revenue Code	278
Min. Negotiated Rate	$95.32
Max. Negotiated Rate	$1,977.50
Rate for Payer: Aetna Commercial	$1,502.90
Rate for Payer: Aetna Medicare Advantage	$1,186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.52
Rate for Payer: Cigna Commercial	$1,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$870.10
Rate for Payer: Qualcare PPO/HMO/WC	$593.25
Rate for Payer: UnitedHealthcare Community & State	$95.32
Rate for Payer: Wellpoint Medicaid Managed Care	$104.81

TIBIAL INLAY POLY SZ 1 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668681
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$870.10
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 1 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668681
Hospital Revenue Code	278
Min. Negotiated Rate	$95.32
Max. Negotiated Rate	$1,977.50
Rate for Payer: Aetna Commercial	$1,502.90
Rate for Payer: Aetna Medicare Advantage	$1,186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.52
Rate for Payer: Cigna Commercial	$1,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$870.10
Rate for Payer: Qualcare PPO/HMO/WC	$593.25
Rate for Payer: UnitedHealthcare Community & State	$95.32
Rate for Payer: Wellpoint Medicaid Managed Care	$104.81

TIBIAL INLAY POLY SZ 2 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668682
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$870.10
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 2 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668682
Hospital Revenue Code	278
Min. Negotiated Rate	$95.32
Max. Negotiated Rate	$1,977.50
Rate for Payer: Aetna Commercial	$1,502.90
Rate for Payer: Aetna Medicare Advantage	$1,186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.52
Rate for Payer: Cigna Commercial	$1,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$870.10
Rate for Payer: Qualcare PPO/HMO/WC	$593.25
Rate for Payer: UnitedHealthcare Community & State	$95.32
Rate for Payer: Wellpoint Medicaid Managed Care	$104.81

TIBIAL INLAY POLY SZ 2 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668683
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$870.10
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 2 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668683
Hospital Revenue Code	278
Min. Negotiated Rate	$95.32
Max. Negotiated Rate	$1,977.50
Rate for Payer: Aetna Commercial	$1,502.90
Rate for Payer: Aetna Medicare Advantage	$1,186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.52
Rate for Payer: Cigna Commercial	$1,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$870.10
Rate for Payer: Qualcare PPO/HMO/WC	$593.25
Rate for Payer: UnitedHealthcare Community & State	$95.32
Rate for Payer: Wellpoint Medicaid Managed Care	$104.81

TIBIAL INLAY POLY SZ 2 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668684
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$870.10
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

TIBIAL INLAY POLY SZ 2 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668684
Hospital Revenue Code	278
Min. Negotiated Rate	$95.32
Max. Negotiated Rate	$1,977.50
Rate for Payer: Aetna Commercial	$1,502.90
Rate for Payer: Aetna Medicare Advantage	$1,186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,008.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,008.52
Rate for Payer: Cigna Commercial	$1,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$870.10
Rate for Payer: Qualcare PPO/HMO/WC	$593.25
Rate for Payer: UnitedHealthcare Community & State	$95.32
Rate for Payer: Wellpoint Medicaid Managed Care	$104.81

TIBIAL INLAY POLY SZ 3 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668685
Hospital Revenue Code	278
Min. Negotiated Rate	$593.25
Max. Negotiated Rate	$957.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$957.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$870.10
Rate for Payer: Qualcare PPO/HMO/WC	$593.25

Know your out-of-pocket cost for care.

All Charges