Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL INLAY POLY SZ 7 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668698
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 7 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668698
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 7 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668699
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 7 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668699
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 8 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668700
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 8 6.5MM

Facility

$3,955.00

Hospital Charge Code	270668700
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 8 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668701
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 8 7.5MM

Facility

$3,955.00

Hospital Charge Code	270668701
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 8 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668702
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 8 8.5MM

Facility

$3,955.00

Hospital Charge Code	270668702
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 INSERT

Facility

$6,945.00

Service Code	HCPCS C1713
Hospital Charge Code	270667711
Hospital Revenue Code	278
Min. Negotiated Rate	$167.37
Max. Negotiated Rate	$3,472.50
Rate for Payer: Aetna Commercial	$2,639.10
Rate for Payer: Aetna Medicare Advantage	$2,083.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,770.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,770.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,389.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,770.97
Rate for Payer: Cigna Commercial	$3,472.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,680.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,527.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.75
Rate for Payer: UnitedHealthcare Community & State	$167.37
Rate for Payer: Wellpoint Medicaid Managed Care	$184.04

TIBIAL INSERT

Facility

$6,945.00

Service Code	HCPCS C1713
Hospital Charge Code	270667711
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.75
Max. Negotiated Rate	$1,680.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,389.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,680.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,527.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.75

TIBIAL INSERT 11MM SZ 5 LEFT

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683576
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

TIBIAL INSERT 11MM SZ 5 LEFT

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270683576
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

TIBIAL INSERT 17MM

Facility

$6,945.00

Hospital Charge Code	270672087
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.75
Max. Negotiated Rate	$1,680.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,389.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,680.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,527.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.75

TIBIAL INSERT 17MM

Facility

$6,945.00

Hospital Charge Code	270672087
Hospital Revenue Code	278
Min. Negotiated Rate	$167.37
Max. Negotiated Rate	$3,472.50
Rate for Payer: Aetna Commercial	$2,639.10
Rate for Payer: Aetna Medicare Advantage	$2,083.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,770.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,770.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,389.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,770.97
Rate for Payer: Cigna Commercial	$3,472.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,680.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,527.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.75
Rate for Payer: UnitedHealthcare Community & State	$167.37
Rate for Payer: Wellpoint Medicaid Managed Care	$184.04

TIBIAL INSERT 5/13MMRIGHT FLEX

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681016
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

TIBIAL INSERT 5/13MMRIGHT FLEX

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681016
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

TIBIAL INSERT #5 15MM THICK

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270679378
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

TIBIAL INSERT #5 15MM THICK

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270679378
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

TIBIAL INSERT 80MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676067
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

TIBIAL INSERT 80MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270676067
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

TIBIAL INSERT CR/CONG SZ1 10MM

Facility

$3,000.00

Hospital Charge Code	270672559
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

TIBIAL INSERT CR/CONG SZ1 10MM

Facility

$3,000.00

Hospital Charge Code	270672559
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

TIBIAL INSERT CR/CONG SZ1 12MM

Facility

$3,000.00

Hospital Charge Code	270672560
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

Know your out-of-pocket cost for care.

All Charges