Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL INSERT SZ3 13MM TS

Facility

$23,925.00

Service Code	HCPCS C1776
Hospital Charge Code	270693303
Hospital Revenue Code	278
Min. Negotiated Rate	$576.59
Max. Negotiated Rate	$11,962.50
Rate for Payer: Aetna Commercial	$9,091.50
Rate for Payer: Aetna Medicare Advantage	$7,177.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,100.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,100.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,100.88
Rate for Payer: Cigna Commercial	$11,962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,789.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,263.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,588.75
Rate for Payer: UnitedHealthcare Community & State	$576.59
Rate for Payer: Wellpoint Medicaid Managed Care	$634.01

TIBIAL INSERT SZ 3 14MM

Facility

$6,945.00

Service Code	HCPCS C1776
Hospital Charge Code	270668531
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 SZ 3 14MM

Facility

$6,945.00

Service Code	HCPCS C1776
Hospital Charge Code	270668531
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 SZ 3 18MM

Facility

$6,903.00

Service Code	HCPCS C1776
Hospital Charge Code	270674013
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$1,670.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,518.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

TIBIAL INSERT SZ 3 18MM

Facility

$6,903.00

Service Code	HCPCS C1776
Hospital Charge Code	270674013
Hospital Revenue Code	278
Min. Negotiated Rate	$166.36
Max. Negotiated Rate	$3,451.50
Rate for Payer: Aetna Commercial	$2,623.14
Rate for Payer: Aetna Medicare Advantage	$2,070.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,760.27
Rate for Payer: Cigna Commercial	$3,451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,518.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45
Rate for Payer: UnitedHealthcare Community & State	$166.36
Rate for Payer: Wellpoint Medicaid Managed Care	$182.93

TIBIAL INSERT SZ 3-4 10MM

Facility

$4,898.85

Hospital Charge Code	270671356
Hospital Revenue Code	278
Min. Negotiated Rate	$118.06
Max. Negotiated Rate	$2,449.43
Rate for Payer: Aetna Commercial	$1,861.56
Rate for Payer: Aetna Medicare Advantage	$1,469.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,249.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,249.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$979.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,249.21
Rate for Payer: Cigna Commercial	$2,449.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,077.75
Rate for Payer: Qualcare PPO/HMO/WC	$734.83
Rate for Payer: UnitedHealthcare Community & State	$118.06
Rate for Payer: Wellpoint Medicaid Managed Care	$129.82

TIBIAL INSERT SZ 3-4 10MM

Facility

$4,898.85

Hospital Charge Code	270671356
Hospital Revenue Code	278
Min. Negotiated Rate	$734.83
Max. Negotiated Rate	$1,185.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$979.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,185.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,077.75
Rate for Payer: Qualcare PPO/HMO/WC	$734.83

TIBIAL INSERT SZ4 11 MM POST

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684045
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

TIBIAL INSERT SZ4 11 MM POST

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270684045
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

TIBIAL INSERT SZ4 9mm POST

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680394
Hospital Revenue Code	278
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$84.35
Rate for Payer: Wellpoint Medicaid Managed Care	$92.75

TIBIAL INSERT SZ4 9mm POST

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680394
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$770.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

TIBIAL INSERT SZ 4 RT 11mm

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678743
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

TIBIAL INSERT SZ 4 RT 11mm

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678744
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 SZ 4 RT 11mm

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678743
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

TIBIAL INSERT SZ 4 RT 11mm

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678744
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 TS SZ 5 11MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270696277
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 INSERT TS SZ 5 11MM

Facility

$4,985.30

Service Code	HCPCS C1776
Hospital Charge Code	270696277
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 INSERT UC 12MM SIZE 2

Facility

$6,945.00

Hospital Charge Code	270672248
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 UC 12MM SIZE 2

Facility

$6,945.00

Hospital Charge Code	270672248
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 ULTRA SZ1 10MM

Facility

$3,000.00

Hospital Charge Code	270672629
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 ULTRA SZ1 10MM

Facility

$3,000.00

Hospital Charge Code	270672629
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 ULTRA SZ1 12MM

Facility

$3,000.00

Hospital Charge Code	270672630
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 ULTRA SZ1 12MM

Facility

$3,000.00

Hospital Charge Code	270672630
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 ULTRA SZ1 14MM

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672631
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 ULTRA SZ1 14MM

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672631
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