Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL POSTERIOR STAB SZ1 11MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679842
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 POSTERIOR STAB SZ1 11MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270679842
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 POSTERIOR STAB SZ1 13MM

Facility

$4,000.00

Hospital Charge Code	270671564
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 POSTERIOR STAB SZ1 13MM

Facility

$4,000.00

Hospital Charge Code	270671564
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 POSTERIOR STAB SZ1 18MM

Facility

$4,284.65

Hospital Charge Code	270670879
Hospital Revenue Code	278
Min. Negotiated Rate	$103.26
Max. Negotiated Rate	$2,142.32
Rate for Payer: Aetna Commercial	$1,628.17
Rate for Payer: Aetna Medicare Advantage	$1,285.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.59
Rate for Payer: Cigna Commercial	$2,142.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.62
Rate for Payer: Qualcare PPO/HMO/WC	$642.70
Rate for Payer: UnitedHealthcare Community & State	$103.26
Rate for Payer: Wellpoint Medicaid Managed Care	$113.54

TIBIAL POSTERIOR STAB SZ1 18MM

Facility

$4,284.65

Hospital Charge Code	270670879
Hospital Revenue Code	278
Min. Negotiated Rate	$642.70
Max. Negotiated Rate	$1,036.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.62
Rate for Payer: Qualcare PPO/HMO/WC	$642.70

TIBIAL POSTERIOR STAB SZ1 30MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680581
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 POSTERIOR STAB SZ1 30MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680581
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 POSTERIOR STAB SZ1 9MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678221
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 POSTERIOR STAB SZ1 9MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270678221
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 POSTERIOR STAB SZ2 15MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270671566
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 POSTERIOR STAB SZ2 15MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270671566
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 POSTERIOR STAB SZ2 18MM

Facility

$5,360.00

Service Code	HCPCS C1776
Hospital Charge Code	270668732
Hospital Revenue Code	278
Min. Negotiated Rate	$129.18
Max. Negotiated Rate	$2,680.00
Rate for Payer: Aetna Commercial	$2,036.80
Rate for Payer: Aetna Medicare Advantage	$1,608.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,366.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,366.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,072.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,366.80
Rate for Payer: Cigna Commercial	$2,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,297.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,179.20
Rate for Payer: Qualcare PPO/HMO/WC	$804.00
Rate for Payer: UnitedHealthcare Community & State	$129.18
Rate for Payer: Wellpoint Medicaid Managed Care	$142.04

TIBIAL POSTERIOR STAB SZ2 18MM

Facility

$5,360.00

Service Code	HCPCS C1776
Hospital Charge Code	270668732
Hospital Revenue Code	278
Min. Negotiated Rate	$804.00
Max. Negotiated Rate	$1,297.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,072.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,297.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,179.20
Rate for Payer: Qualcare PPO/HMO/WC	$804.00

TIBIAL POSTERIOR STAB. SZ2 22M

Facility

$4,284.65

Service Code	HCPCS C1776
Hospital Charge Code	270669871
Hospital Revenue Code	278
Min. Negotiated Rate	$642.70
Max. Negotiated Rate	$1,036.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.62
Rate for Payer: Qualcare PPO/HMO/WC	$642.70

TIBIAL POSTERIOR STAB. SZ2 22M

Facility

$4,284.65

Service Code	HCPCS C1776
Hospital Charge Code	270669871
Hospital Revenue Code	278
Min. Negotiated Rate	$103.26
Max. Negotiated Rate	$2,142.32
Rate for Payer: Aetna Commercial	$1,628.17
Rate for Payer: Aetna Medicare Advantage	$1,285.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.59
Rate for Payer: Cigna Commercial	$2,142.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.62
Rate for Payer: Qualcare PPO/HMO/WC	$642.70
Rate for Payer: UnitedHealthcare Community & State	$103.26
Rate for Payer: Wellpoint Medicaid Managed Care	$113.54

TIBIAL POSTERIOR STAB SZ3 13MM

Facility

$4,284.65

Service Code	HCPCS C1776
Hospital Charge Code	270670880
Hospital Revenue Code	278
Min. Negotiated Rate	$642.70
Max. Negotiated Rate	$1,036.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.62
Rate for Payer: Qualcare PPO/HMO/WC	$642.70

TIBIAL POSTERIOR STAB SZ3 13MM

Facility

$4,284.65

Service Code	HCPCS C1776
Hospital Charge Code	270670880
Hospital Revenue Code	278
Min. Negotiated Rate	$103.26
Max. Negotiated Rate	$2,142.32
Rate for Payer: Aetna Commercial	$1,628.17
Rate for Payer: Aetna Medicare Advantage	$1,285.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.59
Rate for Payer: Cigna Commercial	$2,142.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.62
Rate for Payer: Qualcare PPO/HMO/WC	$642.70
Rate for Payer: UnitedHealthcare Community & State	$103.26
Rate for Payer: Wellpoint Medicaid Managed Care	$113.54

TIBIAL POSTERIOR STAB SZ6 13MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677944
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 POSTERIOR STAB SZ6 13MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677944
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 POSTERIOR SZ1 26MM STAB

Facility

$5,360.00

Service Code	HCPCS C1776
Hospital Charge Code	270668730
Hospital Revenue Code	278
Min. Negotiated Rate	$129.18
Max. Negotiated Rate	$2,680.00
Rate for Payer: Aetna Commercial	$2,036.80
Rate for Payer: Aetna Medicare Advantage	$1,608.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,366.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,366.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,072.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,366.80
Rate for Payer: Cigna Commercial	$2,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,297.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,179.20
Rate for Payer: Qualcare PPO/HMO/WC	$804.00
Rate for Payer: UnitedHealthcare Community & State	$129.18
Rate for Payer: Wellpoint Medicaid Managed Care	$142.04

TIBIAL POSTERIOR SZ1 26MM STAB

Facility

$5,360.00

Service Code	HCPCS C1776
Hospital Charge Code	270668730
Hospital Revenue Code	278
Min. Negotiated Rate	$804.00
Max. Negotiated Rate	$1,297.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,072.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,297.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,179.20
Rate for Payer: Qualcare PPO/HMO/WC	$804.00

TIBIAL POSTERIOR SZ3 15MM STAB

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270668546
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 POSTERIOR SZ3 15MM STAB

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270668546
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 POST STB INSRT SZ0 11MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270680414
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

Know your out-of-pocket cost for care.

All Charges