Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 POST STB INSRT SZ1 22MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270673368
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 POST STB INSRT SZ1 22MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270673368
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 POST STB INSRT SZ4 13MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672121
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 POST STB INSRT SZ4 13MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672121
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 SZ4 15MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677536
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 POST STB INSRT SZ4 15MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270677536
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 POST STB INSRT SZ4 18MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270673794
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 POST STB INSRT SZ4 18MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270673794
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 POST STB INSRT SZ5 11MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672123
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 SZ5 11MM

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672123
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 POST STB INSRT SZ5 13MM

Facility

$3,500.00

Hospital Charge Code	270676256
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 POST STB INSRT SZ5 13MM

Facility

$3,500.00

Hospital Charge Code	270676256
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 POST SZ1 15MM STAB

Facility

$5,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270668437
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 POST SZ1 15MM STAB

Facility

$5,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270668437
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 PREP KIT SZ4 CR

Facility

$1,750.00

Hospital Charge Code	270698201
Hospital Revenue Code	272
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$525.00
Rate for Payer: Oxford Commercial	$350.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Commercial	$350.00
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

TIBIAL PREP KIT SZ4 CR

Facility

$1,750.00

Hospital Charge Code	270698201
Hospital Revenue Code	272
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

TIBIAL PROPHECY ALIGNMENT

Facility

$6,095.00

Service Code	HCPCS C1776
Hospital Charge Code	270670900
Hospital Revenue Code	278
Min. Negotiated Rate	$146.89
Max. Negotiated Rate	$3,047.50
Rate for Payer: Aetna Commercial	$2,316.10
Rate for Payer: Aetna Medicare Advantage	$1,828.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,554.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,554.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,219.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,554.22
Rate for Payer: Cigna Commercial	$3,047.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,474.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,340.90
Rate for Payer: Qualcare PPO/HMO/WC	$914.25
Rate for Payer: UnitedHealthcare Community & State	$146.89
Rate for Payer: Wellpoint Medicaid Managed Care	$161.52

TIBIAL PROPHECY ALIGNMENT

Facility

$6,095.00

Service Code	HCPCS C1776
Hospital Charge Code	270670900
Hospital Revenue Code	278
Min. Negotiated Rate	$914.25
Max. Negotiated Rate	$1,474.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,219.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,474.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,340.90
Rate for Payer: Qualcare PPO/HMO/WC	$914.25

TIBIAL PSN REV HALF BLOCK 5 MM

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270690104
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

TIBIAL PSN REV HALF BLOCK 5 MM

Facility

$7,975.00

Service Code	HCPCS C1776
Hospital Charge Code	270690104
Hospital Revenue Code	278
Min. Negotiated Rate	$192.20
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$192.20
Rate for Payer: Wellpoint Medicaid Managed Care	$211.34

TIBIAL SOFT TISSUE FASTENER

Facility

$3,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270679465
Hospital Revenue Code	278
Min. Negotiated Rate	$558.00
Max. Negotiated Rate	$900.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$744.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$900.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$818.40
Rate for Payer: Qualcare PPO/HMO/WC	$558.00

TIBIAL SOFT TISSUE FASTENER

Facility

$3,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270679465
Hospital Revenue Code	278
Min. Negotiated Rate	$89.65
Max. Negotiated Rate	$1,860.00
Rate for Payer: Aetna Commercial	$1,413.60
Rate for Payer: Aetna Medicare Advantage	$1,116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$948.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$948.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$948.60
Rate for Payer: Cigna Commercial	$1,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$900.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$818.40
Rate for Payer: Qualcare PPO/HMO/WC	$558.00
Rate for Payer: UnitedHealthcare Community & State	$89.65
Rate for Payer: Wellpoint Medicaid Managed Care	$98.58

TIBIAL SPACER MOLD 70x42MM

Facility

$3,785.00

Service Code	HCPCS C1776
Hospital Charge Code	270672773
Hospital Revenue Code	278
Min. Negotiated Rate	$91.22
Max. Negotiated Rate	$1,892.50
Rate for Payer: Aetna Commercial	$1,438.30
Rate for Payer: Aetna Medicare Advantage	$1,135.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$965.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$965.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$757.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$965.17
Rate for Payer: Cigna Commercial	$1,892.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$915.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$832.70
Rate for Payer: Qualcare PPO/HMO/WC	$567.75
Rate for Payer: UnitedHealthcare Community & State	$91.22
Rate for Payer: Wellpoint Medicaid Managed Care	$100.30

TIBIAL SPACER MOLD 70x42MM

Facility

$3,785.00

Service Code	HCPCS C1776
Hospital Charge Code	270672773
Hospital Revenue Code	278
Min. Negotiated Rate	$567.75
Max. Negotiated Rate	$915.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$757.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$915.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$832.70
Rate for Payer: Qualcare PPO/HMO/WC	$567.75

Know your out-of-pocket cost for care.

All Charges