Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL TRAY FIXED SZ2 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676449
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

TIBIAL TRAY FIXED SZ2 LEFT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270676449
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TIBIAL TRAY FIXED SZ3 RT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675655
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

TIBIAL TRAY FIXED SZ3 RT

Facility

$5,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270675655
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TIBIAL TRAY INFINITY SZ 3 LNG

Facility

$17,240.00

Service Code	HCPCS C1776
Hospital Charge Code	270676973
Hospital Revenue Code	278
Min. Negotiated Rate	$2,586.00
Max. Negotiated Rate	$4,172.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,448.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,172.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,792.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,586.00

TIBIAL TRAY INFINITY SZ 3 LNG

Facility

$17,240.00

Service Code	HCPCS C1776
Hospital Charge Code	270676973
Hospital Revenue Code	278
Min. Negotiated Rate	$415.48
Max. Negotiated Rate	$8,620.00
Rate for Payer: Aetna Commercial	$6,551.20
Rate for Payer: Aetna Medicare Advantage	$5,172.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,396.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,396.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,448.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,396.20
Rate for Payer: Cigna Commercial	$8,620.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,172.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,792.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,586.00
Rate for Payer: UnitedHealthcare Community & State	$415.48
Rate for Payer: Wellpoint Medicaid Managed Care	$456.86

TIBIAL TRAY OFFSET 3F/3T

Facility

$11,513.25

Service Code	HCPCS C1776
Hospital Charge Code	270674855
Hospital Revenue Code	278
Min. Negotiated Rate	$277.47
Max. Negotiated Rate	$5,756.62
Rate for Payer: Aetna Commercial	$4,375.03
Rate for Payer: Aetna Medicare Advantage	$3,453.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,935.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,935.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,302.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,935.88
Rate for Payer: Cigna Commercial	$5,756.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,786.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,532.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,726.99
Rate for Payer: UnitedHealthcare Community & State	$277.47
Rate for Payer: Wellpoint Medicaid Managed Care	$305.10

TIBIAL TRAY OFFSET 3F/3T

Facility

$11,513.25

Service Code	HCPCS C1776
Hospital Charge Code	270674855
Hospital Revenue Code	278
Min. Negotiated Rate	$1,726.99
Max. Negotiated Rate	$2,786.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,302.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,786.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,532.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,726.99

TIBIAL TRAY PRIM 71mm W/LCK BR

Facility

$11,060.00

Service Code	HCPCS C1713
Hospital Charge Code	270646613
Hospital Revenue Code	278
Min. Negotiated Rate	$266.55
Max. Negotiated Rate	$5,530.00
Rate for Payer: Aetna Commercial	$4,202.80
Rate for Payer: Aetna Medicare Advantage	$3,318.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,820.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,820.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,212.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,820.30
Rate for Payer: Cigna Commercial	$5,530.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,676.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,433.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,659.00
Rate for Payer: UnitedHealthcare Community & State	$266.55
Rate for Payer: Wellpoint Medicaid Managed Care	$293.09

TIBIAL TRAY PRIM 71mm W/LCK BR

Facility

$11,060.00

Service Code	HCPCS C1713
Hospital Charge Code	270646613
Hospital Revenue Code	278
Min. Negotiated Rate	$1,659.00
Max. Negotiated Rate	$2,676.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,212.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,676.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,433.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,659.00

TIBIAL TRAY SZ 1 STD INFINITY

Facility

$22,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270670885
Hospital Revenue Code	278
Min. Negotiated Rate	$3,360.00
Max. Negotiated Rate	$5,420.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,420.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,928.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,360.00

TIBIAL TRAY SZ 1 STD INFINITY

Facility

$22,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270670885
Hospital Revenue Code	278
Min. Negotiated Rate	$539.84
Max. Negotiated Rate	$11,200.00
Rate for Payer: Aetna Commercial	$8,512.00
Rate for Payer: Aetna Medicare Advantage	$6,720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,712.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,712.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,712.00
Rate for Payer: Cigna Commercial	$11,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,420.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,928.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,360.00
Rate for Payer: UnitedHealthcare Community & State	$539.84
Rate for Payer: Wellpoint Medicaid Managed Care	$593.60

TIBIAL TRAY SZ 4

Facility

$65,168.10

Service Code	HCPCS C1713
Hospital Charge Code	270704971
Hospital Revenue Code	278
Min. Negotiated Rate	$9,775.22
Max. Negotiated Rate	$15,770.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,033.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,770.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,336.98
Rate for Payer: Qualcare PPO/HMO/WC	$9,775.22

TIBIAL TRAY SZ 4

Facility

$65,168.10

Service Code	HCPCS C1713
Hospital Charge Code	270704971
Hospital Revenue Code	278
Min. Negotiated Rate	$1,570.55
Max. Negotiated Rate	$32,584.05
Rate for Payer: Aetna Commercial	$24,763.88
Rate for Payer: Aetna Medicare Advantage	$19,550.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,617.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,617.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,617.87
Rate for Payer: Cigna Commercial	$32,584.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,770.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,336.98
Rate for Payer: Qualcare PPO/HMO/WC	$9,775.22
Rate for Payer: UnitedHealthcare Community & State	$1,570.55
Rate for Payer: Wellpoint Medicaid Managed Care	$1,726.95

TIBIAL TRAY SZ 5

Facility

$22,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270680022
Hospital Revenue Code	278
Min. Negotiated Rate	$539.84
Max. Negotiated Rate	$11,200.00
Rate for Payer: Aetna Commercial	$8,512.00
Rate for Payer: Aetna Medicare Advantage	$6,720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,712.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,712.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,712.00
Rate for Payer: Cigna Commercial	$11,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,420.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,928.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,360.00
Rate for Payer: UnitedHealthcare Community & State	$539.84
Rate for Payer: Wellpoint Medicaid Managed Care	$593.60

TIBIAL TRAY SZ 5

Facility

$22,400.00

Service Code	HCPCS C1776
Hospital Charge Code	270680022
Hospital Revenue Code	278
Min. Negotiated Rate	$3,360.00
Max. Negotiated Rate	$5,420.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,420.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,928.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,360.00

TIBIAL TRAY TRAPEZOID SZ 3F/4T

Facility

$8,903.25

Service Code	HCPCS C1776
Hospital Charge Code	270670753
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.49
Max. Negotiated Rate	$2,154.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,154.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,958.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.49

TIBIAL TRAY TRAPEZOID SZ 3F/4T

Facility

$8,903.25

Service Code	HCPCS C1776
Hospital Charge Code	270670753
Hospital Revenue Code	278
Min. Negotiated Rate	$214.57
Max. Negotiated Rate	$4,451.62
Rate for Payer: Aetna Commercial	$3,383.24
Rate for Payer: Aetna Medicare Advantage	$2,670.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,270.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,270.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,270.33
Rate for Payer: Cigna Commercial	$4,451.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,154.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,958.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.49
Rate for Payer: UnitedHealthcare Community & State	$214.57
Rate for Payer: Wellpoint Medicaid Managed Care	$235.94

TIBIAL TRAY TRAPEZOID SZ5F/5T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672124
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 TRAY TRAPEZOID SZ5F/5T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270672124
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 TRAY TRAP SZ1F/1T 2F/1T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270671565
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 TRAY TRAP SZ1F/1T 2F/1T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270671565
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 TRAY TRAP SZ1F/2T,2F/2T

Facility

$8,903.25

Service Code	HCPCS C1776
Hospital Charge Code	270668733
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.49
Max. Negotiated Rate	$2,154.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,154.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,958.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.49

TIBIAL TRAY TRAP SZ1F/2T,2F/2T

Facility

$8,903.25

Service Code	HCPCS C1776
Hospital Charge Code	270668733
Hospital Revenue Code	278
Min. Negotiated Rate	$214.57
Max. Negotiated Rate	$4,451.62
Rate for Payer: Aetna Commercial	$3,383.24
Rate for Payer: Aetna Medicare Advantage	$2,670.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,270.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,270.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,780.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,270.33
Rate for Payer: Cigna Commercial	$4,451.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,154.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,958.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,335.49
Rate for Payer: UnitedHealthcare Community & State	$214.57
Rate for Payer: Wellpoint Medicaid Managed Care	$235.94

TIBIAL TRAY TRAP SZ1F/3T 2F/3T

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270669784
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

Know your out-of-pocket cost for care.

All Charges