Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TIBIA TOTAL ANKLE SZ2

Facility

$20,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677296
Hospital Revenue Code	278
Min. Negotiated Rate	$482.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$482.00
Rate for Payer: Wellpoint Medicaid Managed Care	$530.00

TIBIA TOTAL ANKLE SZ2

Facility

$20,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677296
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

TIBIA TOTAL ANKLE SZ4

Facility

$20,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678163
Hospital Revenue Code	278
Min. Negotiated Rate	$482.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$482.00
Rate for Payer: Wellpoint Medicaid Managed Care	$530.00

TIBIA TOTAL ANKLE SZ4

Facility

$20,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678163
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

TIBIA TOTAL ANKLE SZ4 +0MM

Facility

$11,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270678161
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

TIBIA TOTAL ANKLE SZ4 +0MM

Facility

$11,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270678161
Hospital Revenue Code	278
Min. Negotiated Rate	$271.12
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50
Rate for Payer: UnitedHealthcare Community & State	$271.12
Rate for Payer: Wellpoint Medicaid Managed Care	$298.12

TIBIA TRIAL VA 3.5 MM SM 3H LT

Facility

$2,189.70

Service Code	HCPCS C1776
Hospital Charge Code	270686032
Hospital Revenue Code	278
Min. Negotiated Rate	$52.77
Max. Negotiated Rate	$1,094.85
Rate for Payer: Aetna Commercial	$832.09
Rate for Payer: Aetna Medicare Advantage	$656.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$558.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$558.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$437.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$558.37
Rate for Payer: Cigna Commercial	$1,094.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$529.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$481.73
Rate for Payer: Qualcare PPO/HMO/WC	$328.45
Rate for Payer: UnitedHealthcare Community & State	$52.77
Rate for Payer: Wellpoint Medicaid Managed Care	$58.03

TIBIA TRIAL VA 3.5 MM SM 3H LT

Facility

$2,189.70

Service Code	HCPCS C1776
Hospital Charge Code	270686032
Hospital Revenue Code	278
Min. Negotiated Rate	$328.45
Max. Negotiated Rate	$529.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$437.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$529.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$481.73
Rate for Payer: Qualcare PPO/HMO/WC	$328.45

TIBIA TRIAL VA 3.5 MM SM 3H RT

Facility

$2,189.70

Service Code	HCPCS C1776
Hospital Charge Code	270686031
Hospital Revenue Code	278
Min. Negotiated Rate	$52.77
Max. Negotiated Rate	$1,094.85
Rate for Payer: Aetna Commercial	$832.09
Rate for Payer: Aetna Medicare Advantage	$656.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$558.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$558.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$437.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$558.37
Rate for Payer: Cigna Commercial	$1,094.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$529.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$481.73
Rate for Payer: Qualcare PPO/HMO/WC	$328.45
Rate for Payer: UnitedHealthcare Community & State	$52.77
Rate for Payer: Wellpoint Medicaid Managed Care	$58.03

TIBIA TRIAL VA 3.5 MM SM 3H RT

Facility

$2,189.70

Service Code	HCPCS C1776
Hospital Charge Code	270686031
Hospital Revenue Code	278
Min. Negotiated Rate	$328.45
Max. Negotiated Rate	$529.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$437.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$529.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$481.73
Rate for Payer: Qualcare PPO/HMO/WC	$328.45

TIBIA UNIVERSAL SZ6 LT EMPOWR

Facility

$10,337.50

Service Code	HCPCS C1776
Hospital Charge Code	270692549
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.62
Max. Negotiated Rate	$2,501.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,067.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,501.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,274.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,550.62

TIBIA UNIVERSAL SZ6 LT EMPOWR

Facility

$10,337.50

Service Code	HCPCS C1776
Hospital Charge Code	270692549
Hospital Revenue Code	278
Min. Negotiated Rate	$249.13
Max. Negotiated Rate	$5,168.75
Rate for Payer: Aetna Commercial	$3,928.25
Rate for Payer: Aetna Medicare Advantage	$3,101.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,636.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,636.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,067.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,636.06
Rate for Payer: Cigna Commercial	$5,168.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,501.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,274.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,550.62
Rate for Payer: UnitedHealthcare Community & State	$249.13
Rate for Payer: Wellpoint Medicaid Managed Care	$273.94

TIBIA Z NAIL 10MM X 30CM

Facility

$9,415.00

Hospital Charge Code	270658849
Hospital Revenue Code	278
Min. Negotiated Rate	$1,412.25
Max. Negotiated Rate	$2,278.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,883.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,278.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,071.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,412.25

TIBIA Z NAIL 10MM X 30CM

Facility

$9,415.00

Hospital Charge Code	270658849
Hospital Revenue Code	278
Min. Negotiated Rate	$226.90
Max. Negotiated Rate	$4,707.50
Rate for Payer: Aetna Commercial	$3,577.70
Rate for Payer: Aetna Medicare Advantage	$2,824.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,400.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,400.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,883.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,400.82
Rate for Payer: Cigna Commercial	$4,707.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,278.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,071.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,412.25
Rate for Payer: UnitedHealthcare Community & State	$226.90
Rate for Payer: Wellpoint Medicaid Managed Care	$249.50

TIBILA BEARING 67MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270681761
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

TIBILA BEARING 67MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270681761
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

TIBILA BEARING 75 MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270687124
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

TIBILA BEARING 75 MM

Facility

$5,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270687124
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

TIBILA BEARING CONDYL 63/67x16

Facility

$12,930.00

Hospital Charge Code	270676087
Hospital Revenue Code	278
Min. Negotiated Rate	$1,939.50
Max. Negotiated Rate	$3,129.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,586.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,129.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,844.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,939.50

TIBILA BEARING CONDYL 63/67x16

Facility

$12,930.00

Hospital Charge Code	270676087
Hospital Revenue Code	278
Min. Negotiated Rate	$311.61
Max. Negotiated Rate	$6,465.00
Rate for Payer: Aetna Commercial	$4,913.40
Rate for Payer: Aetna Medicare Advantage	$3,879.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,297.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,297.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,586.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,297.15
Rate for Payer: Cigna Commercial	$6,465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,129.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,844.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,939.50
Rate for Payer: UnitedHealthcare Community & State	$311.61
Rate for Payer: Wellpoint Medicaid Managed Care	$342.64

TIBILA CUTTING BLOCK

Facility

$500.00

Hospital Charge Code	270678757
Hospital Revenue Code	272
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

TIBILA CUTTING BLOCK

Facility

$500.00

Hospital Charge Code	270678757
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

TIB INSERT ANKLE TMPROLONGSZ5

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697191
Hospital Revenue Code	278
Min. Negotiated Rate	$277.15
Max. Negotiated Rate	$5,750.00
Rate for Payer: Aetna Commercial	$4,370.00
Rate for Payer: Aetna Medicare Advantage	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,932.50
Rate for Payer: Cigna Commercial	$5,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,530.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00
Rate for Payer: UnitedHealthcare Community & State	$277.15
Rate for Payer: Wellpoint Medicaid Managed Care	$304.75

TIB INSERT ANKLE TMPROLONGSZ5

Facility

$11,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697191
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$2,783.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,783.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,530.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,725.00

TIB INS POST STAB SZ 2 11MM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697208
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

Know your out-of-pocket cost for care.

All Charges