Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

16MM CANNULATED PERC FLEX DRIL

Facility

$4,016.60

Hospital Charge Code	270681682
Hospital Revenue Code	272
Min. Negotiated Rate	$96.80
Max. Negotiated Rate	$2,008.30
Rate for Payer: Aetna Commercial	$1,526.31
Rate for Payer: Aetna Medicare Advantage	$1,204.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,024.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,024.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,024.23
Rate for Payer: Cigna Commercial	$2,008.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,204.98
Rate for Payer: Oxford Commercial	$803.32
Rate for Payer: Qualcare PPO/HMO/WC	$602.49
Rate for Payer: UnitedHealthcare Commercial	$803.32
Rate for Payer: UnitedHealthcare Community & State	$96.80
Rate for Payer: Wellpoint Medicaid Managed Care	$106.44

16MM FIXED SELF DRILLSCREW

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705108
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

16MM FIXED SELF DRILLSCREW

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705108
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

16MM SD FIXED SCREWS

Facility

$600.00

Service Code	HCPCS C1713
Hospital Charge Code	270703880
Hospital Revenue Code	278
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$132.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

16MM SD FIXED SCREWS

Facility

$600.00

Service Code	HCPCS C1713
Hospital Charge Code	270703880
Hospital Revenue Code	278
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$132.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

16MM SELF DRILLING SCREW

Facility

$425.00

Service Code	HCPCS C1713
Hospital Charge Code	270703789
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

16MM SELF DRILLING SCREW

Facility

$425.00

Service Code	HCPCS C1713
Hospital Charge Code	270703789
Hospital Revenue Code	278
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

1.6MM THREADED GUIDE WIRE 150M

Facility

$148.00

Service Code	HCPCS C1769
Hospital Charge Code	270604929
Hospital Revenue Code	278
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$74.00
Rate for Payer: Aetna Commercial	$56.24
Rate for Payer: Aetna Medicare Advantage	$44.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.74
Rate for Payer: Cigna Commercial	$74.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$32.56
Rate for Payer: Qualcare PPO/HMO/WC	$22.20
Rate for Payer: UnitedHealthcare Community & State	$3.57
Rate for Payer: Wellpoint Medicaid Managed Care	$3.92

1.6MM THREADED GUIDE WIRE 150M

Facility

$148.00

Service Code	HCPCS C1769
Hospital Charge Code	270604929
Hospital Revenue Code	278
Min. Negotiated Rate	$22.20
Max. Negotiated Rate	$35.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$32.56
Rate for Payer: Qualcare PPO/HMO/WC	$22.20

16MM UNIPLATE

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270669799
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

16MM UNIPLATE

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270669799
Hospital Revenue Code	278
Min. Negotiated Rate	$135.56
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$2,137.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Community & State	$135.56
Rate for Payer: Wellpoint Medicaid Managed Care	$149.06

16MM VARIABLE SELF DRILLSCREW

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705107
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

16MM VARIABLE SELF DRILLSCREW

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270705107
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

1.6MMX6IN PRTIL THRED TIP GIDE

Facility

$479.70

Hospital Charge Code	270663177
Hospital Revenue Code	270
Min. Negotiated Rate	$71.95
Max. Negotiated Rate	$71.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.95

1.6MMX6IN PRTIL THRED TIP GIDE

Facility

$479.70

Hospital Charge Code	270663177
Hospital Revenue Code	270
Min. Negotiated Rate	$11.56
Max. Negotiated Rate	$239.85
Rate for Payer: Aetna Commercial	$182.29
Rate for Payer: Aetna Medicare Advantage	$143.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.32
Rate for Payer: Cigna Commercial	$239.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.91
Rate for Payer: Oxford Commercial	$95.94
Rate for Payer: Qualcare PPO/HMO/WC	$71.95
Rate for Payer: UnitedHealthcare Commercial	$95.94
Rate for Payer: UnitedHealthcare Community & State	$11.56
Rate for Payer: Wellpoint Medicaid Managed Care	$12.71

16X13X6 INTERBODY SYS

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705953
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

16X13X6 INTERBODY SYS

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705953
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

16X14X7MM STATIC CERVICAL

Facility

$17,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270706197
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.50
Max. Negotiated Rate	$4,174.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50

16X14X7MM STATIC CERVICAL

Facility

$17,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270706197
Hospital Revenue Code	278
Min. Negotiated Rate	$415.73
Max. Negotiated Rate	$8,625.00
Rate for Payer: Aetna Commercial	$6,555.00
Rate for Payer: Aetna Medicare Advantage	$5,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,398.75
Rate for Payer: Cigna Commercial	$8,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50
Rate for Payer: UnitedHealthcare Community & State	$415.73
Rate for Payer: Wellpoint Medicaid Managed Care	$457.12

16X14X8MM STATIC CERVICAL

Facility

$17,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270706120
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.50
Max. Negotiated Rate	$4,174.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50

16X14X8MM STATIC CERVICAL

Facility

$17,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270706120
Hospital Revenue Code	278
Min. Negotiated Rate	$415.73
Max. Negotiated Rate	$8,625.00
Rate for Payer: Aetna Commercial	$6,555.00
Rate for Payer: Aetna Medicare Advantage	$5,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,398.75
Rate for Payer: Cigna Commercial	$8,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50
Rate for Payer: UnitedHealthcare Community & State	$415.73
Rate for Payer: Wellpoint Medicaid Managed Care	$457.12

1.6X58MM TW DRILL WKLG 26MM

Facility

$461.85

Hospital Charge Code	270705882
Hospital Revenue Code	279
Min. Negotiated Rate	$11.13
Max. Negotiated Rate	$230.93
Rate for Payer: Aetna Commercial	$175.50
Rate for Payer: Aetna Medicare Advantage	$138.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.77
Rate for Payer: Cigna Commercial	$230.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.56
Rate for Payer: Oxford Commercial	$92.37
Rate for Payer: Qualcare PPO/HMO/WC	$69.28
Rate for Payer: UnitedHealthcare Commercial	$92.37
Rate for Payer: UnitedHealthcare Community & State	$11.13
Rate for Payer: Wellpoint Medicaid Managed Care	$12.24

1.6X58MM TW DRILL WKLG 26MM

Facility

$461.85

Hospital Charge Code	270705882
Hospital Revenue Code	279
Min. Negotiated Rate	$69.28
Max. Negotiated Rate	$69.28
Rate for Payer: Qualcare PPO/HMO/WC	$69.28

1.6X5MM TW DRILL

Facility

$461.85

Hospital Charge Code	270705881
Hospital Revenue Code	279
Min. Negotiated Rate	$11.13
Max. Negotiated Rate	$230.93
Rate for Payer: Aetna Commercial	$175.50
Rate for Payer: Aetna Medicare Advantage	$138.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.77
Rate for Payer: Cigna Commercial	$230.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.56
Rate for Payer: Oxford Commercial	$92.37
Rate for Payer: Qualcare PPO/HMO/WC	$69.28
Rate for Payer: UnitedHealthcare Commercial	$92.37
Rate for Payer: UnitedHealthcare Community & State	$11.13
Rate for Payer: Wellpoint Medicaid Managed Care	$12.24

1.6X5MM TW DRILL

Facility

$461.85

Hospital Charge Code	270705881
Hospital Revenue Code	279
Min. Negotiated Rate	$69.28
Max. Negotiated Rate	$69.28
Rate for Payer: Qualcare PPO/HMO/WC	$69.28

Know your out-of-pocket cost for care.

All Charges