Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DOWEL 10 MM CANNULATED

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688476
Hospital Revenue Code	278
Min. Negotiated Rate	$860.62
Max. Negotiated Rate	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,262.25
Rate for Payer: Qualcare PPO/HMO/WC	$860.62

DOWEL 10 MM CANNULATED

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688476
Hospital Revenue Code	278
Min. Negotiated Rate	$138.27
Max. Negotiated Rate	$2,868.75
Rate for Payer: Aetna Commercial	$2,180.25
Rate for Payer: Aetna Medicare Advantage	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,463.06
Rate for Payer: Cigna Commercial	$2,868.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,262.25
Rate for Payer: Qualcare PPO/HMO/WC	$860.62
Rate for Payer: UnitedHealthcare Community & State	$138.27
Rate for Payer: Wellpoint Medicaid Managed Care	$152.04

DOWEL 11 MM CANNULATED

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688475
Hospital Revenue Code	278
Min. Negotiated Rate	$138.27
Max. Negotiated Rate	$2,868.75
Rate for Payer: Aetna Commercial	$2,180.25
Rate for Payer: Aetna Medicare Advantage	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,463.06
Rate for Payer: Cigna Commercial	$2,868.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,262.25
Rate for Payer: Qualcare PPO/HMO/WC	$860.62
Rate for Payer: UnitedHealthcare Community & State	$138.27
Rate for Payer: Wellpoint Medicaid Managed Care	$152.04

DOWEL 11 MM CANNULATED

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688475
Hospital Revenue Code	278
Min. Negotiated Rate	$860.62
Max. Negotiated Rate	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,262.25
Rate for Payer: Qualcare PPO/HMO/WC	$860.62

DOWEL 9 MM CANNULATED

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688477
Hospital Revenue Code	278
Min. Negotiated Rate	$860.62
Max. Negotiated Rate	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,262.25
Rate for Payer: Qualcare PPO/HMO/WC	$860.62

DOWEL 9 MM CANNULATED

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688477
Hospital Revenue Code	278
Min. Negotiated Rate	$138.27
Max. Negotiated Rate	$2,868.75
Rate for Payer: Aetna Commercial	$2,180.25
Rate for Payer: Aetna Medicare Advantage	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,463.06
Rate for Payer: Cigna Commercial	$2,868.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,262.25
Rate for Payer: Qualcare PPO/HMO/WC	$860.62
Rate for Payer: UnitedHealthcare Community & State	$138.27
Rate for Payer: Wellpoint Medicaid Managed Care	$152.04

DOWEL ALLOGRAFT CORTICAL 5.0MM

Facility

$16,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270696629
Hospital Revenue Code	278
Min. Negotiated Rate	$2,437.50
Max. Negotiated Rate	$3,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,932.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,575.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,437.50

DOWEL ALLOGRAFT CORTICAL 5.0MM

Facility

$16,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270696629
Hospital Revenue Code	278
Min. Negotiated Rate	$391.62
Max. Negotiated Rate	$8,125.00
Rate for Payer: Aetna Commercial	$6,175.00
Rate for Payer: Aetna Medicare Advantage	$4,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,143.75
Rate for Payer: Cigna Commercial	$8,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,932.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,575.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,437.50
Rate for Payer: UnitedHealthcare Community & State	$391.62
Rate for Payer: Wellpoint Medicaid Managed Care	$430.62

DOWEL BONE THREADED 401-218

Facility

$9,424.00

Hospital Charge Code	270608931
Hospital Revenue Code	278
Min. Negotiated Rate	$1,413.60
Max. Negotiated Rate	$2,280.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,884.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,280.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,073.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.60

DOWEL BONE THREADED 401-218

Facility

$9,424.00

Hospital Charge Code	270608931
Hospital Revenue Code	278
Min. Negotiated Rate	$227.12
Max. Negotiated Rate	$4,712.00
Rate for Payer: Aetna Commercial	$3,581.12
Rate for Payer: Aetna Medicare Advantage	$2,827.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,403.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,403.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,884.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,403.12
Rate for Payer: Cigna Commercial	$4,712.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,280.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,073.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.60
Rate for Payer: UnitedHealthcare Community & State	$227.12
Rate for Payer: Wellpoint Medicaid Managed Care	$249.74

DOWEL BONE THRED 18x20 401-118

Facility

$9,424.00

Hospital Charge Code	270608156
Hospital Revenue Code	278
Min. Negotiated Rate	$1,413.60
Max. Negotiated Rate	$2,280.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,884.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,280.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,073.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.60

DOWEL BONE THRED 18x20 401-118

Facility

$9,424.00

Hospital Charge Code	270608156
Hospital Revenue Code	278
Min. Negotiated Rate	$227.12
Max. Negotiated Rate	$4,712.00
Rate for Payer: Aetna Commercial	$3,581.12
Rate for Payer: Aetna Medicare Advantage	$2,827.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,403.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,403.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,884.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,403.12
Rate for Payer: Cigna Commercial	$4,712.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,280.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,073.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.60
Rate for Payer: UnitedHealthcare Community & State	$227.12
Rate for Payer: Wellpoint Medicaid Managed Care	$249.74

DOWEL CANNUALTED 14 MMX 35 MM

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688473
Hospital Revenue Code	278
Min. Negotiated Rate	$860.62
Max. Negotiated Rate	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,262.25
Rate for Payer: Qualcare PPO/HMO/WC	$860.62

DOWEL CANNUALTED 14 MMX 35 MM

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688473
Hospital Revenue Code	278
Min. Negotiated Rate	$138.27
Max. Negotiated Rate	$2,868.75
Rate for Payer: Aetna Commercial	$2,180.25
Rate for Payer: Aetna Medicare Advantage	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,463.06
Rate for Payer: Cigna Commercial	$2,868.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,262.25
Rate for Payer: Qualcare PPO/HMO/WC	$860.62
Rate for Payer: UnitedHealthcare Community & State	$138.27
Rate for Payer: Wellpoint Medicaid Managed Care	$152.04

DOWEL CANNULATED 12 MM

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688474
Hospital Revenue Code	278
Min. Negotiated Rate	$138.27
Max. Negotiated Rate	$2,868.75
Rate for Payer: Aetna Commercial	$2,180.25
Rate for Payer: Aetna Medicare Advantage	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,463.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,463.06
Rate for Payer: Cigna Commercial	$2,868.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,262.25
Rate for Payer: Qualcare PPO/HMO/WC	$860.62
Rate for Payer: UnitedHealthcare Community & State	$138.27
Rate for Payer: Wellpoint Medicaid Managed Care	$152.04

DOWEL CANNULATED 12 MM

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270688474
Hospital Revenue Code	278
Min. Negotiated Rate	$860.62
Max. Negotiated Rate	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,262.25
Rate for Payer: Qualcare PPO/HMO/WC	$860.62

DOWEL CANNUL REVISION 11X27MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270693717
Hospital Revenue Code	278
Min. Negotiated Rate	$733.12
Max. Negotiated Rate	$1,182.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,075.25
Rate for Payer: Qualcare PPO/HMO/WC	$733.12

DOWEL CANNUL REVISION 11X27MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270693717
Hospital Revenue Code	278
Min. Negotiated Rate	$117.79
Max. Negotiated Rate	$2,443.75
Rate for Payer: Aetna Commercial	$1,857.25
Rate for Payer: Aetna Medicare Advantage	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,246.31
Rate for Payer: Cigna Commercial	$2,443.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,075.25
Rate for Payer: Qualcare PPO/HMO/WC	$733.12
Rate for Payer: UnitedHealthcare Community & State	$117.79
Rate for Payer: Wellpoint Medicaid Managed Care	$129.52

DOWEL CANNUL REVISION 12X28MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270693718
Hospital Revenue Code	278
Min. Negotiated Rate	$117.79
Max. Negotiated Rate	$2,443.75
Rate for Payer: Aetna Commercial	$1,857.25
Rate for Payer: Aetna Medicare Advantage	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,246.31
Rate for Payer: Cigna Commercial	$2,443.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,075.25
Rate for Payer: Qualcare PPO/HMO/WC	$733.12
Rate for Payer: UnitedHealthcare Community & State	$117.79
Rate for Payer: Wellpoint Medicaid Managed Care	$129.52

DOWEL CANNUL REVISION 12X28MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270693718
Hospital Revenue Code	278
Min. Negotiated Rate	$733.12
Max. Negotiated Rate	$1,182.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,075.25
Rate for Payer: Qualcare PPO/HMO/WC	$733.12

DOWEL CANNUL REVISION 13X29MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270693719
Hospital Revenue Code	278
Min. Negotiated Rate	$117.79
Max. Negotiated Rate	$2,443.75
Rate for Payer: Aetna Commercial	$1,857.25
Rate for Payer: Aetna Medicare Advantage	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,246.31
Rate for Payer: Cigna Commercial	$2,443.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,075.25
Rate for Payer: Qualcare PPO/HMO/WC	$733.12
Rate for Payer: UnitedHealthcare Community & State	$117.79
Rate for Payer: Wellpoint Medicaid Managed Care	$129.52

DOWEL CANNUL REVISION 13X29MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270693719
Hospital Revenue Code	278
Min. Negotiated Rate	$733.12
Max. Negotiated Rate	$1,182.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,075.25
Rate for Payer: Qualcare PPO/HMO/WC	$733.12

DOWEL CANNUL REVISION 14X29MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270693720
Hospital Revenue Code	278
Min. Negotiated Rate	$117.79
Max. Negotiated Rate	$2,443.75
Rate for Payer: Aetna Commercial	$1,857.25
Rate for Payer: Aetna Medicare Advantage	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,246.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,246.31
Rate for Payer: Cigna Commercial	$2,443.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,075.25
Rate for Payer: Qualcare PPO/HMO/WC	$733.12
Rate for Payer: UnitedHealthcare Community & State	$117.79
Rate for Payer: Wellpoint Medicaid Managed Care	$129.52

DOWEL CANNUL REVISION 14X29MM

Facility

$4,887.50

Service Code	HCPCS C1713
Hospital Charge Code	270693720
Hospital Revenue Code	278
Min. Negotiated Rate	$733.12
Max. Negotiated Rate	$1,182.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,182.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,075.25
Rate for Payer: Qualcare PPO/HMO/WC	$733.12

DOWEL CANNUL REVISION 16X35MM

Facility

$5,737.50

Service Code	HCPCS C1713
Hospital Charge Code	270693721
Hospital Revenue Code	278
Min. Negotiated Rate	$860.62
Max. Negotiated Rate	$1,388.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,388.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,262.25
Rate for Payer: Qualcare PPO/HMO/WC	$860.62

Know your out-of-pocket cost for care.

All Charges