Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

23 X 16 CORTICAL SCREW

Facility

$475.00

Service Code	HCPCS C1713
Hospital Charge Code	270656435
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

2.3 X 16MM LOCK SCREW

Facility

$540.00

Service Code	HCPCS C1713
Hospital Charge Code	270656005
Hospital Revenue Code	278
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$130.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$118.80
Rate for Payer: Qualcare PPO/HMO/WC	$81.00

2.3 X 16MM LOCK SCREW

Facility

$540.00

Service Code	HCPCS C1713
Hospital Charge Code	270656005
Hospital Revenue Code	278
Min. Negotiated Rate	$13.01
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna Commercial	$205.20
Rate for Payer: Aetna Medicare Advantage	$162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$137.70
Rate for Payer: Cigna Commercial	$270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$118.80
Rate for Payer: Qualcare PPO/HMO/WC	$81.00
Rate for Payer: UnitedHealthcare Community & State	$13.01
Rate for Payer: Wellpoint Medicaid Managed Care	$14.31

2.3 X 16 SOLID SCREW

Facility

$240.00

Hospital Charge Code	270662472
Hospital Revenue Code	278
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Community & State	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

2.3 X 16 SOLID SCREW

Facility

$240.00

Hospital Charge Code	270662472
Hospital Revenue Code	278
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

2.3 X 16 SOLID SCREW

Facility

$465.00

Hospital Charge Code	270662539
Hospital Revenue Code	278
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$112.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$102.30
Rate for Payer: Qualcare PPO/HMO/WC	$69.75

2.3 X 16 SOLID SCREW

Facility

$465.00

Hospital Charge Code	270662539
Hospital Revenue Code	278
Min. Negotiated Rate	$11.21
Max. Negotiated Rate	$232.50
Rate for Payer: Aetna Commercial	$176.70
Rate for Payer: Aetna Medicare Advantage	$139.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.58
Rate for Payer: Cigna Commercial	$232.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$102.30
Rate for Payer: Qualcare PPO/HMO/WC	$69.75
Rate for Payer: UnitedHealthcare Community & State	$11.21
Rate for Payer: Wellpoint Medicaid Managed Care	$12.32

2.3 X 18 CANNULATED SCREW

Facility

$680.00

Hospital Charge Code	270656424
Hospital Revenue Code	278
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$164.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.60
Rate for Payer: Qualcare PPO/HMO/WC	$102.00

2.3 X 18 CANNULATED SCREW

Facility

$680.00

Hospital Charge Code	270656424
Hospital Revenue Code	278
Min. Negotiated Rate	$16.39
Max. Negotiated Rate	$340.00
Rate for Payer: Aetna Commercial	$258.40
Rate for Payer: Aetna Medicare Advantage	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.40
Rate for Payer: Cigna Commercial	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.60
Rate for Payer: Qualcare PPO/HMO/WC	$102.00
Rate for Payer: UnitedHealthcare Community & State	$16.39
Rate for Payer: Wellpoint Medicaid Managed Care	$18.02

2.3 X 18 CORTICAL SCREW

Facility

$465.00

Service Code	HCPCS C1713
Hospital Charge Code	270656436
Hospital Revenue Code	278
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$112.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$102.30
Rate for Payer: Qualcare PPO/HMO/WC	$69.75

2.3 X 18 CORTICAL SCREW

Facility

$465.00

Service Code	HCPCS C1713
Hospital Charge Code	270656436
Hospital Revenue Code	278
Min. Negotiated Rate	$11.21
Max. Negotiated Rate	$232.50
Rate for Payer: Aetna Commercial	$176.70
Rate for Payer: Aetna Medicare Advantage	$139.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.58
Rate for Payer: Cigna Commercial	$232.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$102.30
Rate for Payer: Qualcare PPO/HMO/WC	$69.75
Rate for Payer: UnitedHealthcare Community & State	$11.21
Rate for Payer: Wellpoint Medicaid Managed Care	$12.32

2.3 X 20 CANNULATED SCREW

Facility

$680.00

Service Code	HCPCS C1713
Hospital Charge Code	270656425
Hospital Revenue Code	278
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$164.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.60
Rate for Payer: Qualcare PPO/HMO/WC	$102.00

2.3 X 20 CANNULATED SCREW

Facility

$680.00

Service Code	HCPCS C1713
Hospital Charge Code	270656425
Hospital Revenue Code	278
Min. Negotiated Rate	$16.39
Max. Negotiated Rate	$340.00
Rate for Payer: Aetna Commercial	$258.40
Rate for Payer: Aetna Medicare Advantage	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.40
Rate for Payer: Cigna Commercial	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.60
Rate for Payer: Qualcare PPO/HMO/WC	$102.00
Rate for Payer: UnitedHealthcare Community & State	$16.39
Rate for Payer: Wellpoint Medicaid Managed Care	$18.02

2.3X20 CORTICAL SCREW

Facility

$325.00

Service Code	HCPCS C1713
Hospital Charge Code	270656440
Hospital Revenue Code	278
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$162.50
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare Advantage	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.88
Rate for Payer: Cigna Commercial	$162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$48.75
Rate for Payer: UnitedHealthcare Community & State	$7.83
Rate for Payer: Wellpoint Medicaid Managed Care	$8.61

2.3X20 CORTICAL SCREW

Facility

$325.00

Service Code	HCPCS C1713
Hospital Charge Code	270656440
Hospital Revenue Code	278
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$78.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

2.3 X 20 LOCKING SCREW

Facility

$520.00

Hospital Charge Code	270665466
Hospital Revenue Code	278
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$125.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.40
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

2.3 X 20 LOCKING SCREW

Facility

$520.00

Hospital Charge Code	270665466
Hospital Revenue Code	278
Min. Negotiated Rate	$12.53
Max. Negotiated Rate	$260.00
Rate for Payer: Aetna Commercial	$197.60
Rate for Payer: Aetna Medicare Advantage	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.60
Rate for Payer: Cigna Commercial	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.40
Rate for Payer: Qualcare PPO/HMO/WC	$78.00
Rate for Payer: UnitedHealthcare Community & State	$12.53
Rate for Payer: Wellpoint Medicaid Managed Care	$13.78

2.3 X 22 CANNULATED SCREW

Facility

$680.00

Hospital Charge Code	270656426
Hospital Revenue Code	278
Min. Negotiated Rate	$16.39
Max. Negotiated Rate	$340.00
Rate for Payer: Aetna Commercial	$258.40
Rate for Payer: Aetna Medicare Advantage	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.40
Rate for Payer: Cigna Commercial	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.60
Rate for Payer: Qualcare PPO/HMO/WC	$102.00
Rate for Payer: UnitedHealthcare Community & State	$16.39
Rate for Payer: Wellpoint Medicaid Managed Care	$18.02

2.3 X 22 CANNULATED SCREW

Facility

$680.00

Hospital Charge Code	270656426
Hospital Revenue Code	278
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$164.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.60
Rate for Payer: Qualcare PPO/HMO/WC	$102.00

2.3 X 22 CORTICAL SCREW

Facility

$465.00

Service Code	HCPCS C1713
Hospital Charge Code	270656427
Hospital Revenue Code	278
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$112.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$102.30
Rate for Payer: Qualcare PPO/HMO/WC	$69.75

2.3 X 22 CORTICAL SCREW

Facility

$465.00

Service Code	HCPCS C1713
Hospital Charge Code	270656427
Hospital Revenue Code	278
Min. Negotiated Rate	$11.21
Max. Negotiated Rate	$232.50
Rate for Payer: Aetna Commercial	$176.70
Rate for Payer: Aetna Medicare Advantage	$139.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.58
Rate for Payer: Cigna Commercial	$232.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$102.30
Rate for Payer: Qualcare PPO/HMO/WC	$69.75
Rate for Payer: UnitedHealthcare Community & State	$11.21
Rate for Payer: Wellpoint Medicaid Managed Care	$12.32

2.3X24 CORTICAL SCRW

Facility

$465.00

Hospital Charge Code	270656442
Hospital Revenue Code	278
Min. Negotiated Rate	$11.21
Max. Negotiated Rate	$232.50
Rate for Payer: Aetna Commercial	$176.70
Rate for Payer: Aetna Medicare Advantage	$139.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.58
Rate for Payer: Cigna Commercial	$232.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$102.30
Rate for Payer: Qualcare PPO/HMO/WC	$69.75
Rate for Payer: UnitedHealthcare Community & State	$11.21
Rate for Payer: Wellpoint Medicaid Managed Care	$12.32

2.3X24 CORTICAL SCRW

Facility

$465.00

Hospital Charge Code	270656442
Hospital Revenue Code	278
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$112.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$102.30
Rate for Payer: Qualcare PPO/HMO/WC	$69.75

2.3X28MM LOCKING SCREW

Facility

$470.00

Hospital Charge Code	270656012
Hospital Revenue Code	278
Min. Negotiated Rate	$11.33
Max. Negotiated Rate	$235.00
Rate for Payer: Aetna Commercial	$178.60
Rate for Payer: Aetna Medicare Advantage	$141.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.85
Rate for Payer: Cigna Commercial	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$103.40
Rate for Payer: Qualcare PPO/HMO/WC	$70.50
Rate for Payer: UnitedHealthcare Community & State	$11.33
Rate for Payer: Wellpoint Medicaid Managed Care	$12.46

2.3X28MM LOCKING SCREW

Facility

$470.00

Hospital Charge Code	270656012
Hospital Revenue Code	278
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$113.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$103.40
Rate for Payer: Qualcare PPO/HMO/WC	$70.50

Know your out-of-pocket cost for care.

All Charges