Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

Plastic Stents

Facility

$355.00

Service Code	HCPCS C2617
Hospital Charge Code	270685515
Hospital Revenue Code	278
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$85.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$78.10
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

PLASTIC SURGERY OVERNIGHT STAY

Facility

$580.00

Hospital Charge Code	1600175
Hospital Revenue Code	121
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$6,764.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,312.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,764.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

PLATE 100DEG TUBULAR 10 HOLE

Facility

$467.50

Service Code	HCPCS C1713
Hospital Charge Code	270688923
Hospital Revenue Code	278
Min. Negotiated Rate	$70.12
Max. Negotiated Rate	$113.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$70.12

PLATE 100DEG TUBULAR 10 HOLE

Facility

$467.50

Service Code	HCPCS C1713
Hospital Charge Code	270688923
Hospital Revenue Code	278
Min. Negotiated Rate	$11.27
Max. Negotiated Rate	$233.75
Rate for Payer: Aetna Commercial	$177.65
Rate for Payer: Aetna Medicare Advantage	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.21
Rate for Payer: Cigna Commercial	$233.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$70.12
Rate for Payer: UnitedHealthcare Community & State	$11.27
Rate for Payer: Wellpoint Medicaid Managed Care	$12.39

PLATE 100 DEG TUBULAR 7 HOLE

Facility

$440.00

Service Code	HCPCS C1713
Hospital Charge Code	270632799
Hospital Revenue Code	278
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$220.00
Rate for Payer: Aetna Commercial	$167.20
Rate for Payer: Aetna Medicare Advantage	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.20
Rate for Payer: Cigna Commercial	$220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$96.80
Rate for Payer: Qualcare PPO/HMO/WC	$66.00
Rate for Payer: UnitedHealthcare Community & State	$10.60
Rate for Payer: Wellpoint Medicaid Managed Care	$11.66

PLATE 100 DEG TUBULAR 7 HOLE

Facility

$440.00

Service Code	HCPCS C1713
Hospital Charge Code	270632799
Hospital Revenue Code	278
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$96.80
Rate for Payer: Qualcare PPO/HMO/WC	$66.00

PLATE 100 DEG TUBULAR 8 HOLE

Facility

$384.00

Service Code	HCPCS C1713
Hospital Charge Code	270682614
Hospital Revenue Code	278
Min. Negotiated Rate	$9.25
Max. Negotiated Rate	$192.00
Rate for Payer: Aetna Commercial	$145.92
Rate for Payer: Aetna Medicare Advantage	$115.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.92
Rate for Payer: Cigna Commercial	$192.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$84.48
Rate for Payer: Qualcare PPO/HMO/WC	$57.60
Rate for Payer: UnitedHealthcare Community & State	$9.25
Rate for Payer: Wellpoint Medicaid Managed Care	$10.18

PLATE 100 DEG TUBULAR 8 HOLE

Facility

$384.00

Service Code	HCPCS C1713
Hospital Charge Code	270682614
Hospital Revenue Code	278
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$92.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$84.48
Rate for Payer: Qualcare PPO/HMO/WC	$57.60

PLATE 10 HOLE RIGHT DISTAL TIB

Facility

$11,065.00

Hospital Charge Code	270671354
Hospital Revenue Code	278
Min. Negotiated Rate	$1,659.75
Max. Negotiated Rate	$2,677.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,213.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,677.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,434.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,659.75

PLATE 10 HOLE RIGHT DISTAL TIB

Facility

$11,065.00

Hospital Charge Code	270671354
Hospital Revenue Code	278
Min. Negotiated Rate	$266.67
Max. Negotiated Rate	$5,532.50
Rate for Payer: Aetna Commercial	$4,204.70
Rate for Payer: Aetna Medicare Advantage	$3,319.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,821.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,821.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,821.57
Rate for Payer: Cigna Commercial	$5,532.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,677.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,434.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,659.75
Rate for Payer: UnitedHealthcare Community & State	$266.67
Rate for Payer: Wellpoint Medicaid Managed Care	$293.22

PLATE 10 HOLE RT CLAV SUP 110M

Facility

$9,801.05

Service Code	HCPCS C1713
Hospital Charge Code	270703717
Hospital Revenue Code	278
Min. Negotiated Rate	$1,470.16
Max. Negotiated Rate	$2,371.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,960.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,371.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,156.23
Rate for Payer: Qualcare PPO/HMO/WC	$1,470.16

PLATE 10 HOLE RT CLAV SUP 110M

Facility

$9,801.05

Service Code	HCPCS C1713
Hospital Charge Code	270703717
Hospital Revenue Code	278
Min. Negotiated Rate	$236.21
Max. Negotiated Rate	$4,900.52
Rate for Payer: Aetna Commercial	$3,724.40
Rate for Payer: Aetna Medicare Advantage	$2,940.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,499.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,499.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,960.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,499.27
Rate for Payer: Cigna Commercial	$4,900.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,371.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,156.23
Rate for Payer: Qualcare PPO/HMO/WC	$1,470.16
Rate for Payer: UnitedHealthcare Community & State	$236.21
Rate for Payer: Wellpoint Medicaid Managed Care	$259.73

PLATE 10MM

Facility

$12,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270688570
Hospital Revenue Code	278
Min. Negotiated Rate	$295.83
Max. Negotiated Rate	$6,137.50
Rate for Payer: Aetna Commercial	$4,664.50
Rate for Payer: Aetna Medicare Advantage	$3,682.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,130.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,130.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,455.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,130.12
Rate for Payer: Cigna Commercial	$6,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,970.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,700.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,841.25
Rate for Payer: UnitedHealthcare Community & State	$295.83
Rate for Payer: Wellpoint Medicaid Managed Care	$325.29

PLATE 10MM

Facility

$12,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270688570
Hospital Revenue Code	278
Min. Negotiated Rate	$1,841.25
Max. Negotiated Rate	$2,970.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,455.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,970.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,700.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,841.25

PLATE 10MM DOGBONE

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270690341
Hospital Revenue Code	278
Min. Negotiated Rate	$240.40
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$3,790.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,194.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25
Rate for Payer: UnitedHealthcare Community & State	$240.40
Rate for Payer: Wellpoint Medicaid Managed Care	$264.34

PLATE 10MM DOGBONE

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270690341
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,194.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

PLATE 12HOLE 1.5mm

Facility

$1,023.00

Hospital Charge Code	270656590
Hospital Revenue Code	278
Min. Negotiated Rate	$24.65
Max. Negotiated Rate	$511.50
Rate for Payer: Aetna Commercial	$388.74
Rate for Payer: Aetna Medicare Advantage	$306.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$260.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$260.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$204.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$260.87
Rate for Payer: Cigna Commercial	$511.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.06
Rate for Payer: Qualcare PPO/HMO/WC	$153.45
Rate for Payer: UnitedHealthcare Community & State	$24.65
Rate for Payer: Wellpoint Medicaid Managed Care	$27.11

PLATE 12HOLE 1.5mm

Facility

$1,023.00

Hospital Charge Code	270656590
Hospital Revenue Code	278
Min. Negotiated Rate	$153.45
Max. Negotiated Rate	$247.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$204.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.06
Rate for Payer: Qualcare PPO/HMO/WC	$153.45

PLATE 12 HOLE STR 2.0MM

Facility

$2,542.95

Service Code	HCPCS C1713
Hospital Charge Code	270686760
Hospital Revenue Code	278
Min. Negotiated Rate	$381.44
Max. Negotiated Rate	$615.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$508.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$615.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$559.45
Rate for Payer: Qualcare PPO/HMO/WC	$381.44

PLATE 12 HOLE STR 2.0MM

Facility

$2,542.95

Service Code	HCPCS C1713
Hospital Charge Code	270686760
Hospital Revenue Code	278
Min. Negotiated Rate	$61.29
Max. Negotiated Rate	$1,271.47
Rate for Payer: Aetna Commercial	$966.32
Rate for Payer: Aetna Medicare Advantage	$762.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$648.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$648.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$508.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$648.45
Rate for Payer: Cigna Commercial	$1,271.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$615.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$559.45
Rate for Payer: Qualcare PPO/HMO/WC	$381.44
Rate for Payer: UnitedHealthcare Community & State	$61.29
Rate for Payer: Wellpoint Medicaid Managed Care	$67.39

PLATE 12 MM

Facility

$5,000.00

Service Code	HCPCS C1716
Hospital Charge Code	270701785
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

PLATE 12 MM

Facility

$5,000.00

Service Code	HCPCS C1716
Hospital Charge Code	270701785
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,155.71
Rate for Payer: Aetna Commercial	$1,624.38
Rate for Payer: Aetna Medicare Advantage	$1,934.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$597.20
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	$2,155.71
Rate for Payer: Cigna Commercial	$1,197.08
Rate for Payer: Cigna Medicare Advantage	$597.20
Rate for Payer: Clover Medicare Advantage	$567.34
Rate for Payer: EmblemHealth Commercial	$1,791.60
Rate for Payer: Humana Medicare Advantage	$615.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$597.20
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: UnitedHealthcare Medicare Advantage	$597.20
Rate for Payer: Wellcare Medicare Advantage	$597.20
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

PLATE 12MM

Facility

$4,750.00

Hospital Charge Code	270703037
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

PLATE 12MM

Facility

$4,750.00

Hospital Charge Code	270703037
Hospital Revenue Code	278
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

PLATE 1/3 TUB 10 HOLES/121MM

Facility

$318.25

Service Code	HCPCS C1713
Hospital Charge Code	270655690
Hospital Revenue Code	278
Min. Negotiated Rate	$7.67
Max. Negotiated Rate	$159.12
Rate for Payer: Aetna Commercial	$120.94
Rate for Payer: Aetna Medicare Advantage	$95.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.15
Rate for Payer: Cigna Commercial	$159.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$70.02
Rate for Payer: Qualcare PPO/HMO/WC	$47.74
Rate for Payer: UnitedHealthcare Community & State	$7.67
Rate for Payer: Wellpoint Medicaid Managed Care	$8.43

Know your out-of-pocket cost for care.

All Charges