Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$47.74
Max. Negotiated Rate	$77.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.65
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

PLATE 1/3 TUB 2HOLES/25MM

Facility

$245.65

Service Code	HCPCS C1713
Hospital Charge Code	270655674
Hospital Revenue Code	278
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$122.83
Rate for Payer: Aetna Commercial	$93.35
Rate for Payer: Aetna Medicare Advantage	$73.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.64
Rate for Payer: Cigna Commercial	$122.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.04
Rate for Payer: Qualcare PPO/HMO/WC	$36.85
Rate for Payer: UnitedHealthcare Community & State	$5.92
Rate for Payer: Wellpoint Medicaid Managed Care	$6.51

PLATE 1/3 TUB 2HOLES/25MM

Facility

$245.65

Service Code	HCPCS C1713
Hospital Charge Code	270655674
Hospital Revenue Code	278
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$59.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.04
Rate for Payer: Qualcare PPO/HMO/WC	$36.85

PLATE 1/3 TUB 3HOLES/37MM

Facility

$251.85

Service Code	HCPCS C1713
Hospital Charge Code	270655676
Hospital Revenue Code	278
Min. Negotiated Rate	$37.78
Max. Negotiated Rate	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.41
Rate for Payer: Qualcare PPO/HMO/WC	$37.78

PLATE 1/3 TUB 3HOLES/37MM

Facility

$251.85

Service Code	HCPCS C1713
Hospital Charge Code	270655676
Hospital Revenue Code	278
Min. Negotiated Rate	$6.07
Max. Negotiated Rate	$125.92
Rate for Payer: Aetna Commercial	$95.70
Rate for Payer: Aetna Medicare Advantage	$75.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.22
Rate for Payer: Cigna Commercial	$125.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.41
Rate for Payer: Qualcare PPO/HMO/WC	$37.78
Rate for Payer: UnitedHealthcare Community & State	$6.07
Rate for Payer: Wellpoint Medicaid Managed Care	$6.67

PLATE 1/3 TUB 4HOLES/49MM

Facility

$318.25

Service Code	HCPCS C1713
Hospital Charge Code	270655678
Hospital Revenue Code	278
Min. Negotiated Rate	$47.74
Max. Negotiated Rate	$77.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.65
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

PLATE 1/3 TUB 4HOLES/49MM

Facility

$318.25

Service Code	HCPCS C1713
Hospital Charge Code	270655678
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

PLATE 1/3 TUB 6 HOLES/73MM

Facility

$307.45

Service Code	HCPCS C1713
Hospital Charge Code	270655682
Hospital Revenue Code	278
Min. Negotiated Rate	$7.41
Max. Negotiated Rate	$153.72
Rate for Payer: Aetna Commercial	$116.83
Rate for Payer: Aetna Medicare Advantage	$92.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.40
Rate for Payer: Cigna Commercial	$153.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$67.64
Rate for Payer: Qualcare PPO/HMO/WC	$46.12
Rate for Payer: UnitedHealthcare Community & State	$7.41
Rate for Payer: Wellpoint Medicaid Managed Care	$8.15

PLATE 1/3 TUB 6 HOLES/73MM

Facility

$307.45

Service Code	HCPCS C1713
Hospital Charge Code	270655682
Hospital Revenue Code	278
Min. Negotiated Rate	$46.12
Max. Negotiated Rate	$74.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$67.64
Rate for Payer: Qualcare PPO/HMO/WC	$46.12

PLATE 1/3 TUBULAR 10HOLE 121MM

Facility

$312.10

Service Code	HCPCS C1713
Hospital Charge Code	270603385
Hospital Revenue Code	278
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$156.05
Rate for Payer: Aetna Commercial	$118.60
Rate for Payer: Aetna Medicare Advantage	$93.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.59
Rate for Payer: Cigna Commercial	$156.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.66
Rate for Payer: Qualcare PPO/HMO/WC	$46.81
Rate for Payer: UnitedHealthcare Community & State	$7.52
Rate for Payer: Wellpoint Medicaid Managed Care	$8.27

PLATE 1/3 TUBULAR 10HOLE 121MM

Facility

$312.10

Service Code	HCPCS C1713
Hospital Charge Code	270603385
Hospital Revenue Code	278
Min. Negotiated Rate	$46.81
Max. Negotiated Rate	$75.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.66
Rate for Payer: Qualcare PPO/HMO/WC	$46.81

PLATE 1/3 TUBULAR 12H 145MM

Facility

$327.55

Service Code	HCPCS C1713
Hospital Charge Code	270604308
Hospital Revenue Code	278
Min. Negotiated Rate	$7.89
Max. Negotiated Rate	$163.78
Rate for Payer: Aetna Commercial	$124.47
Rate for Payer: Aetna Medicare Advantage	$98.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.53
Rate for Payer: Cigna Commercial	$163.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$72.06
Rate for Payer: Qualcare PPO/HMO/WC	$49.13
Rate for Payer: UnitedHealthcare Community & State	$7.89
Rate for Payer: Wellpoint Medicaid Managed Care	$8.68

PLATE 1/3 TUBULAR 12H 145MM

Facility

$327.55

Service Code	HCPCS C1713
Hospital Charge Code	270604308
Hospital Revenue Code	278
Min. Negotiated Rate	$49.13
Max. Negotiated Rate	$79.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$72.06
Rate for Payer: Qualcare PPO/HMO/WC	$49.13

PLATE 1/3 TUBULAR 2HOLE 25MM

Facility

$237.95

Service Code	HCPCS C1713
Hospital Charge Code	270603362
Hospital Revenue Code	278
Min. Negotiated Rate	$35.69
Max. Negotiated Rate	$57.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.35
Rate for Payer: Qualcare PPO/HMO/WC	$35.69

PLATE 1/3 TUBULAR 2HOLE 25MM

Facility

$237.95

Service Code	HCPCS C1713
Hospital Charge Code	270603362
Hospital Revenue Code	278
Min. Negotiated Rate	$5.73
Max. Negotiated Rate	$118.97
Rate for Payer: Aetna Commercial	$90.42
Rate for Payer: Aetna Medicare Advantage	$71.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.68
Rate for Payer: Cigna Commercial	$118.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.35
Rate for Payer: Qualcare PPO/HMO/WC	$35.69
Rate for Payer: UnitedHealthcare Community & State	$5.73
Rate for Payer: Wellpoint Medicaid Managed Care	$6.31

PLATE 1/3 TUBULAR 3HOLE 37MM

Facility

$244.10

Service Code	HCPCS C1713
Hospital Charge Code	270603363
Hospital Revenue Code	278
Min. Negotiated Rate	$36.62
Max. Negotiated Rate	$59.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$53.70
Rate for Payer: Qualcare PPO/HMO/WC	$36.62

PLATE 1/3 TUBULAR 3HOLE 37MM

Facility

$244.10

Service Code	HCPCS C1713
Hospital Charge Code	270603363
Hospital Revenue Code	278
Min. Negotiated Rate	$5.88
Max. Negotiated Rate	$122.05
Rate for Payer: Aetna Commercial	$92.76
Rate for Payer: Aetna Medicare Advantage	$73.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.25
Rate for Payer: Cigna Commercial	$122.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$53.70
Rate for Payer: Qualcare PPO/HMO/WC	$36.62
Rate for Payer: UnitedHealthcare Community & State	$5.88
Rate for Payer: Wellpoint Medicaid Managed Care	$6.47

PLATE 1/3 TUBULAR 4HOLE 49MM

Facility

$289.65

Service Code	HCPCS C1713
Hospital Charge Code	270601907
Hospital Revenue Code	278
Min. Negotiated Rate	$6.98
Max. Negotiated Rate	$144.82
Rate for Payer: Aetna Commercial	$110.07
Rate for Payer: Aetna Medicare Advantage	$86.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.86
Rate for Payer: Cigna Commercial	$144.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$63.72
Rate for Payer: Qualcare PPO/HMO/WC	$43.45
Rate for Payer: UnitedHealthcare Community & State	$6.98
Rate for Payer: Wellpoint Medicaid Managed Care	$7.68

PLATE 1/3 TUBULAR 4HOLE 49MM

Facility

$289.65

Service Code	HCPCS C1713
Hospital Charge Code	270601907
Hospital Revenue Code	278
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$70.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$63.72
Rate for Payer: Qualcare PPO/HMO/WC	$43.45

PLATE 1/3 TUBULAR 5H 61MM

Facility

$289.65

Service Code	HCPCS C1713
Hospital Charge Code	270601908
Hospital Revenue Code	278
Min. Negotiated Rate	$6.98
Max. Negotiated Rate	$144.82
Rate for Payer: Aetna Commercial	$110.07
Rate for Payer: Aetna Medicare Advantage	$86.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.86
Rate for Payer: Cigna Commercial	$144.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$63.72
Rate for Payer: Qualcare PPO/HMO/WC	$43.45
Rate for Payer: UnitedHealthcare Community & State	$6.98
Rate for Payer: Wellpoint Medicaid Managed Care	$7.68

PLATE 1/3 TUBULAR 5H 61MM

Facility

$289.65

Service Code	HCPCS C1713
Hospital Charge Code	270601908
Hospital Revenue Code	278
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$70.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$63.72
Rate for Payer: Qualcare PPO/HMO/WC	$43.45

PLATE-1/3 TUBULAR 6 HOLE

Facility

$445.00

Hospital Charge Code	270656542
Hospital Revenue Code	278
Min. Negotiated Rate	$66.75
Max. Negotiated Rate	$107.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$97.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.75

PLATE-1/3 TUBULAR 6 HOLE

Facility

$445.00

Hospital Charge Code	270656542
Hospital Revenue Code	278
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$222.50
Rate for Payer: Aetna Commercial	$169.10
Rate for Payer: Aetna Medicare Advantage	$133.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.47
Rate for Payer: Cigna Commercial	$222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$97.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.75
Rate for Payer: UnitedHealthcare Community & State	$10.72
Rate for Payer: Wellpoint Medicaid Managed Care	$11.79

PLATE 1/3 TUBULAR 6HOLE 73MM

Facility

$292.00

Service Code	HCPCS C1713
Hospital Charge Code	270603381
Hospital Revenue Code	278
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$146.00
Rate for Payer: Aetna Commercial	$110.96
Rate for Payer: Aetna Medicare Advantage	$87.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.46
Rate for Payer: Cigna Commercial	$146.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$64.24
Rate for Payer: Qualcare PPO/HMO/WC	$43.80
Rate for Payer: UnitedHealthcare Community & State	$7.04
Rate for Payer: Wellpoint Medicaid Managed Care	$7.74

PLATE 1/3 TUBULAR 6HOLE 73MM

Facility

$292.00

Service Code	HCPCS C1713
Hospital Charge Code	270603381
Hospital Revenue Code	278
Min. Negotiated Rate	$43.80
Max. Negotiated Rate	$70.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$64.24
Rate for Payer: Qualcare PPO/HMO/WC	$43.80

Know your out-of-pocket cost for care.

All Charges