Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE 1/3 TUBULAR 7H 85MM

Facility

$300.75

Service Code	HCPCS C1713
Hospital Charge Code	270601911
Hospital Revenue Code	278
Min. Negotiated Rate	$45.11
Max. Negotiated Rate	$72.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$66.17
Rate for Payer: Qualcare PPO/HMO/WC	$45.11

PLATE 1/3 TUBULAR 7H 85MM

Facility

$300.75

Service Code	HCPCS C1713
Hospital Charge Code	270601911
Hospital Revenue Code	278
Min. Negotiated Rate	$7.25
Max. Negotiated Rate	$150.38
Rate for Payer: Aetna Commercial	$114.28
Rate for Payer: Aetna Medicare Advantage	$90.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.69
Rate for Payer: Cigna Commercial	$150.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$66.17
Rate for Payer: Qualcare PPO/HMO/WC	$45.11
Rate for Payer: UnitedHealthcare Community & State	$7.25
Rate for Payer: Wellpoint Medicaid Managed Care	$7.97

PLATE 1/3 TUBULAR 8 X 97MM

Facility

$302.80

Service Code	HCPCS C1713
Hospital Charge Code	270603383
Hospital Revenue Code	278
Min. Negotiated Rate	$45.42
Max. Negotiated Rate	$73.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$66.62
Rate for Payer: Qualcare PPO/HMO/WC	$45.42

PLATE 1/3 TUBULAR 8 X 97MM

Facility

$302.80

Service Code	HCPCS C1713
Hospital Charge Code	270603383
Hospital Revenue Code	278
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$151.40
Rate for Payer: Aetna Commercial	$115.06
Rate for Payer: Aetna Medicare Advantage	$90.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.21
Rate for Payer: Cigna Commercial	$151.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$66.62
Rate for Payer: Qualcare PPO/HMO/WC	$45.42
Rate for Payer: UnitedHealthcare Community & State	$7.30
Rate for Payer: Wellpoint Medicaid Managed Care	$8.02

PLATE 1/3 TUBULAR 9H 109MM

Facility

$312.10

Service Code	HCPCS C1713
Hospital Charge Code	270651852
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 9H 109MM

Facility

$312.10

Service Code	HCPCS C1713
Hospital Charge Code	270651852
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 14HOLE CONDYLAR LEFT

Facility

$7,477.80

Service Code	HCPCS C1713
Hospital Charge Code	270656609
Hospital Revenue Code	278
Min. Negotiated Rate	$1,121.67
Max. Negotiated Rate	$1,809.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,809.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,645.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.67

PLATE 14HOLE CONDYLAR LEFT

Facility

$7,477.80

Service Code	HCPCS C1713
Hospital Charge Code	270656609
Hospital Revenue Code	278
Min. Negotiated Rate	$180.21
Max. Negotiated Rate	$3,738.90
Rate for Payer: Aetna Commercial	$2,841.56
Rate for Payer: Aetna Medicare Advantage	$2,243.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.84
Rate for Payer: Cigna Commercial	$3,738.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,809.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,645.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.67
Rate for Payer: UnitedHealthcare Community & State	$180.21
Rate for Payer: Wellpoint Medicaid Managed Care	$198.16

PLATE 14MM

Facility

$4,775.00

Hospital Charge Code	270703046
Hospital Revenue Code	278
Min. Negotiated Rate	$115.08
Max. Negotiated Rate	$2,387.50
Rate for Payer: Aetna Commercial	$1,814.50
Rate for Payer: Aetna Medicare Advantage	$1,432.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,217.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,217.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,217.62
Rate for Payer: Cigna Commercial	$2,387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,155.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,050.50
Rate for Payer: Qualcare PPO/HMO/WC	$716.25
Rate for Payer: UnitedHealthcare Community & State	$115.08
Rate for Payer: Wellpoint Medicaid Managed Care	$126.54

PLATE 14MM

Facility

$4,775.00

Hospital Charge Code	270703046
Hospital Revenue Code	278
Min. Negotiated Rate	$716.25
Max. Negotiated Rate	$1,155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,155.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,050.50
Rate for Payer: Qualcare PPO/HMO/WC	$716.25

PLATE 1/4 TUB TITN 5H****

Facility

$151.00

Hospital Charge Code	270603410
Hospital Revenue Code	279
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$75.50
Rate for Payer: Aetna Commercial	$57.38
Rate for Payer: Aetna Medicare Advantage	$45.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.51
Rate for Payer: Cigna Commercial	$75.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.30
Rate for Payer: Oxford Commercial	$30.20
Rate for Payer: Qualcare PPO/HMO/WC	$22.65
Rate for Payer: UnitedHealthcare Commercial	$30.20
Rate for Payer: UnitedHealthcare Community & State	$3.64
Rate for Payer: Wellpoint Medicaid Managed Care	$4.00

PLATE 1/4 TUB TITN 5H****

Facility

$151.00

Hospital Charge Code	270603410
Hospital Revenue Code	279
Min. Negotiated Rate	$22.65
Max. Negotiated Rate	$22.65
Rate for Payer: Qualcare PPO/HMO/WC	$22.65

PLATE 15MM

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705410
Hospital Revenue Code	278
Min. Negotiated Rate	$289.20
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

PLATE 15MM

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705410
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

PLATE 1.5MM

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685254
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

PLATE 1.5MM

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270685254
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

PLATE 1.5mm TITAN CHON 6HOLE L

Facility

$1,223.65

Service Code	HCPCS C1713
Hospital Charge Code	270604105
Hospital Revenue Code	278
Min. Negotiated Rate	$183.55
Max. Negotiated Rate	$296.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$269.20
Rate for Payer: Qualcare PPO/HMO/WC	$183.55

PLATE 1.5mm TITAN CHON 6HOLE L

Facility

$1,223.65

Service Code	HCPCS C1713
Hospital Charge Code	270604105
Hospital Revenue Code	278
Min. Negotiated Rate	$29.49
Max. Negotiated Rate	$611.83
Rate for Payer: Aetna Commercial	$464.99
Rate for Payer: Aetna Medicare Advantage	$367.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.03
Rate for Payer: Cigna Commercial	$611.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$269.20
Rate for Payer: Qualcare PPO/HMO/WC	$183.55
Rate for Payer: UnitedHealthcare Community & State	$29.49
Rate for Payer: Wellpoint Medicaid Managed Care	$32.43

PLATE 1.5mm TITAN CHON 6HOLE R

Facility

$1,223.65

Service Code	HCPCS C1713
Hospital Charge Code	270604106
Hospital Revenue Code	278
Min. Negotiated Rate	$183.55
Max. Negotiated Rate	$296.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$269.20
Rate for Payer: Qualcare PPO/HMO/WC	$183.55

PLATE 1.5mm TITAN CHON 6HOLE R

Facility

$1,223.65

Service Code	HCPCS C1713
Hospital Charge Code	270604106
Hospital Revenue Code	278
Min. Negotiated Rate	$29.49
Max. Negotiated Rate	$611.83
Rate for Payer: Aetna Commercial	$464.99
Rate for Payer: Aetna Medicare Advantage	$367.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.03
Rate for Payer: Cigna Commercial	$611.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$269.20
Rate for Payer: Qualcare PPO/HMO/WC	$183.55
Rate for Payer: UnitedHealthcare Community & State	$29.49
Rate for Payer: Wellpoint Medicaid Managed Care	$32.43

PLATE 1.5mm TITAN T H3-S9HOLE

Facility

$861.00

Hospital Charge Code	270604103
Hospital Revenue Code	278
Min. Negotiated Rate	$20.75
Max. Negotiated Rate	$430.50
Rate for Payer: Aetna Commercial	$327.18
Rate for Payer: Aetna Medicare Advantage	$258.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.56
Rate for Payer: Cigna Commercial	$430.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.42
Rate for Payer: Qualcare PPO/HMO/WC	$129.15
Rate for Payer: UnitedHealthcare Community & State	$20.75
Rate for Payer: Wellpoint Medicaid Managed Care	$22.82

PLATE 1.5mm TITAN T H3-S9HOLE

Facility

$861.00

Hospital Charge Code	270604103
Hospital Revenue Code	278
Min. Negotiated Rate	$129.15
Max. Negotiated Rate	$208.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.42
Rate for Payer: Qualcare PPO/HMO/WC	$129.15

PLATE 1.5mm TITAN T H4-S9HOLE

Facility

$967.15

Service Code	HCPCS C1713
Hospital Charge Code	270604104
Hospital Revenue Code	278
Min. Negotiated Rate	$145.07
Max. Negotiated Rate	$234.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$212.77
Rate for Payer: Qualcare PPO/HMO/WC	$145.07

PLATE 1.5mm TITAN T H4-S9HOLE

Facility

$967.15

Service Code	HCPCS C1713
Hospital Charge Code	270604104
Hospital Revenue Code	278
Min. Negotiated Rate	$23.31
Max. Negotiated Rate	$483.57
Rate for Payer: Aetna Commercial	$367.52
Rate for Payer: Aetna Medicare Advantage	$290.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$246.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$246.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$246.62
Rate for Payer: Cigna Commercial	$483.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$212.77
Rate for Payer: Qualcare PPO/HMO/WC	$145.07
Rate for Payer: UnitedHealthcare Community & State	$23.31
Rate for Payer: Wellpoint Medicaid Managed Care	$25.63

PLATE 1.5 RESORB ORBIT

Facility

$984.00

Hospital Charge Code	270332587
Hospital Revenue Code	278
Min. Negotiated Rate	$147.60
Max. Negotiated Rate	$238.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$216.48
Rate for Payer: Qualcare PPO/HMO/WC	$147.60

Know your out-of-pocket cost for care.

All Charges