Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE 24 MM 1 LEVEL ARCHON

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270693083
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

PLATE 2.4 MM 4 HOLE 6 HOLE ST

Facility

$8,580.00

Service Code	HCPCS C1713
Hospital Charge Code	270688276
Hospital Revenue Code	278
Min. Negotiated Rate	$1,287.00
Max. Negotiated Rate	$2,076.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,716.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,076.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,887.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,287.00

PLATE 2.4 MM 4 HOLE 6 HOLE ST

Facility

$8,580.00

Service Code	HCPCS C1713
Hospital Charge Code	270688276
Hospital Revenue Code	278
Min. Negotiated Rate	$206.78
Max. Negotiated Rate	$4,290.00
Rate for Payer: Aetna Commercial	$3,260.40
Rate for Payer: Aetna Medicare Advantage	$2,574.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,187.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,187.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,187.90
Rate for Payer: Cigna Commercial	$4,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,076.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,887.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,287.00
Rate for Payer: UnitedHealthcare Community & State	$206.78
Rate for Payer: Wellpoint Medicaid Managed Care	$227.37

PLATE 2.4MM LCP 7 HOLES 60MM

Facility

$930.00

Hospital Charge Code	270670055
Hospital Revenue Code	278
Min. Negotiated Rate	$139.50
Max. Negotiated Rate	$225.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$186.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$204.60
Rate for Payer: Qualcare PPO/HMO/WC	$139.50

PLATE 2.4MM LCP 7 HOLES 60MM

Facility

$930.00

Hospital Charge Code	270670055
Hospital Revenue Code	278
Min. Negotiated Rate	$22.41
Max. Negotiated Rate	$465.00
Rate for Payer: Aetna Commercial	$353.40
Rate for Payer: Aetna Medicare Advantage	$279.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$186.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.15
Rate for Payer: Cigna Commercial	$465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$204.60
Rate for Payer: Qualcare PPO/HMO/WC	$139.50
Rate for Payer: UnitedHealthcare Community & State	$22.41
Rate for Payer: Wellpoint Medicaid Managed Care	$24.64

PLATE 24MM SLIM 1LVL

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705536
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 24MM SLIM 1LVL

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705536
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 2.4MM ST 12 HOLES

Facility

$1,152.00

Service Code	HCPCS C1713
Hospital Charge Code	270656291
Hospital Revenue Code	278
Min. Negotiated Rate	$27.76
Max. Negotiated Rate	$576.00
Rate for Payer: Aetna Commercial	$437.76
Rate for Payer: Aetna Medicare Advantage	$345.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.76
Rate for Payer: Cigna Commercial	$576.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$253.44
Rate for Payer: Qualcare PPO/HMO/WC	$172.80
Rate for Payer: UnitedHealthcare Community & State	$27.76
Rate for Payer: Wellpoint Medicaid Managed Care	$30.53

PLATE 2.4MM ST 12 HOLES

Facility

$1,152.00

Service Code	HCPCS C1713
Hospital Charge Code	270656291
Hospital Revenue Code	278
Min. Negotiated Rate	$172.80
Max. Negotiated Rate	$278.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$253.44
Rate for Payer: Qualcare PPO/HMO/WC	$172.80

PLATE 2.4MM STR 6 HOLE

Facility

$1,007.35

Service Code	HCPCS C1713
Hospital Charge Code	270654858
Hospital Revenue Code	278
Min. Negotiated Rate	$24.28
Max. Negotiated Rate	$503.68
Rate for Payer: Aetna Commercial	$382.79
Rate for Payer: Aetna Medicare Advantage	$302.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.87
Rate for Payer: Cigna Commercial	$503.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$221.62
Rate for Payer: Qualcare PPO/HMO/WC	$151.10
Rate for Payer: UnitedHealthcare Community & State	$24.28
Rate for Payer: Wellpoint Medicaid Managed Care	$26.69

PLATE 2.4MM STR 6 HOLE

Facility

$1,007.35

Service Code	HCPCS C1713
Hospital Charge Code	270654858
Hospital Revenue Code	278
Min. Negotiated Rate	$151.10
Max. Negotiated Rate	$243.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$221.62
Rate for Payer: Qualcare PPO/HMO/WC	$151.10

PLATE 2.4mm TI 8 HOLE 54mm

Facility

$1,241.25

Service Code	HCPCS C1713
Hospital Charge Code	270680929
Hospital Revenue Code	278
Min. Negotiated Rate	$29.91
Max. Negotiated Rate	$620.62
Rate for Payer: Aetna Commercial	$471.68
Rate for Payer: Aetna Medicare Advantage	$372.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$316.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$316.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$248.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$316.52
Rate for Payer: Cigna Commercial	$620.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$273.07
Rate for Payer: Qualcare PPO/HMO/WC	$186.19
Rate for Payer: UnitedHealthcare Community & State	$29.91
Rate for Payer: Wellpoint Medicaid Managed Care	$32.89

PLATE 2.4mm TI 8 HOLE 54mm

Facility

$1,241.25

Service Code	HCPCS C1713
Hospital Charge Code	270680929
Hospital Revenue Code	278
Min. Negotiated Rate	$186.19
Max. Negotiated Rate	$300.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$248.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$273.07
Rate for Payer: Qualcare PPO/HMO/WC	$186.19

PLATE 2.4MM VA LCP 6H 4H RT

Facility

$4,713.80

Service Code	HCPCS C1713
Hospital Charge Code	270693749
Hospital Revenue Code	278
Min. Negotiated Rate	$113.60
Max. Negotiated Rate	$2,356.90
Rate for Payer: Aetna Commercial	$1,791.24
Rate for Payer: Aetna Medicare Advantage	$1,414.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,202.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,202.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$942.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,202.02
Rate for Payer: Cigna Commercial	$2,356.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,140.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,037.04
Rate for Payer: Qualcare PPO/HMO/WC	$707.07
Rate for Payer: UnitedHealthcare Community & State	$113.60
Rate for Payer: Wellpoint Medicaid Managed Care	$124.92

PLATE 2.4MM VA LCP 6H 4H RT

Facility

$4,713.80

Service Code	HCPCS C1713
Hospital Charge Code	270693749
Hospital Revenue Code	278
Min. Negotiated Rate	$707.07
Max. Negotiated Rate	$1,140.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$942.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,140.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,037.04
Rate for Payer: Qualcare PPO/HMO/WC	$707.07

PLATE 2.4 Ti LC-DCP 4 HOLE

Facility

$1,935.00

Hospital Charge Code	270637594
Hospital Revenue Code	278
Min. Negotiated Rate	$290.25
Max. Negotiated Rate	$468.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$387.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$468.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.70
Rate for Payer: Qualcare PPO/HMO/WC	$290.25

PLATE 2.4 Ti LC-DCP 4 HOLE

Facility

$1,935.00

Hospital Charge Code	270637594
Hospital Revenue Code	278
Min. Negotiated Rate	$46.63
Max. Negotiated Rate	$967.50
Rate for Payer: Aetna Commercial	$735.30
Rate for Payer: Aetna Medicare Advantage	$580.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$493.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$493.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$387.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$493.43
Rate for Payer: Cigna Commercial	$967.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$468.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.70
Rate for Payer: Qualcare PPO/HMO/WC	$290.25
Rate for Payer: UnitedHealthcare Community & State	$46.63
Rate for Payer: Wellpoint Medicaid Managed Care	$51.28

PLATE 2.4 Ti LC-DCP 4 HOLES

Facility

$1,840.00

Hospital Charge Code	270637596
Hospital Revenue Code	278
Min. Negotiated Rate	$44.34
Max. Negotiated Rate	$920.00
Rate for Payer: Aetna Commercial	$699.20
Rate for Payer: Aetna Medicare Advantage	$552.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$469.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$469.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$368.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$469.20
Rate for Payer: Cigna Commercial	$920.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$445.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$404.80
Rate for Payer: Qualcare PPO/HMO/WC	$276.00
Rate for Payer: UnitedHealthcare Community & State	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$48.76

PLATE 2.4 Ti LC-DCP 4 HOLES

Facility

$1,840.00

Hospital Charge Code	270637596
Hospital Revenue Code	278
Min. Negotiated Rate	$276.00
Max. Negotiated Rate	$445.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$368.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$445.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$404.80
Rate for Payer: Qualcare PPO/HMO/WC	$276.00

PLATE 2.4 Ti LC-DCP 6 HOLES

Facility

$2,105.00

Service Code	HCPCS C1713
Hospital Charge Code	270637595
Hospital Revenue Code	278
Min. Negotiated Rate	$50.73
Max. Negotiated Rate	$1,052.50
Rate for Payer: Aetna Commercial	$799.90
Rate for Payer: Aetna Medicare Advantage	$631.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$536.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$536.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$421.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$536.77
Rate for Payer: Cigna Commercial	$1,052.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$509.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$463.10
Rate for Payer: Qualcare PPO/HMO/WC	$315.75
Rate for Payer: UnitedHealthcare Community & State	$50.73
Rate for Payer: Wellpoint Medicaid Managed Care	$55.78

PLATE 2.4 Ti LC-DCP 6 HOLES

Facility

$2,105.00

Service Code	HCPCS C1713
Hospital Charge Code	270637595
Hospital Revenue Code	278
Min. Negotiated Rate	$315.75
Max. Negotiated Rate	$509.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$421.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$509.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$463.10
Rate for Payer: Qualcare PPO/HMO/WC	$315.75

PLATE 2.4 X 2.7

Facility

$4,328.45

Service Code	HCPCS C1713
Hospital Charge Code	270675216
Hospital Revenue Code	278
Min. Negotiated Rate	$649.27
Max. Negotiated Rate	$1,047.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$865.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,047.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$952.26
Rate for Payer: Qualcare PPO/HMO/WC	$649.27

PLATE 2.4 X 2.7

Facility

$4,328.45

Service Code	HCPCS C1713
Hospital Charge Code	270675216
Hospital Revenue Code	278
Min. Negotiated Rate	$104.32
Max. Negotiated Rate	$2,164.22
Rate for Payer: Aetna Commercial	$1,644.81
Rate for Payer: Aetna Medicare Advantage	$1,298.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$865.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,103.75
Rate for Payer: Cigna Commercial	$2,164.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,047.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$952.26
Rate for Payer: Qualcare PPO/HMO/WC	$649.27
Rate for Payer: UnitedHealthcare Community & State	$104.32
Rate for Payer: Wellpoint Medicaid Managed Care	$114.70

PLATE 2.7MM STRAIGHT 10H

Facility

$1,045.00

Service Code	HCPCS C1713
Hospital Charge Code	270702677
Hospital Revenue Code	278
Min. Negotiated Rate	$156.75
Max. Negotiated Rate	$252.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$229.90
Rate for Payer: Qualcare PPO/HMO/WC	$156.75

PLATE 2.7MM STRAIGHT 10H

Facility

$1,045.00

Service Code	HCPCS C1713
Hospital Charge Code	270702677
Hospital Revenue Code	278
Min. Negotiated Rate	$25.18
Max. Negotiated Rate	$522.50
Rate for Payer: Aetna Commercial	$397.10
Rate for Payer: Aetna Medicare Advantage	$313.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.48
Rate for Payer: Cigna Commercial	$522.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$229.90
Rate for Payer: Qualcare PPO/HMO/WC	$156.75
Rate for Payer: UnitedHealthcare Community & State	$25.18
Rate for Payer: Wellpoint Medicaid Managed Care	$27.69

Know your out-of-pocket cost for care.

All Charges