Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE 28MM

Facility

$12,675.00

Service Code	HCPCS C1713
Hospital Charge Code	270703900
Hospital Revenue Code	278
Min. Negotiated Rate	$1,901.25
Max. Negotiated Rate	$3,067.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,067.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,788.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,901.25

PLATE 28MM

Facility

$12,675.00

Service Code	HCPCS C1713
Hospital Charge Code	270703900
Hospital Revenue Code	278
Min. Negotiated Rate	$305.47
Max. Negotiated Rate	$6,337.50
Rate for Payer: Aetna Commercial	$4,816.50
Rate for Payer: Aetna Medicare Advantage	$3,802.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,232.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,232.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,535.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,232.12
Rate for Payer: Cigna Commercial	$6,337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,067.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,788.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,901.25
Rate for Payer: UnitedHealthcare Community & State	$305.47
Rate for Payer: Wellpoint Medicaid Managed Care	$335.89

PLATE 28MM

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705476
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 28MM 2 LEVEL

Facility

$7,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270705765
Hospital Revenue Code	278
Min. Negotiated Rate	$1,091.25
Max. Negotiated Rate	$1,760.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,455.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,760.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,600.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,091.25

PLATE 28MM 2 LEVEL

Facility

$7,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270705765
Hospital Revenue Code	278
Min. Negotiated Rate	$175.33
Max. Negotiated Rate	$3,637.50
Rate for Payer: Aetna Commercial	$2,764.50
Rate for Payer: Aetna Medicare Advantage	$2,182.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,855.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,855.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,455.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,855.12
Rate for Payer: Cigna Commercial	$3,637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,760.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,600.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,091.25
Rate for Payer: UnitedHealthcare Community & State	$175.33
Rate for Payer: Wellpoint Medicaid Managed Care	$192.79

PLATE 2H LONG STR LARGE 17MM

Facility

$805.00

Service Code	HCPCS C1713
Hospital Charge Code	270697127
Hospital Revenue Code	278
Min. Negotiated Rate	$19.40
Max. Negotiated Rate	$402.50
Rate for Payer: Aetna Commercial	$305.90
Rate for Payer: Aetna Medicare Advantage	$241.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$205.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$205.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$161.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$205.28
Rate for Payer: Cigna Commercial	$402.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$177.10
Rate for Payer: Qualcare PPO/HMO/WC	$120.75
Rate for Payer: UnitedHealthcare Community & State	$19.40
Rate for Payer: Wellpoint Medicaid Managed Care	$21.33

PLATE 2H LONG STR LARGE 17MM

Facility

$805.00

Service Code	HCPCS C1713
Hospital Charge Code	270697127
Hospital Revenue Code	278
Min. Negotiated Rate	$120.75
Max. Negotiated Rate	$194.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$161.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$177.10
Rate for Payer: Qualcare PPO/HMO/WC	$120.75

PLATE 2 HOLE 9MM

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270693821
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

PLATE 2 HOLE 9MM

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270693821
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

PLATE 2 HOLE AR-8958-02

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270697225
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

PLATE 2 HOLE AR-8958-02

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270697225
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PLATE 2 HPLE DBL COMP 20MM

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270687447
Hospital Revenue Code	278
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,700.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25
Rate for Payer: UnitedHealthcare Community & State	$107.85
Rate for Payer: Wellpoint Medicaid Managed Care	$118.59

PLATE 2 HPLE DBL COMP 20MM

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270687447
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

PLATE 2 LCP 2.7MM 3HOLES SHAF

Facility

$3,150.85

Service Code	HCPCS C1713
Hospital Charge Code	270684225
Hospital Revenue Code	278
Min. Negotiated Rate	$472.63
Max. Negotiated Rate	$762.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$693.19
Rate for Payer: Qualcare PPO/HMO/WC	$472.63

PLATE 2 LCP 2.7MM 3HOLES SHAF

Facility

$3,150.85

Service Code	HCPCS C1713
Hospital Charge Code	270684225
Hospital Revenue Code	278
Min. Negotiated Rate	$75.94
Max. Negotiated Rate	$1,575.42
Rate for Payer: Aetna Commercial	$1,197.32
Rate for Payer: Aetna Medicare Advantage	$945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$803.47
Rate for Payer: Cigna Commercial	$1,575.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$693.19
Rate for Payer: Qualcare PPO/HMO/WC	$472.63
Rate for Payer: UnitedHealthcare Community & State	$75.94
Rate for Payer: Wellpoint Medicaid Managed Care	$83.50

PLATE 2-LEVEL - 29MM

Facility

$4,500.00

Hospital Charge Code	270703080
Hospital Revenue Code	278
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

PLATE 2-LEVEL - 29MM

Facility

$4,500.00

Hospital Charge Code	270703080
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$990.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

PLATE 30MM

Facility

$0.01

Service Code	HCPCS C1713
Hospital Charge Code	270689969
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

PLATE 30MM

Facility

$16,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270688412
Hospital Revenue Code	278
Min. Negotiated Rate	$385.60
Max. Negotiated Rate	$8,000.00
Rate for Payer: Aetna Commercial	$6,080.00
Rate for Payer: Aetna Medicare Advantage	$4,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,080.00
Rate for Payer: Cigna Commercial	$8,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00
Rate for Payer: UnitedHealthcare Community & State	$385.60
Rate for Payer: Wellpoint Medicaid Managed Care	$424.00

PLATE 30MM

Facility

$0.01

Service Code	HCPCS C1713
Hospital Charge Code	270689969
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

PLATE 30MM

Facility

$16,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270688412
Hospital Revenue Code	278
Min. Negotiated Rate	$2,400.00
Max. Negotiated Rate	$3,872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00

PLATE 31MM 2-LEVEL

Facility

$0.01

Service Code	HCPCS C1713
Hospital Charge Code	270694165
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

PLATE 31MM 2-LEVEL

Facility

$0.01

Service Code	HCPCS C1713
Hospital Charge Code	270694165
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

PLATE 32MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705061
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 32MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705061
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
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
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

Know your out-of-pocket cost for care.

All Charges