Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE 32MM

Facility

$16,341.90

Service Code	HCPCS C1713
Hospital Charge Code	270703885
Hospital Revenue Code	278
Min. Negotiated Rate	$393.84
Max. Negotiated Rate	$8,170.95
Rate for Payer: Aetna Commercial	$6,209.92
Rate for Payer: Aetna Medicare Advantage	$4,902.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,167.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,167.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,268.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,167.18
Rate for Payer: Cigna Commercial	$8,170.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,954.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,595.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,451.28
Rate for Payer: UnitedHealthcare Community & State	$393.84
Rate for Payer: Wellpoint Medicaid Managed Care	$433.06

PLATE 32MM

Facility

$16,341.90

Service Code	HCPCS C1713
Hospital Charge Code	270703885
Hospital Revenue Code	278
Min. Negotiated Rate	$2,451.28
Max. Negotiated Rate	$3,954.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,268.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,954.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,595.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,451.28

PLATE 32MM 2 LEVEL

Facility

$13,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270688897
Hospital Revenue Code	278
Min. Negotiated Rate	$319.32
Max. Negotiated Rate	$6,625.00
Rate for Payer: Aetna Commercial	$5,035.00
Rate for Payer: Aetna Medicare Advantage	$3,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,378.75
Rate for Payer: Cigna Commercial	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,206.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,915.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50
Rate for Payer: UnitedHealthcare Community & State	$319.32
Rate for Payer: Wellpoint Medicaid Managed Care	$351.12

PLATE 32MM 2 LEVEL

Facility

$13,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270688897
Hospital Revenue Code	278
Min. Negotiated Rate	$1,987.50
Max. Negotiated Rate	$3,206.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,206.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,915.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50

PLATE 32MM 2 LEVEL ARCHON

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270693072
Hospital Revenue Code	278
Min. Negotiated Rate	$145.81
Max. Negotiated Rate	$3,025.00
Rate for Payer: Aetna Commercial	$2,299.00
Rate for Payer: Aetna Medicare Advantage	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,542.75
Rate for Payer: Cigna Commercial	$3,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$907.50
Rate for Payer: UnitedHealthcare Community & State	$145.81
Rate for Payer: Wellpoint Medicaid Managed Care	$160.32

PLATE 32MM 2 LEVEL ARCHON

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270693072
Hospital Revenue Code	278
Min. Negotiated Rate	$907.50
Max. Negotiated Rate	$1,464.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$907.50

PLATE 32MM 3-LEVEL

Facility

$13,100.00

Service Code	HCPCS C1713
Hospital Charge Code	270688525
Hospital Revenue Code	278
Min. Negotiated Rate	$1,965.00
Max. Negotiated Rate	$3,170.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,620.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,170.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,882.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,965.00

PLATE 32MM 3-LEVEL

Facility

$13,100.00

Service Code	HCPCS C1713
Hospital Charge Code	270688525
Hospital Revenue Code	278
Min. Negotiated Rate	$315.71
Max. Negotiated Rate	$6,550.00
Rate for Payer: Aetna Commercial	$4,978.00
Rate for Payer: Aetna Medicare Advantage	$3,930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,340.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,340.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,340.50
Rate for Payer: Cigna Commercial	$6,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,170.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,882.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,965.00
Rate for Payer: UnitedHealthcare Community & State	$315.71
Rate for Payer: Wellpoint Medicaid Managed Care	$347.15

PLATE 34MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705062
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

PLATE 34MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705062
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 34MM 2 HOLE

Facility

$16,341.90

Service Code	HCPCS C1713
Hospital Charge Code	270703616
Hospital Revenue Code	278
Min. Negotiated Rate	$393.84
Max. Negotiated Rate	$8,170.95
Rate for Payer: Aetna Commercial	$6,209.92
Rate for Payer: Aetna Medicare Advantage	$4,902.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,167.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,167.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,268.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,167.18
Rate for Payer: Cigna Commercial	$8,170.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,954.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,595.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,451.28
Rate for Payer: UnitedHealthcare Community & State	$393.84
Rate for Payer: Wellpoint Medicaid Managed Care	$433.06

PLATE 34MM 2 HOLE

Facility

$16,341.90

Service Code	HCPCS C1713
Hospital Charge Code	270703616
Hospital Revenue Code	278
Min. Negotiated Rate	$2,451.28
Max. Negotiated Rate	$3,954.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,268.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,954.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,595.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,451.28

PLATE 3.5 CLOUM FUSION RIGHT

Facility

$8,882.95

Service Code	HCPCS C1713
Hospital Charge Code	270690795
Hospital Revenue Code	278
Min. Negotiated Rate	$1,332.44
Max. Negotiated Rate	$2,149.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,776.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,149.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,954.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,332.44

PLATE 3.5 CLOUM FUSION RIGHT

Facility

$8,882.95

Service Code	HCPCS C1713
Hospital Charge Code	270690795
Hospital Revenue Code	278
Min. Negotiated Rate	$214.08
Max. Negotiated Rate	$4,441.48
Rate for Payer: Aetna Commercial	$3,375.52
Rate for Payer: Aetna Medicare Advantage	$2,664.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,265.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,265.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,776.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,265.15
Rate for Payer: Cigna Commercial	$4,441.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,149.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,954.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,332.44
Rate for Payer: UnitedHealthcare Community & State	$214.08
Rate for Payer: Wellpoint Medicaid Managed Care	$235.40

PLATE 3.5 LCP PROX HUM 6H163MM

Facility

$28,045.00

Service Code	HCPCS C1713
Hospital Charge Code	270699354
Hospital Revenue Code	278
Min. Negotiated Rate	$675.88
Max. Negotiated Rate	$14,022.50
Rate for Payer: Aetna Commercial	$10,657.10
Rate for Payer: Aetna Medicare Advantage	$8,413.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,151.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,151.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,609.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,151.48
Rate for Payer: Cigna Commercial	$14,022.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,786.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,169.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,206.75
Rate for Payer: UnitedHealthcare Community & State	$675.88
Rate for Payer: Wellpoint Medicaid Managed Care	$743.19

PLATE 3.5 LCP PROX HUM 6H163MM

Facility

$28,045.00

Service Code	HCPCS C1713
Hospital Charge Code	270699354
Hospital Revenue Code	278
Min. Negotiated Rate	$4,206.75
Max. Negotiated Rate	$6,786.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,609.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,786.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,169.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,206.75

PLATE 3.5 LCP PROX HUM 8H RT

Facility

$11,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270696393
Hospital Revenue Code	278
Min. Negotiated Rate	$274.74
Max. Negotiated Rate	$5,700.00
Rate for Payer: Aetna Commercial	$4,332.00
Rate for Payer: Aetna Medicare Advantage	$3,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,907.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,907.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,907.00
Rate for Payer: Cigna Commercial	$5,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,758.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,508.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,710.00
Rate for Payer: UnitedHealthcare Community & State	$274.74
Rate for Payer: Wellpoint Medicaid Managed Care	$302.10

PLATE 3.5 LCP PROX HUM 8H RT

Facility

$11,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270696393
Hospital Revenue Code	278
Min. Negotiated Rate	$1,710.00
Max. Negotiated Rate	$2,758.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,758.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,508.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,710.00

PLATE3.5MM LC-DCP10HOLES/129MM

Facility

$741.60

Service Code	HCPCS C1713
Hospital Charge Code	270655654
Hospital Revenue Code	278
Min. Negotiated Rate	$111.24
Max. Negotiated Rate	$179.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.15
Rate for Payer: Qualcare PPO/HMO/WC	$111.24

PLATE3.5MM LC-DCP10HOLES/129MM

Facility

$741.60

Service Code	HCPCS C1713
Hospital Charge Code	270655654
Hospital Revenue Code	278
Min. Negotiated Rate	$17.87
Max. Negotiated Rate	$370.80
Rate for Payer: Aetna Commercial	$281.81
Rate for Payer: Aetna Medicare Advantage	$222.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.11
Rate for Payer: Cigna Commercial	$370.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.15
Rate for Payer: Qualcare PPO/HMO/WC	$111.24
Rate for Payer: UnitedHealthcare Community & State	$17.87
Rate for Payer: Wellpoint Medicaid Managed Care	$19.65

PLATE3.5MM LC-DCP 9HOLES/116MM

Facility

$732.35

Service Code	HCPCS C1713
Hospital Charge Code	270655652
Hospital Revenue Code	278
Min. Negotiated Rate	$17.65
Max. Negotiated Rate	$366.18
Rate for Payer: Aetna Commercial	$278.29
Rate for Payer: Aetna Medicare Advantage	$219.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$146.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.75
Rate for Payer: Cigna Commercial	$366.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$161.12
Rate for Payer: Qualcare PPO/HMO/WC	$109.85
Rate for Payer: UnitedHealthcare Community & State	$17.65
Rate for Payer: Wellpoint Medicaid Managed Care	$19.41

PLATE3.5MM LC-DCP 9HOLES/116MM

Facility

$732.35

Service Code	HCPCS C1713
Hospital Charge Code	270655652
Hospital Revenue Code	278
Min. Negotiated Rate	$109.85
Max. Negotiated Rate	$177.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$146.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$161.12
Rate for Payer: Qualcare PPO/HMO/WC	$109.85

PLATE 3.5MM LCP PROX HUMERUS

Facility

$6,498.00

Hospital Charge Code	270656205
Hospital Revenue Code	278
Min. Negotiated Rate	$156.60
Max. Negotiated Rate	$3,249.00
Rate for Payer: Aetna Commercial	$2,469.24
Rate for Payer: Aetna Medicare Advantage	$1,949.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,656.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,656.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,299.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,656.99
Rate for Payer: Cigna Commercial	$3,249.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,572.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,429.56
Rate for Payer: Qualcare PPO/HMO/WC	$974.70
Rate for Payer: UnitedHealthcare Community & State	$156.60
Rate for Payer: Wellpoint Medicaid Managed Care	$172.20

PLATE 3.5MM LCP PROX HUMERUS

Facility

$6,702.00

Hospital Charge Code	270656206
Hospital Revenue Code	278
Min. Negotiated Rate	$161.52
Max. Negotiated Rate	$3,351.00
Rate for Payer: Aetna Commercial	$2,546.76
Rate for Payer: Aetna Medicare Advantage	$2,010.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,709.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,709.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,340.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,709.01
Rate for Payer: Cigna Commercial	$3,351.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,621.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,474.44
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.30
Rate for Payer: UnitedHealthcare Community & State	$161.52
Rate for Payer: Wellpoint Medicaid Managed Care	$177.60

PLATE 3.5MM LCP PROX HUMERUS

Facility

$6,702.00

Hospital Charge Code	270656206
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.30
Max. Negotiated Rate	$1,621.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,340.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,621.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,474.44
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.30

Know your out-of-pocket cost for care.

All Charges