Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE 36MM

Facility

$0.01

Service Code	HCPCS C1713
Hospital Charge Code	270689965
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 38MM 2LVL

Facility

$5,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270706122
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$1,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

PLATE 38MM 2LVL

Facility

$5,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270706122
Hospital Revenue Code	278
Min. Negotiated Rate	$138.57
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$2,185.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Community & State	$138.57
Rate for Payer: Wellpoint Medicaid Managed Care	$152.38

PLATE 3 HOLE

Facility

$10,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270665933
Hospital Revenue Code	278
Min. Negotiated Rate	$257.39
Max. Negotiated Rate	$5,340.00
Rate for Payer: Aetna Commercial	$4,058.40
Rate for Payer: Aetna Medicare Advantage	$3,204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,723.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,723.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,136.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,723.40
Rate for Payer: Cigna Commercial	$5,340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,584.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,349.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,602.00
Rate for Payer: UnitedHealthcare Community & State	$257.39
Rate for Payer: Wellpoint Medicaid Managed Care	$283.02

PLATE 3 HOLE

Facility

$10,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270665933
Hospital Revenue Code	278
Min. Negotiated Rate	$1,602.00
Max. Negotiated Rate	$2,584.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,136.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,584.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,349.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,602.00

PLATE 3HOLE OLECRANON 70-0302

Facility

$5,350.00

Hospital Charge Code	270646195
Hospital Revenue Code	278
Min. Negotiated Rate	$128.94
Max. Negotiated Rate	$2,675.00
Rate for Payer: Aetna Commercial	$2,033.00
Rate for Payer: Aetna Medicare Advantage	$1,605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,364.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,364.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,070.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,364.25
Rate for Payer: Cigna Commercial	$2,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,294.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,177.00
Rate for Payer: Qualcare PPO/HMO/WC	$802.50
Rate for Payer: UnitedHealthcare Community & State	$128.94
Rate for Payer: Wellpoint Medicaid Managed Care	$141.78

PLATE 3HOLE OLECRANON 70-0302

Facility

$5,350.00

Hospital Charge Code	270646195
Hospital Revenue Code	278
Min. Negotiated Rate	$802.50
Max. Negotiated Rate	$1,294.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,294.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,177.00
Rate for Payer: Qualcare PPO/HMO/WC	$802.50

PLATE 3 HOL R PROX HUME 437123

Facility

$6,900.00

Hospital Charge Code	270640119
Hospital Revenue Code	278
Min. Negotiated Rate	$166.29
Max. Negotiated Rate	$3,450.00
Rate for Payer: Aetna Commercial	$2,622.00
Rate for Payer: Aetna Medicare Advantage	$2,070.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,759.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,759.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,759.50
Rate for Payer: Cigna Commercial	$3,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,669.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,518.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.00
Rate for Payer: UnitedHealthcare Community & State	$166.29
Rate for Payer: Wellpoint Medicaid Managed Care	$182.85

PLATE 3 HOL R PROX HUME 437123

Facility

$6,900.00

Hospital Charge Code	270640119
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.00
Max. Negotiated Rate	$1,669.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,669.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,518.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.00

PLATE 3 LEVEL 45MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270694168
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$4,658.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

PLATE 3 LEVEL 45MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270694168
Hospital Revenue Code	278
Min. Negotiated Rate	$463.93
Max. Negotiated Rate	$9,625.00
Rate for Payer: Aetna Commercial	$7,315.00
Rate for Payer: Aetna Medicare Advantage	$5,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,908.75
Rate for Payer: Cigna Commercial	$9,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50
Rate for Payer: UnitedHealthcare Community & State	$463.93
Rate for Payer: Wellpoint Medicaid Managed Care	$510.12

PLATE 3MM WEDGE

Facility

$7,537.50

Service Code	HCPCS C1713
Hospital Charge Code	270679461
Hospital Revenue Code	278
Min. Negotiated Rate	$181.65
Max. Negotiated Rate	$3,768.75
Rate for Payer: Aetna Commercial	$2,864.25
Rate for Payer: Aetna Medicare Advantage	$2,261.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,922.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,922.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,507.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,922.06
Rate for Payer: Cigna Commercial	$3,768.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,824.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,658.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,130.62
Rate for Payer: UnitedHealthcare Community & State	$181.65
Rate for Payer: Wellpoint Medicaid Managed Care	$199.74

PLATE 3MM WEDGE

Facility

$7,537.50

Service Code	HCPCS C1713
Hospital Charge Code	270679461
Hospital Revenue Code	278
Min. Negotiated Rate	$1,130.62
Max. Negotiated Rate	$1,824.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,507.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,824.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,658.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,130.62

PLATE 4.0 MM X 14 MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270692990
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

PLATE 4.0 MM X 14 MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270692990
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

PLATE 41 MM X 2 LEVEL FUS

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692107
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

PLATE 41 MM X 2 LEVEL FUS

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692107
Hospital Revenue Code	278
Min. Negotiated Rate	$331.38
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$5,225.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50
Rate for Payer: UnitedHealthcare Community & State	$331.38
Rate for Payer: Wellpoint Medicaid Managed Care	$364.38

PLATE 42MM

Facility

$5,237.45

Service Code	HCPCS C1713
Hospital Charge Code	270703881
Hospital Revenue Code	278
Min. Negotiated Rate	$126.22
Max. Negotiated Rate	$2,618.72
Rate for Payer: Aetna Commercial	$1,990.23
Rate for Payer: Aetna Medicare Advantage	$1,571.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,335.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,335.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,047.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,335.55
Rate for Payer: Cigna Commercial	$2,618.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,267.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,152.24
Rate for Payer: Qualcare PPO/HMO/WC	$785.62
Rate for Payer: UnitedHealthcare Community & State	$126.22
Rate for Payer: Wellpoint Medicaid Managed Care	$138.79

PLATE 42MM

Facility

$5,237.45

Service Code	HCPCS C1713
Hospital Charge Code	270703881
Hospital Revenue Code	278
Min. Negotiated Rate	$785.62
Max. Negotiated Rate	$1,267.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,047.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,267.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,152.24
Rate for Payer: Qualcare PPO/HMO/WC	$785.62

PLATE 42MM 2LVL

Facility

$5,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693716
Hospital Revenue Code	278
Min. Negotiated Rate	$138.57
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$2,185.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Community & State	$138.57
Rate for Payer: Wellpoint Medicaid Managed Care	$152.38

PLATE 42MM 2LVL

Facility

$5,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693716
Hospital Revenue Code	278
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$1,391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,391.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,265.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

PLATE 44MM

Facility

$2,000.00

Hospital Charge Code	270703128
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 44MM

Facility

$2,000.00

Hospital Charge Code	270703128
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 4.5mm ACT 8-H 146688000

Facility

$639.90

Hospital Charge Code	270633296
Hospital Revenue Code	278
Min. Negotiated Rate	$95.98
Max. Negotiated Rate	$154.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$140.78
Rate for Payer: Qualcare PPO/HMO/WC	$95.98

PLATE 4.5mm ACT 8-H 146688000

Facility

$639.90

Hospital Charge Code	270633296
Hospital Revenue Code	278
Min. Negotiated Rate	$15.42
Max. Negotiated Rate	$319.95
Rate for Payer: Aetna Commercial	$243.16
Rate for Payer: Aetna Medicare Advantage	$191.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.17
Rate for Payer: Cigna Commercial	$319.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$140.78
Rate for Payer: Qualcare PPO/HMO/WC	$95.98
Rate for Payer: UnitedHealthcare Community & State	$15.42
Rate for Payer: Wellpoint Medicaid Managed Care	$16.96

Know your out-of-pocket cost for care.

All Charges