Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE 4.5mm CONDYLAR 12HOLE LT

Facility

$7,048.30

Service Code	HCPCS C1713
Hospital Charge Code	270641542
Hospital Revenue Code	278
Min. Negotiated Rate	$169.86
Max. Negotiated Rate	$3,524.15
Rate for Payer: Aetna Commercial	$2,678.35
Rate for Payer: Aetna Medicare Advantage	$2,114.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,409.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.32
Rate for Payer: Cigna Commercial	$3,524.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,705.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,550.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.24
Rate for Payer: UnitedHealthcare Community & State	$169.86
Rate for Payer: Wellpoint Medicaid Managed Care	$186.78

PLATE 4.5mm CONDYLAR 12HOLE LT

Facility

$7,048.30

Service Code	HCPCS C1713
Hospital Charge Code	270641542
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.24
Max. Negotiated Rate	$1,705.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,409.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,705.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,550.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.24

PLATE 4.5MM NARROW LC-DCP

Facility

$816.00

Hospital Charge Code	270656208
Hospital Revenue Code	278
Min. Negotiated Rate	$19.67
Max. Negotiated Rate	$408.00
Rate for Payer: Aetna Commercial	$310.08
Rate for Payer: Aetna Medicare Advantage	$244.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.08
Rate for Payer: Cigna Commercial	$408.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$179.52
Rate for Payer: Qualcare PPO/HMO/WC	$122.40
Rate for Payer: UnitedHealthcare Community & State	$19.67
Rate for Payer: Wellpoint Medicaid Managed Care	$21.62

PLATE 4.5MM NARROW LC-DCP

Facility

$816.00

Hospital Charge Code	270656208
Hospital Revenue Code	278
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$197.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$179.52
Rate for Payer: Qualcare PPO/HMO/WC	$122.40

PLATE 4.5 VA LCP 14H 301MM RT

Facility

$29,585.00

Service Code	HCPCS C1713
Hospital Charge Code	270699395
Hospital Revenue Code	278
Min. Negotiated Rate	$713.00
Max. Negotiated Rate	$14,792.50
Rate for Payer: Aetna Commercial	$11,242.30
Rate for Payer: Aetna Medicare Advantage	$8,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,544.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,544.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,917.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,544.18
Rate for Payer: Cigna Commercial	$14,792.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,159.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,508.70
Rate for Payer: Qualcare PPO/HMO/WC	$4,437.75
Rate for Payer: UnitedHealthcare Community & State	$713.00
Rate for Payer: Wellpoint Medicaid Managed Care	$784.00

PLATE 4.5 VA LCP 14H 301MM RT

Facility

$29,585.00

Service Code	HCPCS C1713
Hospital Charge Code	270699395
Hospital Revenue Code	278
Min. Negotiated Rate	$4,437.75
Max. Negotiated Rate	$7,159.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,917.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,159.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,508.70
Rate for Payer: Qualcare PPO/HMO/WC	$4,437.75

PLATE 46 MM 2 LEVEL

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270691971
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$1,577.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,434.40
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

PLATE 46 MM 2 LEVEL

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270691971
Hospital Revenue Code	278
Min. Negotiated Rate	$157.13
Max. Negotiated Rate	$3,260.00
Rate for Payer: Aetna Commercial	$2,477.60
Rate for Payer: Aetna Medicare Advantage	$1,956.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,662.60
Rate for Payer: Cigna Commercial	$3,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,434.40
Rate for Payer: Qualcare PPO/HMO/WC	$978.00
Rate for Payer: UnitedHealthcare Community & State	$157.13
Rate for Payer: Wellpoint Medicaid Managed Care	$172.78

PLATE 48MM

Facility

$11,225.00

Service Code	HCPCS C1713
Hospital Charge Code	270663487
Hospital Revenue Code	278
Min. Negotiated Rate	$1,683.75
Max. Negotiated Rate	$2,716.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,245.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,716.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,469.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,683.75

PLATE 48MM

Facility

$11,225.00

Service Code	HCPCS C1713
Hospital Charge Code	270663487
Hospital Revenue Code	278
Min. Negotiated Rate	$270.52
Max. Negotiated Rate	$5,612.50
Rate for Payer: Aetna Commercial	$4,265.50
Rate for Payer: Aetna Medicare Advantage	$3,367.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,862.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,862.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,245.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,862.38
Rate for Payer: Cigna Commercial	$5,612.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,716.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,469.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,683.75
Rate for Payer: UnitedHealthcare Community & State	$270.52
Rate for Payer: Wellpoint Medicaid Managed Care	$297.46

PLATE 4HLE LF LT PRX TIB 26130

Facility

$6,425.00

Hospital Charge Code	270639191
Hospital Revenue Code	278
Min. Negotiated Rate	$154.84
Max. Negotiated Rate	$3,212.50
Rate for Payer: Aetna Commercial	$2,441.50
Rate for Payer: Aetna Medicare Advantage	$1,927.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,638.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,638.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,638.38
Rate for Payer: Cigna Commercial	$3,212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,413.50
Rate for Payer: Qualcare PPO/HMO/WC	$963.75
Rate for Payer: UnitedHealthcare Community & State	$154.84
Rate for Payer: Wellpoint Medicaid Managed Care	$170.26

PLATE 4HLE LF LT PRX TIB 26130

Facility

$6,425.00

Hospital Charge Code	270639191
Hospital Revenue Code	278
Min. Negotiated Rate	$963.75
Max. Negotiated Rate	$1,554.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,285.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,554.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,413.50
Rate for Payer: Qualcare PPO/HMO/WC	$963.75

PLATE 4 HOLE 14MM

Facility

$21,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693155
Hospital Revenue Code	278
Min. Negotiated Rate	$512.12
Max. Negotiated Rate	$10,625.00
Rate for Payer: Aetna Commercial	$8,075.00
Rate for Payer: Aetna Medicare Advantage	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,418.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,418.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,418.75
Rate for Payer: Cigna Commercial	$10,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,142.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,675.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,187.50
Rate for Payer: UnitedHealthcare Community & State	$512.12
Rate for Payer: Wellpoint Medicaid Managed Care	$563.12

PLATE 4 HOLE 14MM

Facility

$21,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693155
Hospital Revenue Code	278
Min. Negotiated Rate	$3,187.50
Max. Negotiated Rate	$5,142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,142.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,675.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,187.50

PLATE 4 HOLE 25MM CLAW II

Facility

$8,715.00

Service Code	HCPCS C1713
Hospital Charge Code	270671023
Hospital Revenue Code	278
Min. Negotiated Rate	$210.03
Max. Negotiated Rate	$4,357.50
Rate for Payer: Aetna Commercial	$3,311.70
Rate for Payer: Aetna Medicare Advantage	$2,614.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,222.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,222.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,743.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,222.32
Rate for Payer: Cigna Commercial	$4,357.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,109.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,917.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,307.25
Rate for Payer: UnitedHealthcare Community & State	$210.03
Rate for Payer: Wellpoint Medicaid Managed Care	$230.95

PLATE 4 HOLE 25MM CLAW II

Facility

$8,715.00

Service Code	HCPCS C1713
Hospital Charge Code	270671023
Hospital Revenue Code	278
Min. Negotiated Rate	$1,307.25
Max. Negotiated Rate	$2,109.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,743.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,109.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,917.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,307.25

PLATE 4 HOLE 30MM CLAW II

Facility

$8,715.00

Service Code	HCPCS C1713
Hospital Charge Code	270672103
Hospital Revenue Code	278
Min. Negotiated Rate	$1,307.25
Max. Negotiated Rate	$2,109.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,743.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,109.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,917.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,307.25

PLATE 4 HOLE 30MM CLAW II

Facility

$8,715.00

Service Code	HCPCS C1713
Hospital Charge Code	270672103
Hospital Revenue Code	278
Min. Negotiated Rate	$210.03
Max. Negotiated Rate	$4,357.50
Rate for Payer: Aetna Commercial	$3,311.70
Rate for Payer: Aetna Medicare Advantage	$2,614.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,222.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,222.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,743.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,222.32
Rate for Payer: Cigna Commercial	$4,357.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,109.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,917.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,307.25
Rate for Payer: UnitedHealthcare Community & State	$210.03
Rate for Payer: Wellpoint Medicaid Managed Care	$230.95

PLATE 4 HOLE 3.5 LCP

Facility

$5,838.00

Service Code	HCPCS C1713
Hospital Charge Code	270664330
Hospital Revenue Code	278
Min. Negotiated Rate	$875.70
Max. Negotiated Rate	$1,412.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,167.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,412.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,284.36
Rate for Payer: Qualcare PPO/HMO/WC	$875.70

PLATE 4 HOLE 3.5 LCP

Facility

$5,838.00

Service Code	HCPCS C1713
Hospital Charge Code	270664330
Hospital Revenue Code	278
Min. Negotiated Rate	$140.70
Max. Negotiated Rate	$2,919.00
Rate for Payer: Aetna Commercial	$2,218.44
Rate for Payer: Aetna Medicare Advantage	$1,751.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,488.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,488.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,167.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,488.69
Rate for Payer: Cigna Commercial	$2,919.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,412.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,284.36
Rate for Payer: Qualcare PPO/HMO/WC	$875.70
Rate for Payer: UnitedHealthcare Community & State	$140.70
Rate for Payer: Wellpoint Medicaid Managed Care	$154.71

PLATE 4 HOLE 3.5x20MM

Facility

$7,990.00

Hospital Charge Code	270656791
Hospital Revenue Code	278
Min. Negotiated Rate	$1,198.50
Max. Negotiated Rate	$1,933.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,598.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,933.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,757.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,198.50

PLATE 4 HOLE 3.5x20MM

Facility

$7,990.00

Hospital Charge Code	270656791
Hospital Revenue Code	278
Min. Negotiated Rate	$192.56
Max. Negotiated Rate	$3,995.00
Rate for Payer: Aetna Commercial	$3,036.20
Rate for Payer: Aetna Medicare Advantage	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,037.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,037.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,037.45
Rate for Payer: Cigna Commercial	$3,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,933.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,757.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,198.50
Rate for Payer: UnitedHealthcare Community & State	$192.56
Rate for Payer: Wellpoint Medicaid Managed Care	$211.74

PLATE 4 HOLE 3.5x25MM

Facility

$7,990.00

Hospital Charge Code	270656794
Hospital Revenue Code	278
Min. Negotiated Rate	$1,198.50
Max. Negotiated Rate	$1,933.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,598.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,933.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,757.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,198.50

PLATE 4 HOLE 3.5x25MM

Facility

$7,990.00

Hospital Charge Code	270656794
Hospital Revenue Code	278
Min. Negotiated Rate	$192.56
Max. Negotiated Rate	$3,995.00
Rate for Payer: Aetna Commercial	$3,036.20
Rate for Payer: Aetna Medicare Advantage	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,037.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,037.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,598.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,037.45
Rate for Payer: Cigna Commercial	$3,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,933.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,757.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,198.50
Rate for Payer: UnitedHealthcare Community & State	$192.56
Rate for Payer: Wellpoint Medicaid Managed Care	$211.74

PLATE 4HOLE 64mm MEDIAL LEFT

Facility

$4,116.00

Hospital Charge Code	270643697
Hospital Revenue Code	278
Min. Negotiated Rate	$99.20
Max. Negotiated Rate	$2,058.00
Rate for Payer: Aetna Commercial	$1,564.08
Rate for Payer: Aetna Medicare Advantage	$1,234.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,049.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,049.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$823.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,049.58
Rate for Payer: Cigna Commercial	$2,058.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$996.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$905.52
Rate for Payer: Qualcare PPO/HMO/WC	$617.40
Rate for Payer: UnitedHealthcare Community & State	$99.20
Rate for Payer: Wellpoint Medicaid Managed Care	$109.07

Know your out-of-pocket cost for care.

All Charges