Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE ACP 1.6V 2LEVEL 34MM

Facility

$12,144.00

Service Code	HCPCS C1713
Hospital Charge Code	270694722
Hospital Revenue Code	278
Min. Negotiated Rate	$1,821.60
Max. Negotiated Rate	$2,938.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,428.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,938.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,671.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,821.60

PLATE ACP 1.6V 2LEVEL 34MM

Facility

$12,144.00

Service Code	HCPCS C1713
Hospital Charge Code	270694722
Hospital Revenue Code	278
Min. Negotiated Rate	$292.67
Max. Negotiated Rate	$6,072.00
Rate for Payer: Aetna Commercial	$4,614.72
Rate for Payer: Aetna Medicare Advantage	$3,643.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,428.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,096.72
Rate for Payer: Cigna Commercial	$6,072.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,938.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,671.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,821.60
Rate for Payer: UnitedHealthcare Community & State	$292.67
Rate for Payer: Wellpoint Medicaid Managed Care	$321.82

PLATE ACP 1.6V 36MM 2-LEVEL

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270695254
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

PLATE ACP 1.6V 36MM 2-LEVEL

Facility

$850.00

Service Code	HCPCS C1713
Hospital Charge Code	270695254
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

PLATE ACP 1.6V 38MM 2 LEVEL

Facility

$12,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270693080
Hospital Revenue Code	278
Min. Negotiated Rate	$292.57
Max. Negotiated Rate	$6,070.00
Rate for Payer: Aetna Commercial	$4,613.20
Rate for Payer: Aetna Medicare Advantage	$3,642.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,095.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,095.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,428.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,095.70
Rate for Payer: Cigna Commercial	$6,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,937.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,670.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,821.00
Rate for Payer: UnitedHealthcare Community & State	$292.57
Rate for Payer: Wellpoint Medicaid Managed Care	$321.71

PLATE ACP 1.6V 38MM 2 LEVEL

Facility

$12,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270693080
Hospital Revenue Code	278
Min. Negotiated Rate	$1,821.00
Max. Negotiated Rate	$2,937.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,428.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,937.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,670.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,821.00

PLATE ACP 1.6V 40MM 2LEVEL

Facility

$12,144.00

Service Code	HCPCS C1713
Hospital Charge Code	270694179
Hospital Revenue Code	278
Min. Negotiated Rate	$1,821.60
Max. Negotiated Rate	$2,938.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,428.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,938.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,671.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,821.60

PLATE ACP 1.6V 40MM 2LEVEL

Facility

$12,144.00

Service Code	HCPCS C1713
Hospital Charge Code	270694179
Hospital Revenue Code	278
Min. Negotiated Rate	$292.67
Max. Negotiated Rate	$6,072.00
Rate for Payer: Aetna Commercial	$4,614.72
Rate for Payer: Aetna Medicare Advantage	$3,643.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,096.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,428.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,096.72
Rate for Payer: Cigna Commercial	$6,072.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,938.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,671.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,821.60
Rate for Payer: UnitedHealthcare Community & State	$292.67
Rate for Payer: Wellpoint Medicaid Managed Care	$321.82

PLATE ACP 1.6V 42MM 2LEVEL

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270695490
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 ACP 1.6V 42MM 2LEVEL

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270695490
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 ACP 1.9 1 LEVEL

Facility

$11,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270694206
Hospital Revenue Code	278
Min. Negotiated Rate	$269.92
Max. Negotiated Rate	$5,600.00
Rate for Payer: Aetna Commercial	$4,256.00
Rate for Payer: Aetna Medicare Advantage	$3,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,856.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,856.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,856.00
Rate for Payer: Cigna Commercial	$5,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,710.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,464.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,680.00
Rate for Payer: UnitedHealthcare Community & State	$269.92
Rate for Payer: Wellpoint Medicaid Managed Care	$296.80

PLATE ACP 1.9 1 LEVEL

Facility

$11,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270694206
Hospital Revenue Code	278
Min. Negotiated Rate	$1,680.00
Max. Negotiated Rate	$2,710.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,710.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,464.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,680.00

PLATE ACP 1.9 1 LEVEL 16MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698447
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 ACP 1.9 1 LEVEL 16MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698447
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 ACP 1.9H 3LEVEL 52MM

Facility

$13,068.00

Service Code	HCPCS C1713
Hospital Charge Code	270694727
Hospital Revenue Code	278
Min. Negotiated Rate	$1,960.20
Max. Negotiated Rate	$3,162.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,613.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,162.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,874.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,960.20

PLATE ACP 1.9H 3LEVEL 52MM

Facility

$13,068.00

Service Code	HCPCS C1713
Hospital Charge Code	270694727
Hospital Revenue Code	278
Min. Negotiated Rate	$314.94
Max. Negotiated Rate	$6,534.00
Rate for Payer: Aetna Commercial	$4,965.84
Rate for Payer: Aetna Medicare Advantage	$3,920.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,332.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,332.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,613.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,332.34
Rate for Payer: Cigna Commercial	$6,534.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,162.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,874.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,960.20
Rate for Payer: UnitedHealthcare Community & State	$314.94
Rate for Payer: Wellpoint Medicaid Managed Care	$346.30

PLATE ACP 1.9H 54MM 3-LEVEL

Facility

$13,068.00

Service Code	HCPCS C1713
Hospital Charge Code	270695128
Hospital Revenue Code	278
Min. Negotiated Rate	$314.94
Max. Negotiated Rate	$6,534.00
Rate for Payer: Aetna Commercial	$4,965.84
Rate for Payer: Aetna Medicare Advantage	$3,920.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,332.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,332.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,613.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,332.34
Rate for Payer: Cigna Commercial	$6,534.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,162.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,874.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,960.20
Rate for Payer: UnitedHealthcare Community & State	$314.94
Rate for Payer: Wellpoint Medicaid Managed Care	$346.30

PLATE ACP 1.9H 54MM 3-LEVEL

Facility

$13,068.00

Service Code	HCPCS C1713
Hospital Charge Code	270695128
Hospital Revenue Code	278
Min. Negotiated Rate	$1,960.20
Max. Negotiated Rate	$3,162.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,613.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,162.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,874.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,960.20

PLATE ACP 1.9H 56MM 3LEVEL

Facility

$13,068.00

Service Code	HCPCS C1713
Hospital Charge Code	270694183
Hospital Revenue Code	278
Min. Negotiated Rate	$1,960.20
Max. Negotiated Rate	$3,162.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,613.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,162.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,874.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,960.20

PLATE ACP 1.9H 56MM 3LEVEL

Facility

$13,068.00

Service Code	HCPCS C1713
Hospital Charge Code	270694183
Hospital Revenue Code	278
Min. Negotiated Rate	$314.94
Max. Negotiated Rate	$6,534.00
Rate for Payer: Aetna Commercial	$4,965.84
Rate for Payer: Aetna Medicare Advantage	$3,920.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,332.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,332.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,613.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,332.34
Rate for Payer: Cigna Commercial	$6,534.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,162.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,874.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,960.20
Rate for Payer: UnitedHealthcare Community & State	$314.94
Rate for Payer: Wellpoint Medicaid Managed Care	$346.30

PLATE ACP GRUVE 20MM 1681-020

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698920
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 ACP GRUVE 20MM 1681-020

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698920
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 ADAPTION 20HOL 100 44710

Facility

$1,383.90

Hospital Charge Code	270633380
Hospital Revenue Code	278
Min. Negotiated Rate	$33.35
Max. Negotiated Rate	$691.95
Rate for Payer: Aetna Commercial	$525.88
Rate for Payer: Aetna Medicare Advantage	$415.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$352.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$352.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$276.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$352.89
Rate for Payer: Cigna Commercial	$691.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$334.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$304.46
Rate for Payer: Qualcare PPO/HMO/WC	$207.59
Rate for Payer: UnitedHealthcare Community & State	$33.35
Rate for Payer: Wellpoint Medicaid Managed Care	$36.67

PLATE ADAPTION 20HOL 100 44710

Facility

$1,383.90

Hospital Charge Code	270633380
Hospital Revenue Code	278
Min. Negotiated Rate	$207.59
Max. Negotiated Rate	$334.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$276.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$334.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$304.46
Rate for Payer: Qualcare PPO/HMO/WC	$207.59

PLATE ALIP 25MM

Facility

$28,297.50

Service Code	HCPCS C1713
Hospital Charge Code	270679296
Hospital Revenue Code	278
Min. Negotiated Rate	$681.97
Max. Negotiated Rate	$14,148.75
Rate for Payer: Aetna Commercial	$10,753.05
Rate for Payer: Aetna Medicare Advantage	$8,489.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,215.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,215.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,659.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,215.86
Rate for Payer: Cigna Commercial	$14,148.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,847.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,225.45
Rate for Payer: Qualcare PPO/HMO/WC	$4,244.62
Rate for Payer: UnitedHealthcare Community & State	$681.97
Rate for Payer: Wellpoint Medicaid Managed Care	$749.88

Know your out-of-pocket cost for care.

All Charges