Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE ALIP 25MM

Facility

$28,297.50

Service Code	HCPCS C1713
Hospital Charge Code	270679296
Hospital Revenue Code	278
Min. Negotiated Rate	$4,244.62
Max. Negotiated Rate	$6,847.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,659.50
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

PLATE AMBASSADOR 1 LEVEL 14MM

Facility

$19,250.55

Service Code	HCPCS C1713
Hospital Charge Code	270695211
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.58
Max. Negotiated Rate	$4,658.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,235.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.58

PLATE AMBASSADOR 1 LEVEL 14MM

Facility

$19,250.55

Service Code	HCPCS C1713
Hospital Charge Code	270695211
Hospital Revenue Code	278
Min. Negotiated Rate	$463.94
Max. Negotiated Rate	$9,625.27
Rate for Payer: Aetna Commercial	$7,315.21
Rate for Payer: Aetna Medicare Advantage	$5,775.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,908.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,908.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,908.89
Rate for Payer: Cigna Commercial	$9,625.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,235.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.58
Rate for Payer: UnitedHealthcare Community & State	$463.94
Rate for Payer: Wellpoint Medicaid Managed Care	$510.14

PLATE, AMP-LTX, 2-HOLE

Facility

$15,505.00

Hospital Charge Code	270702580
Hospital Revenue Code	278
Min. Negotiated Rate	$373.67
Max. Negotiated Rate	$7,752.50
Rate for Payer: Aetna Commercial	$5,891.90
Rate for Payer: Aetna Medicare Advantage	$4,651.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,953.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,953.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,101.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,953.78
Rate for Payer: Cigna Commercial	$7,752.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,752.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,411.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.75
Rate for Payer: UnitedHealthcare Community & State	$373.67
Rate for Payer: Wellpoint Medicaid Managed Care	$410.88

PLATE, AMP-LTX, 2-HOLE

Facility

$15,505.00

Hospital Charge Code	270702580
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.75
Max. Negotiated Rate	$3,752.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,101.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,752.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,411.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.75

PLATE ANATOMIC 6H RT 816207006

Facility

$5,415.00

Hospital Charge Code	270661575
Hospital Revenue Code	278
Min. Negotiated Rate	$130.50
Max. Negotiated Rate	$2,707.50
Rate for Payer: Aetna Commercial	$2,057.70
Rate for Payer: Aetna Medicare Advantage	$1,624.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,380.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,380.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,083.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,380.83
Rate for Payer: Cigna Commercial	$2,707.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,310.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,191.30
Rate for Payer: Qualcare PPO/HMO/WC	$812.25
Rate for Payer: UnitedHealthcare Community & State	$130.50
Rate for Payer: Wellpoint Medicaid Managed Care	$143.50

PLATE ANATOMIC 6H RT 816207006

Facility

$5,415.00

Hospital Charge Code	270661575
Hospital Revenue Code	278
Min. Negotiated Rate	$812.25
Max. Negotiated Rate	$1,310.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,083.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,310.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,191.30
Rate for Payer: Qualcare PPO/HMO/WC	$812.25

PLATE ANATOMIC (R) 54-25386

Facility

$5,145.00

Hospital Charge Code	270643445
Hospital Revenue Code	278
Min. Negotiated Rate	$123.99
Max. Negotiated Rate	$2,572.50
Rate for Payer: Aetna Commercial	$1,955.10
Rate for Payer: Aetna Medicare Advantage	$1,543.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,311.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,311.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,029.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,311.97
Rate for Payer: Cigna Commercial	$2,572.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,245.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,131.90
Rate for Payer: Qualcare PPO/HMO/WC	$771.75
Rate for Payer: UnitedHealthcare Community & State	$123.99
Rate for Payer: Wellpoint Medicaid Managed Care	$136.34

PLATE ANATOMIC (R) 54-25386

Facility

$5,145.00

Hospital Charge Code	270643445
Hospital Revenue Code	278
Min. Negotiated Rate	$771.75
Max. Negotiated Rate	$1,245.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,029.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,245.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,131.90
Rate for Payer: Qualcare PPO/HMO/WC	$771.75

PLATE ANATOMIC STRD LT DVRA

Facility

$3,725.00

Hospital Charge Code	270638277
Hospital Revenue Code	278
Min. Negotiated Rate	$558.75
Max. Negotiated Rate	$901.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$745.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$901.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$819.50
Rate for Payer: Qualcare PPO/HMO/WC	$558.75

PLATE ANATOMIC STRD LT DVRA

Facility

$3,725.00

Hospital Charge Code	270638277
Hospital Revenue Code	278
Min. Negotiated Rate	$89.77
Max. Negotiated Rate	$1,862.50
Rate for Payer: Aetna Commercial	$1,415.50
Rate for Payer: Aetna Medicare Advantage	$1,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$949.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$949.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$745.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$949.88
Rate for Payer: Cigna Commercial	$1,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$901.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$819.50
Rate for Payer: Qualcare PPO/HMO/WC	$558.75
Rate for Payer: UnitedHealthcare Community & State	$89.77
Rate for Payer: Wellpoint Medicaid Managed Care	$98.71

PLATE ANCHON 22 MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270692208
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 ANCHON 22 MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270692208
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 ANCHORING MED 10H 16MM

Facility

$28,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270680019
Hospital Revenue Code	278
Min. Negotiated Rate	$4,200.00
Max. Negotiated Rate	$6,776.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,776.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,160.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,200.00

PLATE ANCHORING MED 10H 16MM

Facility

$28,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270680019
Hospital Revenue Code	278
Min. Negotiated Rate	$674.80
Max. Negotiated Rate	$14,000.00
Rate for Payer: Aetna Commercial	$10,640.00
Rate for Payer: Aetna Medicare Advantage	$8,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,140.00
Rate for Payer: Cigna Commercial	$14,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,776.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,160.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,200.00
Rate for Payer: UnitedHealthcare Community & State	$674.80
Rate for Payer: Wellpoint Medicaid Managed Care	$742.00

PLATE ANCHORING ROI-C

Facility

$11,666.65

Service Code	HCPCS C1713
Hospital Charge Code	270692180
Hospital Revenue Code	278
Min. Negotiated Rate	$1,750.00
Max. Negotiated Rate	$2,823.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,333.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,823.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,566.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,750.00

PLATE ANCHORING ROI-C

Facility

$11,666.65

Service Code	HCPCS C1713
Hospital Charge Code	270692180
Hospital Revenue Code	278
Min. Negotiated Rate	$281.17
Max. Negotiated Rate	$5,833.32
Rate for Payer: Aetna Commercial	$4,433.33
Rate for Payer: Aetna Medicare Advantage	$3,499.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,333.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,975.00
Rate for Payer: Cigna Commercial	$5,833.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,823.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,566.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,750.00
Rate for Payer: UnitedHealthcare Community & State	$281.17
Rate for Payer: Wellpoint Medicaid Managed Care	$309.17

PLATE ANCHORING S

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270683450
Hospital Revenue Code	278
Min. Negotiated Rate	$361.50
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$361.50
Rate for Payer: Wellpoint Medicaid Managed Care	$397.50

PLATE ANCHORING S

Facility

$15,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270683450
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

PLATE ANKLE FUSION POSTERIOR R

Facility

$11,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270678710
Hospital Revenue Code	278
Min. Negotiated Rate	$274.14
Max. Negotiated Rate	$5,687.50
Rate for Payer: Aetna Commercial	$4,322.50
Rate for Payer: Aetna Medicare Advantage	$3,412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,900.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,900.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,900.62
Rate for Payer: Cigna Commercial	$5,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,752.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,502.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,706.25
Rate for Payer: UnitedHealthcare Community & State	$274.14
Rate for Payer: Wellpoint Medicaid Managed Care	$301.44

PLATE ANKLE FUSION POSTERIOR R

Facility

$11,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270678710
Hospital Revenue Code	278
Min. Negotiated Rate	$1,706.25
Max. Negotiated Rate	$2,752.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,752.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,502.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,706.25

PLATE ANT CERV 1 LEV 16MM

Facility

$12,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270695715
Hospital Revenue Code	278
Min. Negotiated Rate	$295.83
Max. Negotiated Rate	$6,137.50
Rate for Payer: Aetna Commercial	$4,664.50
Rate for Payer: Aetna Medicare Advantage	$3,682.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,130.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,130.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,455.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,130.12
Rate for Payer: Cigna Commercial	$6,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,970.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,700.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,841.25
Rate for Payer: UnitedHealthcare Community & State	$295.83
Rate for Payer: Wellpoint Medicaid Managed Care	$325.29

PLATE ANT CERV 1 LEV 16MM

Facility

$12,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270695715
Hospital Revenue Code	278
Min. Negotiated Rate	$1,841.25
Max. Negotiated Rate	$2,970.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,455.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,970.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,700.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,841.25

PLATE ANT CERV 1LEV 16MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270698203
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 ANT CERV 1LEV 16MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270698203
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

Know your out-of-pocket cost for care.

All Charges