Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE ANT CERV SKYLINE 26 MM

Facility

$6,757.50

Service Code	HCPCS C1713
Hospital Charge Code	270691716
Hospital Revenue Code	278
Min. Negotiated Rate	$1,013.62
Max. Negotiated Rate	$1,635.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,351.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,635.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,486.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,013.62

PLATE ANT CERV UNI 1LEV 20MM

Facility

$5,035.00

Service Code	HCPCS C1713
Hospital Charge Code	270689762
Hospital Revenue Code	278
Min. Negotiated Rate	$755.25
Max. Negotiated Rate	$1,218.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,007.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,218.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,107.70
Rate for Payer: Qualcare PPO/HMO/WC	$755.25

PLATE ANT CERV UNI 1LEV 20MM

Facility

$5,035.00

Service Code	HCPCS C1713
Hospital Charge Code	270689762
Hospital Revenue Code	278
Min. Negotiated Rate	$121.34
Max. Negotiated Rate	$2,517.50
Rate for Payer: Aetna Commercial	$1,913.30
Rate for Payer: Aetna Medicare Advantage	$1,510.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,283.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,283.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,007.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,283.92
Rate for Payer: Cigna Commercial	$2,517.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,218.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,107.70
Rate for Payer: Qualcare PPO/HMO/WC	$755.25
Rate for Payer: UnitedHealthcare Community & State	$121.34
Rate for Payer: Wellpoint Medicaid Managed Care	$133.43

PLATE ANTERIOR 2H 6MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694365
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

PLATE ANTERIOR 2H 6MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694365
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

PLATE ANTERIOR LARGE

Facility

$11,020.00

Service Code	HCPCS C1713
Hospital Charge Code	270687138
Hospital Revenue Code	278
Min. Negotiated Rate	$1,653.00
Max. Negotiated Rate	$2,666.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,666.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,424.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,653.00

PLATE ANTERIOR LARGE

Facility

$11,020.00

Service Code	HCPCS C1713
Hospital Charge Code	270687138
Hospital Revenue Code	278
Min. Negotiated Rate	$265.58
Max. Negotiated Rate	$5,510.00
Rate for Payer: Aetna Commercial	$4,187.60
Rate for Payer: Aetna Medicare Advantage	$3,306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,810.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,810.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,810.10
Rate for Payer: Cigna Commercial	$5,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,666.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,424.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,653.00
Rate for Payer: UnitedHealthcare Community & State	$265.58
Rate for Payer: Wellpoint Medicaid Managed Care	$292.03

PLATE ANTERIOR RT LAT SMALL

Facility

$9,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270685125
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$2,286.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,079.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50

PLATE ANTERIOR RT LAT SMALL

Facility

$9,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270685125
Hospital Revenue Code	278
Min. Negotiated Rate	$227.75
Max. Negotiated Rate	$4,725.00
Rate for Payer: Aetna Commercial	$3,591.00
Rate for Payer: Aetna Medicare Advantage	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,409.75
Rate for Payer: Cigna Commercial	$4,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,079.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50
Rate for Payer: UnitedHealthcare Community & State	$227.75
Rate for Payer: Wellpoint Medicaid Managed Care	$250.43

PLATE ANTERIOR STR LG RT 116MM

Facility

$12,965.00

Service Code	HCPCS C1713
Hospital Charge Code	270672734
Hospital Revenue Code	278
Min. Negotiated Rate	$312.46
Max. Negotiated Rate	$6,482.50
Rate for Payer: Aetna Commercial	$4,926.70
Rate for Payer: Aetna Medicare Advantage	$3,889.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,306.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,306.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,593.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,306.07
Rate for Payer: Cigna Commercial	$6,482.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,137.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,852.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,944.75
Rate for Payer: UnitedHealthcare Community & State	$312.46
Rate for Payer: Wellpoint Medicaid Managed Care	$343.57

PLATE ANTERIOR STR LG RT 116MM

Facility

$12,965.00

Service Code	HCPCS C1713
Hospital Charge Code	270672734
Hospital Revenue Code	278
Min. Negotiated Rate	$1,944.75
Max. Negotiated Rate	$3,137.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,593.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,137.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,852.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,944.75

PLATE ARCHON 36MM 2LEVEL

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270693540
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 ARCHON 36MM 2LEVEL

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270693540
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 ARCHON 38MM 2-LEVEL

Facility

$6,050.00

Service Code	HCPCS C1889
Hospital Charge Code	270693343
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 ARCHON 38MM 2-LEVEL

Facility

$6,050.00

Service Code	HCPCS C1889
Hospital Charge Code	270693343
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 ARCHON 40MM 2 LEVEL

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270694489
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 ARCHON 40MM 2 LEVEL

Facility

$6,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270694489
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 ATK BUTRSS 1.75MM 905900

Facility

$1,303.25

Hospital Charge Code	270616221
Hospital Revenue Code	278
Min. Negotiated Rate	$195.49
Max. Negotiated Rate	$315.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$286.71
Rate for Payer: Qualcare PPO/HMO/WC	$195.49

PLATE ATK BUTRSS 1.75MM 905900

Facility

$1,303.25

Hospital Charge Code	270616221
Hospital Revenue Code	278
Min. Negotiated Rate	$31.41
Max. Negotiated Rate	$651.62
Rate for Payer: Aetna Commercial	$495.24
Rate for Payer: Aetna Medicare Advantage	$390.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$332.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$332.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$332.33
Rate for Payer: Cigna Commercial	$651.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$286.71
Rate for Payer: Qualcare PPO/HMO/WC	$195.49
Rate for Payer: UnitedHealthcare Community & State	$31.41
Rate for Payer: Wellpoint Medicaid Managed Care	$34.54

PLATE BEND 4 H 87 MM RIGHT LCP

Facility

$7,162.60

Service Code	HCPCS C1713
Hospital Charge Code	270686078
Hospital Revenue Code	278
Min. Negotiated Rate	$172.62
Max. Negotiated Rate	$3,581.30
Rate for Payer: Aetna Commercial	$2,721.79
Rate for Payer: Aetna Medicare Advantage	$2,148.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,826.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,826.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,432.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,826.46
Rate for Payer: Cigna Commercial	$3,581.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,733.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,575.77
Rate for Payer: Qualcare PPO/HMO/WC	$1,074.39
Rate for Payer: UnitedHealthcare Community & State	$172.62
Rate for Payer: Wellpoint Medicaid Managed Care	$189.81

PLATE BEND 4 H 87 MM RIGHT LCP

Facility

$7,162.60

Service Code	HCPCS C1713
Hospital Charge Code	270686078
Hospital Revenue Code	278
Min. Negotiated Rate	$1,074.39
Max. Negotiated Rate	$1,733.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,432.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,733.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,575.77
Rate for Payer: Qualcare PPO/HMO/WC	$1,074.39

PLATE BGA TIBIAL 12.5 AR13200

Facility

$3,793.65

Hospital Charge Code	270616688
Hospital Revenue Code	278
Min. Negotiated Rate	$569.05
Max. Negotiated Rate	$918.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$758.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$918.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$834.60
Rate for Payer: Qualcare PPO/HMO/WC	$569.05

PLATE BGA TIBIAL 12.5 AR13200

Facility

$3,793.65

Hospital Charge Code	270616688
Hospital Revenue Code	278
Min. Negotiated Rate	$91.43
Max. Negotiated Rate	$1,896.83
Rate for Payer: Aetna Commercial	$1,441.59
Rate for Payer: Aetna Medicare Advantage	$1,138.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$967.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$967.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$758.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$967.38
Rate for Payer: Cigna Commercial	$1,896.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$918.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$834.60
Rate for Payer: Qualcare PPO/HMO/WC	$569.05
Rate for Payer: UnitedHealthcare Community & State	$91.43
Rate for Payer: Wellpoint Medicaid Managed Care	$100.53

PLATE BMT CABLE 248 200325

Facility

$10,113.50

Hospital Charge Code	270627424
Hospital Revenue Code	278
Min. Negotiated Rate	$1,517.03
Max. Negotiated Rate	$2,447.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,022.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,447.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,224.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,517.03

PLATE BMT CABLE 248 200325

Facility

$10,113.50

Hospital Charge Code	270627424
Hospital Revenue Code	278
Min. Negotiated Rate	$243.74
Max. Negotiated Rate	$5,056.75
Rate for Payer: Aetna Commercial	$3,843.13
Rate for Payer: Aetna Medicare Advantage	$3,034.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,578.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,578.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,022.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,578.94
Rate for Payer: Cigna Commercial	$5,056.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,447.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,224.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,517.03
Rate for Payer: UnitedHealthcare Community & State	$243.74
Rate for Payer: Wellpoint Medicaid Managed Care	$268.01

Know your out-of-pocket cost for care.

All Charges