Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE CALC SLIDE

Facility

$7,837.50

Service Code	HCPCS C1713
Hospital Charge Code	270701423
Hospital Revenue Code	278
Min. Negotiated Rate	$188.88
Max. Negotiated Rate	$3,918.75
Rate for Payer: Aetna Commercial	$2,978.25
Rate for Payer: Aetna Medicare Advantage	$2,351.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,998.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,998.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,567.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,998.56
Rate for Payer: Cigna Commercial	$3,918.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,896.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,724.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,175.62
Rate for Payer: UnitedHealthcare Community & State	$188.88
Rate for Payer: Wellpoint Medicaid Managed Care	$207.69

PLATE CAL LEFT

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270684029
Hospital Revenue Code	278
Min. Negotiated Rate	$131.95
Max. Negotiated Rate	$2,737.50
Rate for Payer: Aetna Commercial	$2,080.50
Rate for Payer: Aetna Medicare Advantage	$1,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,396.12
Rate for Payer: Cigna Commercial	$2,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,204.50
Rate for Payer: Qualcare PPO/HMO/WC	$821.25
Rate for Payer: UnitedHealthcare Community & State	$131.95
Rate for Payer: Wellpoint Medicaid Managed Care	$145.09

PLATE CAL LEFT

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270684029
Hospital Revenue Code	278
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$1,324.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,204.50
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

PLATE CASE TRI SZ 6

Facility

$6,303.45

Service Code	HCPCS C1776
Hospital Charge Code	270691999
Hospital Revenue Code	278
Min. Negotiated Rate	$945.52
Max. Negotiated Rate	$1,525.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,525.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,386.76
Rate for Payer: Qualcare PPO/HMO/WC	$945.52

PLATE CASE TRI SZ 6

Facility

$6,303.45

Service Code	HCPCS C1776
Hospital Charge Code	270691999
Hospital Revenue Code	278
Min. Negotiated Rate	$151.91
Max. Negotiated Rate	$3,151.72
Rate for Payer: Aetna Commercial	$2,395.31
Rate for Payer: Aetna Medicare Advantage	$1,891.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,607.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,607.38
Rate for Payer: Cigna Commercial	$3,151.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,525.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,386.76
Rate for Payer: Qualcare PPO/HMO/WC	$945.52
Rate for Payer: UnitedHealthcare Community & State	$151.91
Rate for Payer: Wellpoint Medicaid Managed Care	$167.04

PLATE CAYMAN UNITED 1H 18MM LT

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698868
Hospital Revenue Code	278
Min. Negotiated Rate	$421.75
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$421.75
Rate for Payer: Wellpoint Medicaid Managed Care	$463.75

PLATE CAYMAN UNITED 1H 18MM LT

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698868
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

PLATE CERES 2 LEVEL 40MM

Facility

$4,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270697054
Hospital Revenue Code	278
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$1,161.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,056.00
Rate for Payer: Qualcare PPO/HMO/WC	$720.00

PLATE CERES 2 LEVEL 40MM

Facility

$4,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270697054
Hospital Revenue Code	278
Min. Negotiated Rate	$115.68
Max. Negotiated Rate	$2,400.00
Rate for Payer: Aetna Commercial	$1,824.00
Rate for Payer: Aetna Medicare Advantage	$1,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,224.00
Rate for Payer: Cigna Commercial	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,056.00
Rate for Payer: Qualcare PPO/HMO/WC	$720.00
Rate for Payer: UnitedHealthcare Community & State	$115.68
Rate for Payer: Wellpoint Medicaid Managed Care	$127.20

PLATE CERES 3 LEVEL 39MM

Facility

$4,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270695467
Hospital Revenue Code	278
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$1,161.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,056.00
Rate for Payer: Qualcare PPO/HMO/WC	$720.00

PLATE CERES 3 LEVEL 39MM

Facility

$4,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270695467
Hospital Revenue Code	278
Min. Negotiated Rate	$115.68
Max. Negotiated Rate	$2,400.00
Rate for Payer: Aetna Commercial	$1,824.00
Rate for Payer: Aetna Medicare Advantage	$1,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,224.00
Rate for Payer: Cigna Commercial	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,056.00
Rate for Payer: Qualcare PPO/HMO/WC	$720.00
Rate for Payer: UnitedHealthcare Community & State	$115.68
Rate for Payer: Wellpoint Medicaid Managed Care	$127.20

PLATE CERES 3 LEVEL 42MM

Facility

$4,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270695468
Hospital Revenue Code	278
Min. Negotiated Rate	$115.68
Max. Negotiated Rate	$2,400.00
Rate for Payer: Aetna Commercial	$1,824.00
Rate for Payer: Aetna Medicare Advantage	$1,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,224.00
Rate for Payer: Cigna Commercial	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,056.00
Rate for Payer: Qualcare PPO/HMO/WC	$720.00
Rate for Payer: UnitedHealthcare Community & State	$115.68
Rate for Payer: Wellpoint Medicaid Managed Care	$127.20

PLATE CERES 3 LEVEL 42MM

Facility

$4,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270695468
Hospital Revenue Code	278
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$1,161.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,056.00
Rate for Payer: Qualcare PPO/HMO/WC	$720.00

PLATE CERES ACP 2 LEVEL 28 MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270693004
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 CERES ACP 2 LEVEL 28 MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270693004
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 CERES-C 8MM

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692529
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

PLATE CERES-C 8MM

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692529
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

PLATE CERES-C INTERBODY 7MM

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694123
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

PLATE CERES-C INTERBODY 7MM

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270694123
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

PLATE CERV 1LEV SAPPHIREX 13MM

Facility

$6,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270694724
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

PLATE CERV 1LEV SAPPHIREX 13MM

Facility

$6,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270694724
Hospital Revenue Code	278
Min. Negotiated Rate	$159.06
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$2,508.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.00
Rate for Payer: UnitedHealthcare Community & State	$159.06
Rate for Payer: Wellpoint Medicaid Managed Care	$174.90

PLATE CERV 3LEVEL 14MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693406
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 CERV 3LEVEL 14MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693406
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 CERV ANT 1.6V 20MM 1LEV

Facility

$11,203.50

Service Code	HCPCS C1713
Hospital Charge Code	270696332
Hospital Revenue Code	278
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$5,601.75
Rate for Payer: Aetna Commercial	$4,257.33
Rate for Payer: Aetna Medicare Advantage	$3,361.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,856.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,856.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,240.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,856.89
Rate for Payer: Cigna Commercial	$5,601.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,711.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,464.77
Rate for Payer: Qualcare PPO/HMO/WC	$1,680.53
Rate for Payer: UnitedHealthcare Community & State	$270.00
Rate for Payer: Wellpoint Medicaid Managed Care	$296.89

PLATE CERV ANT 1.6V 20MM 1LEV

Facility

$11,203.50

Service Code	HCPCS C1713
Hospital Charge Code	270696332
Hospital Revenue Code	278
Min. Negotiated Rate	$1,680.53
Max. Negotiated Rate	$2,711.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,240.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,711.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,464.77
Rate for Payer: Qualcare PPO/HMO/WC	$1,680.53

Know your out-of-pocket cost for care.

All Charges