Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE CLOVERLF 2.4/2.7X45MM

Facility

$13,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270700030
Hospital Revenue Code	278
Min. Negotiated Rate	$2,061.00
Max. Negotiated Rate	$3,325.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,748.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,325.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,022.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,061.00

PLATE CLOVERLF 2.4/2.7X45MM

Facility

$13,740.00

Service Code	HCPCS C1713
Hospital Charge Code	270700030
Hospital Revenue Code	278
Min. Negotiated Rate	$331.13
Max. Negotiated Rate	$6,870.00
Rate for Payer: Aetna Commercial	$5,221.20
Rate for Payer: Aetna Medicare Advantage	$4,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,503.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,503.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,748.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,503.70
Rate for Payer: Cigna Commercial	$6,870.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,325.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,022.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,061.00
Rate for Payer: UnitedHealthcare Community & State	$331.13
Rate for Payer: Wellpoint Medicaid Managed Care	$364.11

PLATE & COLLAR 1/3 TUB 10 HL

Facility

$184.00

Hospital Charge Code	1603851
Hospital Revenue Code	274
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$92.00
Rate for Payer: Aetna Commercial	$69.92
Rate for Payer: Aetna Medicare Advantage	$55.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.92
Rate for Payer: Cigna Commercial	$92.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$40.48
Rate for Payer: Qualcare PPO/HMO/WC	$27.60
Rate for Payer: UnitedHealthcare Community & State	$4.43
Rate for Payer: Wellpoint Medicaid Managed Care	$4.88

PLATE & COLLAR 1/3 TUB 10 HL

Facility

$184.00

Hospital Charge Code	1603851
Hospital Revenue Code	274
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$44.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$40.48
Rate for Payer: Qualcare PPO/HMO/WC	$27.60

PLATE & COLLAR 1/3 TUB 2 H

Facility

$135.00

Hospital Charge Code	1603802
Hospital Revenue Code	274
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$32.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$29.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

PLATE & COLLAR 1/3 TUB 2 H

Facility

$135.00

Hospital Charge Code	1603802
Hospital Revenue Code	274
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$29.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

PLATE & COLLAR 1/3 TUB 441.33

Facility

$140.00

Hospital Charge Code	1603810
Hospital Revenue Code	274
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.80
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

PLATE & COLLAR 1/3 TUB 441.33

Facility

$140.00

Hospital Charge Code	1603810
Hospital Revenue Code	274
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$70.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.80
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Community & State	$3.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.71

PLATE & COLLAR 1/3 TUB 4&5 HL

Facility

$169.00

Hospital Charge Code	1603828
Hospital Revenue Code	274
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$84.50
Rate for Payer: Aetna Commercial	$64.22
Rate for Payer: Aetna Medicare Advantage	$50.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.09
Rate for Payer: Cigna Commercial	$84.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$37.18
Rate for Payer: Qualcare PPO/HMO/WC	$25.35
Rate for Payer: UnitedHealthcare Community & State	$4.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.48

PLATE & COLLAR 1/3 TUB 4&5 HL

Facility

$169.00

Hospital Charge Code	1603828
Hospital Revenue Code	274
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$40.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$37.18
Rate for Payer: Qualcare PPO/HMO/WC	$25.35

PLATE & COLLAR 1/3 TUB 6&7 HL

Facility

$179.00

Hospital Charge Code	1603836
Hospital Revenue Code	274
Min. Negotiated Rate	$26.85
Max. Negotiated Rate	$43.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$39.38
Rate for Payer: Qualcare PPO/HMO/WC	$26.85

PLATE & COLLAR 1/3 TUB 6&7 HL

Facility

$179.00

Hospital Charge Code	1603836
Hospital Revenue Code	274
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$89.50
Rate for Payer: Aetna Commercial	$68.02
Rate for Payer: Aetna Medicare Advantage	$53.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.65
Rate for Payer: Cigna Commercial	$89.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$39.38
Rate for Payer: Qualcare PPO/HMO/WC	$26.85
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: Wellpoint Medicaid Managed Care	$4.74

PLATE & COLLAR 1/3 TUB 8 HL

Facility

$184.00

Hospital Charge Code	1603844
Hospital Revenue Code	274
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$44.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$40.48
Rate for Payer: Qualcare PPO/HMO/WC	$27.60

PLATE & COLLAR 1/3 TUB 8 HL

Facility

$184.00

Hospital Charge Code	1603844
Hospital Revenue Code	274
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$92.00
Rate for Payer: Aetna Commercial	$69.92
Rate for Payer: Aetna Medicare Advantage	$55.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.92
Rate for Payer: Cigna Commercial	$92.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$40.48
Rate for Payer: Qualcare PPO/HMO/WC	$27.60
Rate for Payer: UnitedHealthcare Community & State	$4.43
Rate for Payer: Wellpoint Medicaid Managed Care	$4.88

PLATE COMP LCK 10 HOLE 5.0MM

Facility

$12,034.15

Service Code	HCPCS C1713
Hospital Charge Code	270700876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,805.12
Max. Negotiated Rate	$2,912.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,406.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,912.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,647.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,805.12

PLATE COMP LCK 10 HOLE 5.0MM

Facility

$12,034.15

Service Code	HCPCS C1713
Hospital Charge Code	270700876
Hospital Revenue Code	278
Min. Negotiated Rate	$290.02
Max. Negotiated Rate	$6,017.07
Rate for Payer: Aetna Commercial	$4,572.98
Rate for Payer: Aetna Medicare Advantage	$3,610.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,068.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,068.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,406.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,068.71
Rate for Payer: Cigna Commercial	$6,017.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,912.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,647.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,805.12
Rate for Payer: UnitedHealthcare Community & State	$290.02
Rate for Payer: Wellpoint Medicaid Managed Care	$318.90

PLATE COMP LKG 187MM 10H 3.5MM

Facility

$8,186.75

Service Code	HCPCS C1713
Hospital Charge Code	270697112
Hospital Revenue Code	278
Min. Negotiated Rate	$197.30
Max. Negotiated Rate	$4,093.38
Rate for Payer: Aetna Commercial	$3,110.97
Rate for Payer: Aetna Medicare Advantage	$2,456.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,087.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,087.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,637.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,087.62
Rate for Payer: Cigna Commercial	$4,093.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,981.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,801.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,228.01
Rate for Payer: UnitedHealthcare Community & State	$197.30
Rate for Payer: Wellpoint Medicaid Managed Care	$216.95

PLATE COMP LKG 187MM 10H 3.5MM

Facility

$8,186.75

Service Code	HCPCS C1713
Hospital Charge Code	270697112
Hospital Revenue Code	278
Min. Negotiated Rate	$1,228.01
Max. Negotiated Rate	$1,981.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,637.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,981.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,801.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,228.01

PLATE COMPOSITE 8 HOLE

Facility

$1,015.00

Hospital Charge Code	270648905
Hospital Revenue Code	278
Min. Negotiated Rate	$24.46
Max. Negotiated Rate	$507.50
Rate for Payer: Aetna Commercial	$385.70
Rate for Payer: Aetna Medicare Advantage	$304.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$258.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$258.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$258.82
Rate for Payer: Cigna Commercial	$507.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$223.30
Rate for Payer: Qualcare PPO/HMO/WC	$152.25
Rate for Payer: UnitedHealthcare Community & State	$24.46
Rate for Payer: Wellpoint Medicaid Managed Care	$26.90

PLATE COMPOSITE 8 HOLE

Facility

$1,015.00

Hospital Charge Code	270648905
Hospital Revenue Code	278
Min. Negotiated Rate	$152.25
Max. Negotiated Rate	$245.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$203.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$223.30
Rate for Payer: Qualcare PPO/HMO/WC	$152.25

PLATE COMPRESSION 3HOLE 20MM

Facility

$4,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270677562
Hospital Revenue Code	278
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$2,487.50
Rate for Payer: Aetna Commercial	$1,890.50
Rate for Payer: Aetna Medicare Advantage	$1,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,268.62
Rate for Payer: Cigna Commercial	$2,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,094.50
Rate for Payer: Qualcare PPO/HMO/WC	$746.25
Rate for Payer: UnitedHealthcare Community & State	$119.90
Rate for Payer: Wellpoint Medicaid Managed Care	$131.84

PLATE COMPRESSION 3HOLE 20MM

Facility

$4,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270677562
Hospital Revenue Code	278
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$1,203.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,094.50
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

PLATE COMPRESSION 3HOLE 25MM

Facility

$4,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270677561
Hospital Revenue Code	278
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$1,203.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,094.50
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

PLATE COMPRESSION 3HOLE 25MM

Facility

$4,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270677561
Hospital Revenue Code	278
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$2,487.50
Rate for Payer: Aetna Commercial	$1,890.50
Rate for Payer: Aetna Medicare Advantage	$1,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,268.62
Rate for Payer: Cigna Commercial	$2,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,094.50
Rate for Payer: Qualcare PPO/HMO/WC	$746.25
Rate for Payer: UnitedHealthcare Community & State	$119.90
Rate for Payer: Wellpoint Medicaid Managed Care	$131.84

PLATE COMPRESSION 4 HOLE

Facility

$5,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270679503
Hospital Revenue Code	278
Min. Negotiated Rate	$144.00
Max. Negotiated Rate	$2,987.50
Rate for Payer: Aetna Commercial	$2,270.50
Rate for Payer: Aetna Medicare Advantage	$1,792.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,523.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,523.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,523.62
Rate for Payer: Cigna Commercial	$2,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,445.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,314.50
Rate for Payer: Qualcare PPO/HMO/WC	$896.25
Rate for Payer: UnitedHealthcare Community & State	$144.00
Rate for Payer: Wellpoint Medicaid Managed Care	$158.34

Know your out-of-pocket cost for care.

All Charges