Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE CONTOUR 17 HOLE

Facility

$11,085.00

Service Code	HCPCS C1713
Hospital Charge Code	270684922
Hospital Revenue Code	278
Min. Negotiated Rate	$267.15
Max. Negotiated Rate	$5,542.50
Rate for Payer: Aetna Commercial	$4,212.30
Rate for Payer: Aetna Medicare Advantage	$3,325.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,826.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,826.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,217.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,826.68
Rate for Payer: Cigna Commercial	$5,542.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,682.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,438.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,662.75
Rate for Payer: UnitedHealthcare Community & State	$267.15
Rate for Payer: Wellpoint Medicaid Managed Care	$293.75

PLATE CONTOUR 17 HOLE

Facility

$11,085.00

Service Code	HCPCS C1713
Hospital Charge Code	270684922
Hospital Revenue Code	278
Min. Negotiated Rate	$1,662.75
Max. Negotiated Rate	$2,682.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,217.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,682.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,438.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,662.75

PLATE COTTON 4MM

Facility

$3,975.00

Hospital Charge Code	270668302
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$874.50
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

PLATE COTTON 4MM

Facility

$3,975.00

Hospital Charge Code	270668302
Hospital Revenue Code	278
Min. Negotiated Rate	$95.80
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,510.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$874.50
Rate for Payer: Qualcare PPO/HMO/WC	$596.25
Rate for Payer: UnitedHealthcare Community & State	$95.80
Rate for Payer: Wellpoint Medicaid Managed Care	$105.34

PLATE CRANIAL OSSDSIGN PSI

Facility

$65,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270698500
Hospital Revenue Code	278
Min. Negotiated Rate	$9,750.00
Max. Negotiated Rate	$15,730.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,730.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,750.00

PLATE CRANIAL OSSDSIGN PSI

Facility

$65,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270698500
Hospital Revenue Code	278
Min. Negotiated Rate	$1,566.50
Max. Negotiated Rate	$32,500.00
Rate for Payer: Aetna Commercial	$24,700.00
Rate for Payer: Aetna Medicare Advantage	$19,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,575.00
Rate for Payer: Cigna Commercial	$32,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,730.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,750.00
Rate for Payer: UnitedHealthcare Community & State	$1,566.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1,722.50

PLATE CRANIAL STR 2H 12MM

Facility

$560.00

Service Code	HCPCS C1713
Hospital Charge Code	270695276
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$280.00
Rate for Payer: Aetna Commercial	$212.80
Rate for Payer: Aetna Medicare Advantage	$168.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.80
Rate for Payer: Cigna Commercial	$280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$123.20
Rate for Payer: Qualcare PPO/HMO/WC	$84.00
Rate for Payer: UnitedHealthcare Community & State	$13.50
Rate for Payer: Wellpoint Medicaid Managed Care	$14.84

PLATE CRANIAL STR 2H 12MM

Facility

$560.00

Service Code	HCPCS C1713
Hospital Charge Code	270695276
Hospital Revenue Code	278
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$135.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$123.20
Rate for Payer: Qualcare PPO/HMO/WC	$84.00

PLATE CROSSCHECK MTP RT

Facility

$12,965.00

Service Code	HCPCS C1713
Hospital Charge Code	270699979
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 CROSSCHECK MTP RT

Facility

$12,965.00

Service Code	HCPCS C1713
Hospital Charge Code	270699979
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 CROSS CNR SZ3545 2230540

Facility

$2,207.25

Hospital Charge Code	270633070
Hospital Revenue Code	278
Min. Negotiated Rate	$331.09
Max. Negotiated Rate	$534.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$441.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$485.60
Rate for Payer: Qualcare PPO/HMO/WC	$331.09

PLATE CROSS CNR SZ3545 2230540

Facility

$2,207.25

Hospital Charge Code	270633070
Hospital Revenue Code	278
Min. Negotiated Rate	$53.19
Max. Negotiated Rate	$1,103.62
Rate for Payer: Aetna Commercial	$838.75
Rate for Payer: Aetna Medicare Advantage	$662.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$562.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$562.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$441.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$562.85
Rate for Payer: Cigna Commercial	$1,103.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$485.60
Rate for Payer: Qualcare PPO/HMO/WC	$331.09
Rate for Payer: UnitedHealthcare Community & State	$53.19
Rate for Payer: Wellpoint Medicaid Managed Care	$58.49

PLATE CRV 1LVL CONST OZRK 20MM

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270699421
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

PLATE CRV 1LVL CONST OZRK 20MM

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270699421
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

PLATE CRVD BROAD LCP 14H 265MM

Facility

$3,480.00

Service Code	HCPCS C1713
Hospital Charge Code	270674380
Hospital Revenue Code	278
Min. Negotiated Rate	$522.00
Max. Negotiated Rate	$842.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$842.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$765.60
Rate for Payer: Qualcare PPO/HMO/WC	$522.00

PLATE CRVD BROAD LCP 14H 265MM

Facility

$3,480.00

Service Code	HCPCS C1713
Hospital Charge Code	270674380
Hospital Revenue Code	278
Min. Negotiated Rate	$83.87
Max. Negotiated Rate	$1,740.00
Rate for Payer: Aetna Commercial	$1,322.40
Rate for Payer: Aetna Medicare Advantage	$1,044.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$887.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$887.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$696.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$887.40
Rate for Payer: Cigna Commercial	$1,740.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$842.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$765.60
Rate for Payer: Qualcare PPO/HMO/WC	$522.00
Rate for Payer: UnitedHealthcare Community & State	$83.87
Rate for Payer: Wellpoint Medicaid Managed Care	$92.22

PLATE CS CONTOR SZ1530 2230530

Facility

$2,207.25

Hospital Charge Code	270633069
Hospital Revenue Code	278
Min. Negotiated Rate	$331.09
Max. Negotiated Rate	$534.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$441.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$485.60
Rate for Payer: Qualcare PPO/HMO/WC	$331.09

PLATE CS CONTOR SZ1530 2230530

Facility

$2,207.25

Hospital Charge Code	270633069
Hospital Revenue Code	278
Min. Negotiated Rate	$53.19
Max. Negotiated Rate	$1,103.62
Rate for Payer: Aetna Commercial	$838.75
Rate for Payer: Aetna Medicare Advantage	$662.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$562.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$562.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$441.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$562.85
Rate for Payer: Cigna Commercial	$1,103.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$485.60
Rate for Payer: Qualcare PPO/HMO/WC	$331.09
Rate for Payer: UnitedHealthcare Community & State	$53.19
Rate for Payer: Wellpoint Medicaid Managed Care	$58.49

PLATE C-SPINE UNI 16MM

Facility

$4,950.00

Service Code	HCPCS C1713
Hospital Charge Code	270693655
Hospital Revenue Code	278
Min. Negotiated Rate	$742.50
Max. Negotiated Rate	$1,197.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$742.50

PLATE C-SPINE UNI 16MM

Facility

$4,950.00

Service Code	HCPCS C1713
Hospital Charge Code	270693655
Hospital Revenue Code	278
Min. Negotiated Rate	$119.30
Max. Negotiated Rate	$2,475.00
Rate for Payer: Aetna Commercial	$1,881.00
Rate for Payer: Aetna Medicare Advantage	$1,485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,262.25
Rate for Payer: Cigna Commercial	$2,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$742.50
Rate for Payer: UnitedHealthcare Community & State	$119.30
Rate for Payer: Wellpoint Medicaid Managed Care	$131.18

PLATE CURE ACP 5 LEVEL 84MM

Facility

$16,747.50

Service Code	HCPCS C1713
Hospital Charge Code	270699248
Hospital Revenue Code	278
Min. Negotiated Rate	$2,512.12
Max. Negotiated Rate	$4,052.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,349.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,052.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,684.45
Rate for Payer: Qualcare PPO/HMO/WC	$2,512.12

PLATE CURE ACP 5 LEVEL 84MM

Facility

$16,747.50

Service Code	HCPCS C1713
Hospital Charge Code	270699248
Hospital Revenue Code	278
Min. Negotiated Rate	$403.61
Max. Negotiated Rate	$8,373.75
Rate for Payer: Aetna Commercial	$6,364.05
Rate for Payer: Aetna Medicare Advantage	$5,024.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,270.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,270.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,349.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,270.61
Rate for Payer: Cigna Commercial	$8,373.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,052.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,684.45
Rate for Payer: Qualcare PPO/HMO/WC	$2,512.12
Rate for Payer: UnitedHealthcare Community & State	$403.61
Rate for Payer: Wellpoint Medicaid Managed Care	$443.81

PLATE CURVE 36MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270668584
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

PLATE CURVE 36MM

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270668584
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

PLATE CUTTER LOCKING CALCANEAL

Facility

$6,590.95

Service Code	HCPCS C1713
Hospital Charge Code	270651714
Hospital Revenue Code	278
Min. Negotiated Rate	$988.64
Max. Negotiated Rate	$1,595.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,318.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,595.01
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,450.01
Rate for Payer: Qualcare PPO/HMO/WC	$988.64

Know your out-of-pocket cost for care.

All Charges