Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE CUTTER LOCKING CALCANEAL

Facility

$6,590.95

Service Code	HCPCS C1713
Hospital Charge Code	270651714
Hospital Revenue Code	278
Min. Negotiated Rate	$158.84
Max. Negotiated Rate	$3,295.47
Rate for Payer: Aetna Commercial	$2,504.56
Rate for Payer: Aetna Medicare Advantage	$1,977.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,680.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,680.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,318.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,680.69
Rate for Payer: Cigna Commercial	$3,295.47
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
Rate for Payer: UnitedHealthcare Community & State	$158.84
Rate for Payer: Wellpoint Medicaid Managed Care	$174.66

PLATE DCP 10 HOLE 3.5x121MM

Facility

$769.40

Service Code	HCPCS C1713
Hospital Charge Code	270604402
Hospital Revenue Code	278
Min. Negotiated Rate	$115.41
Max. Negotiated Rate	$186.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$169.27
Rate for Payer: Qualcare PPO/HMO/WC	$115.41

PLATE DCP 10 HOLE 3.5x121MM

Facility

$769.40

Service Code	HCPCS C1713
Hospital Charge Code	270604402
Hospital Revenue Code	278
Min. Negotiated Rate	$18.54
Max. Negotiated Rate	$384.70
Rate for Payer: Aetna Commercial	$292.37
Rate for Payer: Aetna Medicare Advantage	$230.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$196.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$196.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$153.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$196.20
Rate for Payer: Cigna Commercial	$384.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$169.27
Rate for Payer: Qualcare PPO/HMO/WC	$115.41
Rate for Payer: UnitedHealthcare Community & State	$18.54
Rate for Payer: Wellpoint Medicaid Managed Care	$20.39

PLATE DCP 2.0MM 4H

Facility

$564.85

Hospital Charge Code	270604351
Hospital Revenue Code	278
Min. Negotiated Rate	$13.61
Max. Negotiated Rate	$282.43
Rate for Payer: Aetna Commercial	$214.64
Rate for Payer: Aetna Medicare Advantage	$169.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.04
Rate for Payer: Cigna Commercial	$282.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$124.27
Rate for Payer: Qualcare PPO/HMO/WC	$84.73
Rate for Payer: UnitedHealthcare Community & State	$13.61
Rate for Payer: Wellpoint Medicaid Managed Care	$14.97

PLATE DCP 2.0MM 4H

Facility

$564.85

Hospital Charge Code	270604351
Hospital Revenue Code	278
Min. Negotiated Rate	$84.73
Max. Negotiated Rate	$136.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$136.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$124.27
Rate for Payer: Qualcare PPO/HMO/WC	$84.73

PLATE DCP 2.0MM 5H

Facility

$581.65

Hospital Charge Code	270604352
Hospital Revenue Code	278
Min. Negotiated Rate	$87.25
Max. Negotiated Rate	$140.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.96
Rate for Payer: Qualcare PPO/HMO/WC	$87.25

PLATE DCP 2.0MM 5H

Facility

$581.65

Hospital Charge Code	270604352
Hospital Revenue Code	278
Min. Negotiated Rate	$14.02
Max. Negotiated Rate	$290.82
Rate for Payer: Aetna Commercial	$221.03
Rate for Payer: Aetna Medicare Advantage	$174.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.32
Rate for Payer: Cigna Commercial	$290.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.96
Rate for Payer: Qualcare PPO/HMO/WC	$87.25
Rate for Payer: UnitedHealthcare Community & State	$14.02
Rate for Payer: Wellpoint Medicaid Managed Care	$15.41

PLATE DCP 2.0MM 6H

Facility

$612.00

Hospital Charge Code	270604353
Hospital Revenue Code	278
Min. Negotiated Rate	$14.75
Max. Negotiated Rate	$306.00
Rate for Payer: Aetna Commercial	$232.56
Rate for Payer: Aetna Medicare Advantage	$183.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.06
Rate for Payer: Cigna Commercial	$306.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$134.64
Rate for Payer: Qualcare PPO/HMO/WC	$91.80
Rate for Payer: UnitedHealthcare Community & State	$14.75
Rate for Payer: Wellpoint Medicaid Managed Care	$16.22

PLATE DCP 2.0MM 6H

Facility

$612.00

Hospital Charge Code	270604353
Hospital Revenue Code	278
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$148.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$134.64
Rate for Payer: Qualcare PPO/HMO/WC	$91.80

PLATE DCP 2.0MM 7H

Facility

$638.45

Hospital Charge Code	270604354
Hospital Revenue Code	278
Min. Negotiated Rate	$95.77
Max. Negotiated Rate	$154.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$140.46
Rate for Payer: Qualcare PPO/HMO/WC	$95.77

PLATE DCP 2.0MM 7H

Facility

$638.45

Hospital Charge Code	270604354
Hospital Revenue Code	278
Min. Negotiated Rate	$15.39
Max. Negotiated Rate	$319.23
Rate for Payer: Aetna Commercial	$242.61
Rate for Payer: Aetna Medicare Advantage	$191.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.80
Rate for Payer: Cigna Commercial	$319.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$140.46
Rate for Payer: Qualcare PPO/HMO/WC	$95.77
Rate for Payer: UnitedHealthcare Community & State	$15.39
Rate for Payer: Wellpoint Medicaid Managed Care	$16.92

PLATE DCP 2.0MM 8H

Facility

$657.65

Hospital Charge Code	270604355
Hospital Revenue Code	278
Min. Negotiated Rate	$98.65
Max. Negotiated Rate	$159.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$131.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$144.68
Rate for Payer: Qualcare PPO/HMO/WC	$98.65

PLATE DCP 2.0MM 8H

Facility

$657.65

Hospital Charge Code	270604355
Hospital Revenue Code	278
Min. Negotiated Rate	$15.85
Max. Negotiated Rate	$328.82
Rate for Payer: Aetna Commercial	$249.91
Rate for Payer: Aetna Medicare Advantage	$197.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$131.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.70
Rate for Payer: Cigna Commercial	$328.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$144.68
Rate for Payer: Qualcare PPO/HMO/WC	$98.65
Rate for Payer: UnitedHealthcare Community & State	$15.85
Rate for Payer: Wellpoint Medicaid Managed Care	$17.43

PLATE DCP 2.7MM 10H 20MM

Facility

$797.65

Hospital Charge Code	270604365
Hospital Revenue Code	278
Min. Negotiated Rate	$19.22
Max. Negotiated Rate	$398.82
Rate for Payer: Aetna Commercial	$303.11
Rate for Payer: Aetna Medicare Advantage	$239.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$203.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$203.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$203.40
Rate for Payer: Cigna Commercial	$398.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$175.48
Rate for Payer: Qualcare PPO/HMO/WC	$119.65
Rate for Payer: UnitedHealthcare Community & State	$19.22
Rate for Payer: Wellpoint Medicaid Managed Care	$21.14

PLATE DCP 2.7MM 10H 20MM

Facility

$797.65

Hospital Charge Code	270604365
Hospital Revenue Code	278
Min. Negotiated Rate	$119.65
Max. Negotiated Rate	$193.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$175.48
Rate for Payer: Qualcare PPO/HMO/WC	$119.65

PLATE DCP 2.7MM 12H 20MM

Facility

$905.65

Hospital Charge Code	270604366
Hospital Revenue Code	278
Min. Negotiated Rate	$135.85
Max. Negotiated Rate	$219.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$199.24
Rate for Payer: Qualcare PPO/HMO/WC	$135.85

PLATE DCP 2.7MM 12H 20MM

Facility

$905.65

Hospital Charge Code	270604366
Hospital Revenue Code	278
Min. Negotiated Rate	$21.83
Max. Negotiated Rate	$452.82
Rate for Payer: Aetna Commercial	$344.15
Rate for Payer: Aetna Medicare Advantage	$271.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$230.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$230.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$230.94
Rate for Payer: Cigna Commercial	$452.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$199.24
Rate for Payer: Qualcare PPO/HMO/WC	$135.85
Rate for Payer: UnitedHealthcare Community & State	$21.83
Rate for Payer: Wellpoint Medicaid Managed Care	$24.00

PLATE DCP 2.7MM 2H 20MM

Facility

$511.25

Hospital Charge Code	270604358
Hospital Revenue Code	278
Min. Negotiated Rate	$12.32
Max. Negotiated Rate	$255.62
Rate for Payer: Aetna Commercial	$194.28
Rate for Payer: Aetna Medicare Advantage	$153.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.37
Rate for Payer: Cigna Commercial	$255.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$112.47
Rate for Payer: Qualcare PPO/HMO/WC	$76.69
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$13.55

PLATE DCP 2.7MM 2H 20MM

Facility

$511.25

Hospital Charge Code	270604358
Hospital Revenue Code	278
Min. Negotiated Rate	$76.69
Max. Negotiated Rate	$123.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$112.47
Rate for Payer: Qualcare PPO/HMO/WC	$76.69

PLATE DCP 2.7MM 2H 26MM

Facility

$681.65

Hospital Charge Code	270604367
Hospital Revenue Code	278
Min. Negotiated Rate	$16.43
Max. Negotiated Rate	$340.82
Rate for Payer: Aetna Commercial	$259.03
Rate for Payer: Aetna Medicare Advantage	$204.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.82
Rate for Payer: Cigna Commercial	$340.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.96
Rate for Payer: Qualcare PPO/HMO/WC	$102.25
Rate for Payer: UnitedHealthcare Community & State	$16.43
Rate for Payer: Wellpoint Medicaid Managed Care	$18.06

PLATE DCP 2.7MM 2H 26MM

Facility

$681.65

Hospital Charge Code	270604367
Hospital Revenue Code	278
Min. Negotiated Rate	$102.25
Max. Negotiated Rate	$164.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.96
Rate for Payer: Qualcare PPO/HMO/WC	$102.25

PLATE DCP 2.7MM 4H 20MM

Facility

$442.45

Hospital Charge Code	270604359
Hospital Revenue Code	278
Min. Negotiated Rate	$66.37
Max. Negotiated Rate	$107.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$97.34
Rate for Payer: Qualcare PPO/HMO/WC	$66.37

PLATE DCP 2.7MM 4H 20MM

Facility

$442.45

Hospital Charge Code	270604359
Hospital Revenue Code	278
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$221.22
Rate for Payer: Aetna Commercial	$168.13
Rate for Payer: Aetna Medicare Advantage	$132.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.82
Rate for Payer: Cigna Commercial	$221.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$97.34
Rate for Payer: Qualcare PPO/HMO/WC	$66.37
Rate for Payer: UnitedHealthcare Community & State	$10.66
Rate for Payer: Wellpoint Medicaid Managed Care	$11.72

PLATE DCP 2.7MM 5H 20MM

Facility

$508.00

Hospital Charge Code	270604360
Hospital Revenue Code	278
Min. Negotiated Rate	$76.20
Max. Negotiated Rate	$122.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$101.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$111.76
Rate for Payer: Qualcare PPO/HMO/WC	$76.20

PLATE DCP 2.7MM 5H 20MM

Facility

$508.00

Hospital Charge Code	270604360
Hospital Revenue Code	278
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$254.00
Rate for Payer: Aetna Commercial	$193.04
Rate for Payer: Aetna Medicare Advantage	$152.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$129.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$129.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$101.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$129.54
Rate for Payer: Cigna Commercial	$254.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$111.76
Rate for Payer: Qualcare PPO/HMO/WC	$76.20
Rate for Payer: UnitedHealthcare Community & State	$12.24
Rate for Payer: Wellpoint Medicaid Managed Care	$13.46

Know your out-of-pocket cost for care.

All Charges