Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE DISTAL FIBULA

Facility

$5,885.00

Hospital Charge Code	270702537
Hospital Revenue Code	278
Min. Negotiated Rate	$141.83
Max. Negotiated Rate	$2,942.50
Rate for Payer: Aetna Commercial	$2,236.30
Rate for Payer: Aetna Medicare Advantage	$1,765.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,500.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,500.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,177.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,500.67
Rate for Payer: Cigna Commercial	$2,942.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,424.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,294.70
Rate for Payer: Qualcare PPO/HMO/WC	$882.75
Rate for Payer: UnitedHealthcare Community & State	$141.83
Rate for Payer: Wellpoint Medicaid Managed Care	$155.95

PLATE DISTALFIBULA 13HOLE 2.7R

Facility

$4,734.00

Hospital Charge Code	270664152
Hospital Revenue Code	278
Min. Negotiated Rate	$114.09
Max. Negotiated Rate	$2,367.00
Rate for Payer: Aetna Commercial	$1,798.92
Rate for Payer: Aetna Medicare Advantage	$1,420.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,207.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,207.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,207.17
Rate for Payer: Cigna Commercial	$2,367.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,041.48
Rate for Payer: Qualcare PPO/HMO/WC	$710.10
Rate for Payer: UnitedHealthcare Community & State	$114.09
Rate for Payer: Wellpoint Medicaid Managed Care	$125.45

PLATE DISTALFIBULA 13HOLE 2.7R

Facility

$4,734.00

Hospital Charge Code	270664152
Hospital Revenue Code	278
Min. Negotiated Rate	$710.10
Max. Negotiated Rate	$1,145.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,145.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,041.48
Rate for Payer: Qualcare PPO/HMO/WC	$710.10

PLATE DISTALFIBULA 15HOLE 2.7L

Facility

$4,938.00

Hospital Charge Code	270664154
Hospital Revenue Code	278
Min. Negotiated Rate	$740.70
Max. Negotiated Rate	$1,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$987.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,195.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,086.36
Rate for Payer: Qualcare PPO/HMO/WC	$740.70

PLATE DISTALFIBULA 15HOLE 2.7L

Facility

$4,938.00

Hospital Charge Code	270664154
Hospital Revenue Code	278
Min. Negotiated Rate	$119.01
Max. Negotiated Rate	$2,469.00
Rate for Payer: Aetna Commercial	$1,876.44
Rate for Payer: Aetna Medicare Advantage	$1,481.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,259.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,259.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$987.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,259.19
Rate for Payer: Cigna Commercial	$2,469.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,195.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,086.36
Rate for Payer: Qualcare PPO/HMO/WC	$740.70
Rate for Payer: UnitedHealthcare Community & State	$119.01
Rate for Payer: Wellpoint Medicaid Managed Care	$130.86

PLATE DISTALFIBULA 15HOLE 2.7R

Facility

$4,938.00

Hospital Charge Code	270664151
Hospital Revenue Code	278
Min. Negotiated Rate	$740.70
Max. Negotiated Rate	$1,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$987.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,195.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,086.36
Rate for Payer: Qualcare PPO/HMO/WC	$740.70

PLATE DISTALFIBULA 15HOLE 2.7R

Facility

$4,938.00

Hospital Charge Code	270664151
Hospital Revenue Code	278
Min. Negotiated Rate	$119.01
Max. Negotiated Rate	$2,469.00
Rate for Payer: Aetna Commercial	$1,876.44
Rate for Payer: Aetna Medicare Advantage	$1,481.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,259.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,259.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$987.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,259.19
Rate for Payer: Cigna Commercial	$2,469.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,195.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,086.36
Rate for Payer: Qualcare PPO/HMO/WC	$740.70
Rate for Payer: UnitedHealthcare Community & State	$119.01
Rate for Payer: Wellpoint Medicaid Managed Care	$130.86

PLATE DISTAL FIBULA 2.7 MM 5 H

Facility

$5,810.00

Hospital Charge Code	207661556
Hospital Revenue Code	278
Min. Negotiated Rate	$871.50
Max. Negotiated Rate	$1,406.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,406.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,278.20
Rate for Payer: Qualcare PPO/HMO/WC	$871.50

PLATE DISTAL FIBULA 2.7 MM 5 H

Facility

$5,810.00

Hospital Charge Code	207661556
Hospital Revenue Code	278
Min. Negotiated Rate	$140.02
Max. Negotiated Rate	$2,905.00
Rate for Payer: Aetna Commercial	$2,207.80
Rate for Payer: Aetna Medicare Advantage	$1,743.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,481.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,481.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,481.55
Rate for Payer: Cigna Commercial	$2,905.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,406.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,278.20
Rate for Payer: Qualcare PPO/HMO/WC	$871.50
Rate for Payer: UnitedHealthcare Community & State	$140.02
Rate for Payer: Wellpoint Medicaid Managed Care	$153.97

PLATE DISTAL FIBULA 4H 2.7x3.5

Facility

$6,282.00

Service Code	HCPCS C1713
Hospital Charge Code	270668470
Hospital Revenue Code	278
Min. Negotiated Rate	$942.30
Max. Negotiated Rate	$1,520.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,256.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,520.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,382.04
Rate for Payer: Qualcare PPO/HMO/WC	$942.30

PLATE DISTAL FIBULA 4H 2.7x3.5

Facility

$6,282.00

Service Code	HCPCS C1713
Hospital Charge Code	270668470
Hospital Revenue Code	278
Min. Negotiated Rate	$151.40
Max. Negotiated Rate	$3,141.00
Rate for Payer: Aetna Commercial	$2,387.16
Rate for Payer: Aetna Medicare Advantage	$1,884.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,601.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,601.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,256.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,601.91
Rate for Payer: Cigna Commercial	$3,141.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,520.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,382.04
Rate for Payer: Qualcare PPO/HMO/WC	$942.30
Rate for Payer: UnitedHealthcare Community & State	$151.40
Rate for Payer: Wellpoint Medicaid Managed Care	$166.47

PLATE DISTAL FIBULA 5 HOLE

Facility

$2,972.65

Service Code	HCPCS C1713
Hospital Charge Code	270686753
Hospital Revenue Code	278
Min. Negotiated Rate	$445.90
Max. Negotiated Rate	$719.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$594.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$719.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$653.98
Rate for Payer: Qualcare PPO/HMO/WC	$445.90

PLATE DISTAL FIBULA 5 HOLE

Facility

$2,972.65

Service Code	HCPCS C1713
Hospital Charge Code	270686753
Hospital Revenue Code	278
Min. Negotiated Rate	$71.64
Max. Negotiated Rate	$1,486.33
Rate for Payer: Aetna Commercial	$1,129.61
Rate for Payer: Aetna Medicare Advantage	$891.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$594.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.03
Rate for Payer: Cigna Commercial	$1,486.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$719.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$653.98
Rate for Payer: Qualcare PPO/HMO/WC	$445.90
Rate for Payer: UnitedHealthcare Community & State	$71.64
Rate for Payer: Wellpoint Medicaid Managed Care	$78.78

PLATE DISTAL FIBULA 6HOLE

Facility

$3,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270671888
Hospital Revenue Code	278
Min. Negotiated Rate	$543.75
Max. Negotiated Rate	$877.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$797.50
Rate for Payer: Qualcare PPO/HMO/WC	$543.75

PLATE DISTAL FIBULA 6HOLE

Facility

$3,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270671888
Hospital Revenue Code	278
Min. Negotiated Rate	$87.36
Max. Negotiated Rate	$1,812.50
Rate for Payer: Aetna Commercial	$1,377.50
Rate for Payer: Aetna Medicare Advantage	$1,087.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$924.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$924.38
Rate for Payer: Cigna Commercial	$1,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$797.50
Rate for Payer: Qualcare PPO/HMO/WC	$543.75
Rate for Payer: UnitedHealthcare Community & State	$87.36
Rate for Payer: Wellpoint Medicaid Managed Care	$96.06

PLATE DISTAL FIBULA 8H 2.7x3.5

Facility

$10,690.00

Service Code	HCPCS C1713
Hospital Charge Code	270672089
Hospital Revenue Code	278
Min. Negotiated Rate	$257.63
Max. Negotiated Rate	$5,345.00
Rate for Payer: Aetna Commercial	$4,062.20
Rate for Payer: Aetna Medicare Advantage	$3,207.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,725.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,725.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,138.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,725.95
Rate for Payer: Cigna Commercial	$5,345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,586.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,351.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,603.50
Rate for Payer: UnitedHealthcare Community & State	$257.63
Rate for Payer: Wellpoint Medicaid Managed Care	$283.29

PLATE DISTAL FIBULA 8H 2.7x3.5

Facility

$10,690.00

Service Code	HCPCS C1713
Hospital Charge Code	270672089
Hospital Revenue Code	278
Min. Negotiated Rate	$1,603.50
Max. Negotiated Rate	$2,586.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,586.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,351.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,603.50

PLATE DISTAL FIBULA SS LEFT 4H

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270660175
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$665.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

PLATE DISTAL FIBULA SS LEFT 4H

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270660175
Hospital Revenue Code	278
Min. Negotiated Rate	$66.28
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$1,045.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.50
Rate for Payer: UnitedHealthcare Community & State	$66.28
Rate for Payer: Wellpoint Medicaid Managed Care	$72.88

PLATE DISTAL FIBULA SS LEFT 5H

Facility

$3,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270671887
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

PLATE DISTAL FIBULA SS LEFT 5H

Facility

$3,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270671887
Hospital Revenue Code	278
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

PLATE DISTAL FIBULA SS LEFT 8H

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270669995
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 DISTAL FIBULA SS LEFT 8H

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270669995
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 DISTAL FIBULA SS LFT 10H

Facility

$4,250.00

Hospital Charge Code	270671889
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

PLATE DISTAL FIBULA SS LFT 10H

Facility

$4,250.00

Hospital Charge Code	270671889
Hospital Revenue Code	278
Min. Negotiated Rate	$102.42
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,615.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50
Rate for Payer: UnitedHealthcare Community & State	$102.42
Rate for Payer: Wellpoint Medicaid Managed Care	$112.62

Know your out-of-pocket cost for care.

All Charges