Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE DISTAL RADIUS 4 HOLE

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270664366
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

PLATE DISTAL RADIUS 4 HOLE, G

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270664370
Hospital Revenue Code	278
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,700.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25
Rate for Payer: UnitedHealthcare Community & State	$107.85
Rate for Payer: Wellpoint Medicaid Managed Care	$118.59

PLATE DISTAL RADIUS 4 HOLE, G

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270664370
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

PLATE DISTAL RADIUS 7 HOLE, GM

Facility

$4,975.00

Hospital Charge Code	270664371
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 DISTAL RADIUS 7 HOLE, GM

Facility

$4,975.00

Hospital Charge Code	270664371
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 DISTAL RADIUS NRW 3H RT

Facility

$3,973.75

Service Code	HCPCS C1713
Hospital Charge Code	270664185
Hospital Revenue Code	278
Min. Negotiated Rate	$95.77
Max. Negotiated Rate	$1,986.88
Rate for Payer: Aetna Commercial	$1,510.03
Rate for Payer: Aetna Medicare Advantage	$1,192.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$794.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.31
Rate for Payer: Cigna Commercial	$1,986.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$874.23
Rate for Payer: Qualcare PPO/HMO/WC	$596.06
Rate for Payer: UnitedHealthcare Community & State	$95.77
Rate for Payer: Wellpoint Medicaid Managed Care	$105.30

PLATE DISTAL RADIUS NRW 3H RT

Facility

$3,973.75

Service Code	HCPCS C1713
Hospital Charge Code	270664185
Hospital Revenue Code	278
Min. Negotiated Rate	$596.06
Max. Negotiated Rate	$961.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$794.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$874.23
Rate for Payer: Qualcare PPO/HMO/WC	$596.06

PLATE DISTAL RADIUS NRW 4H LF

Facility

$4,675.00

Service Code	HCPCS C1713
Hospital Charge Code	270664367
Hospital Revenue Code	278
Min. Negotiated Rate	$112.67
Max. Negotiated Rate	$2,337.50
Rate for Payer: Aetna Commercial	$1,776.50
Rate for Payer: Aetna Medicare Advantage	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,192.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,192.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,192.12
Rate for Payer: Cigna Commercial	$2,337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,131.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$701.25
Rate for Payer: UnitedHealthcare Community & State	$112.67
Rate for Payer: Wellpoint Medicaid Managed Care	$123.89

PLATE DISTAL RADIUS NRW 4H LF

Facility

$4,675.00

Service Code	HCPCS C1713
Hospital Charge Code	270664367
Hospital Revenue Code	278
Min. Negotiated Rate	$701.25
Max. Negotiated Rate	$1,131.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$935.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,131.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$701.25

PLATE DISTAL RADUIS, 3 HOLE

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270664365
Hospital Revenue Code	278
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,700.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25
Rate for Payer: UnitedHealthcare Community & State	$107.85
Rate for Payer: Wellpoint Medicaid Managed Care	$118.59

PLATE DISTAL RADUIS, 3 HOLE

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270664365
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

PLATE DISTAL TIBIA MED. 6H RT

Facility

$10,085.00

Service Code	HCPCS C1713
Hospital Charge Code	270673661
Hospital Revenue Code	278
Min. Negotiated Rate	$1,512.75
Max. Negotiated Rate	$2,440.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,017.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,440.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,218.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,512.75

PLATE DISTAL TIBIA MED. 6H RT

Facility

$10,085.00

Service Code	HCPCS C1713
Hospital Charge Code	270673661
Hospital Revenue Code	278
Min. Negotiated Rate	$243.05
Max. Negotiated Rate	$5,042.50
Rate for Payer: Aetna Commercial	$3,832.30
Rate for Payer: Aetna Medicare Advantage	$3,025.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,571.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,571.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,017.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,571.68
Rate for Payer: Cigna Commercial	$5,042.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,440.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,218.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,512.75
Rate for Payer: UnitedHealthcare Community & State	$243.05
Rate for Payer: Wellpoint Medicaid Managed Care	$267.25

PLATE DISTAL VOL/RADIUS 22x51m

Facility

$13,250.00

Hospital Charge Code	270667474
Hospital Revenue Code	278
Min. Negotiated Rate	$319.32
Max. Negotiated Rate	$6,625.00
Rate for Payer: Aetna Commercial	$5,035.00
Rate for Payer: Aetna Medicare Advantage	$3,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,378.75
Rate for Payer: Cigna Commercial	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,206.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,915.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50
Rate for Payer: UnitedHealthcare Community & State	$319.32
Rate for Payer: Wellpoint Medicaid Managed Care	$351.12

PLATE DISTAL VOL/RADIUS 22x51m

Facility

$13,250.00

Hospital Charge Code	270667474
Hospital Revenue Code	278
Min. Negotiated Rate	$1,987.50
Max. Negotiated Rate	$3,206.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,206.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,915.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50

PLATE DIST FEM NCB 15H LT317MM

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270699605
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

PLATE DIST FEM NCB 15H LT317MM

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270699605
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

PLATE DIST FIBULA 8H RT 212238

Facility

$4,995.00

Hospital Charge Code	270643373
Hospital Revenue Code	278
Min. Negotiated Rate	$120.38
Max. Negotiated Rate	$2,497.50
Rate for Payer: Aetna Commercial	$1,898.10
Rate for Payer: Aetna Medicare Advantage	$1,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,273.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,273.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,273.72
Rate for Payer: Cigna Commercial	$2,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,098.90
Rate for Payer: Qualcare PPO/HMO/WC	$749.25
Rate for Payer: UnitedHealthcare Community & State	$120.38
Rate for Payer: Wellpoint Medicaid Managed Care	$132.37

PLATE DIST FIBULA 8H RT 212238

Facility

$4,995.00

Hospital Charge Code	270643373
Hospital Revenue Code	278
Min. Negotiated Rate	$749.25
Max. Negotiated Rate	$1,208.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,098.90
Rate for Payer: Qualcare PPO/HMO/WC	$749.25

PLATE DIST LAT FEM LT FEM 10H

Facility

$14,942.05

Service Code	HCPCS C1713
Hospital Charge Code	270693021
Hospital Revenue Code	278
Min. Negotiated Rate	$360.10
Max. Negotiated Rate	$7,471.02
Rate for Payer: Aetna Commercial	$5,677.98
Rate for Payer: Aetna Medicare Advantage	$4,482.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,810.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,810.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,988.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,810.22
Rate for Payer: Cigna Commercial	$7,471.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,615.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,287.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,241.31
Rate for Payer: UnitedHealthcare Community & State	$360.10
Rate for Payer: Wellpoint Medicaid Managed Care	$395.96

PLATE DIST LAT FEM LT FEM 10H

Facility

$14,942.05

Service Code	HCPCS C1713
Hospital Charge Code	270693021
Hospital Revenue Code	278
Min. Negotiated Rate	$2,241.31
Max. Negotiated Rate	$3,615.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,988.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,615.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,287.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,241.31

PLATE DISTL CLAVICAL 10 HOLE L

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270687601
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

PLATE DISTL CLAVICAL 10 HOLE L

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270687601
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

PLATE DISTL CLAVICAL 10 HOLE R

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270687602
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

PLATE DISTL CLAVICAL 10 HOLE R

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270687602
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

Know your out-of-pocket cost for care.

All Charges