Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE DIST RAD VOL STD 3H RT

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270664368
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 DIST RAD VOL STD 3H RT

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270664368
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 DM TIBIA RT 10H LT 175MM

Facility

$12,751.25

Service Code	HCPCS C1713
Hospital Charge Code	270699640
Hospital Revenue Code	278
Min. Negotiated Rate	$1,912.69
Max. Negotiated Rate	$3,085.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,550.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,085.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,805.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.69

PLATE DM TIBIA RT 10H LT 175MM

Facility

$12,751.25

Service Code	HCPCS C1713
Hospital Charge Code	270699640
Hospital Revenue Code	278
Min. Negotiated Rate	$307.31
Max. Negotiated Rate	$6,375.62
Rate for Payer: Aetna Commercial	$4,845.48
Rate for Payer: Aetna Medicare Advantage	$3,825.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,251.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,251.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,550.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,251.57
Rate for Payer: Cigna Commercial	$6,375.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,085.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,805.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.69
Rate for Payer: UnitedHealthcare Community & State	$307.31
Rate for Payer: Wellpoint Medicaid Managed Care	$337.91

PLATE DORSAL 2.4X51MM 5H-90

Facility

$2,373.00

Hospital Charge Code	270661609
Hospital Revenue Code	278
Min. Negotiated Rate	$355.95
Max. Negotiated Rate	$574.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$474.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$522.06
Rate for Payer: Qualcare PPO/HMO/WC	$355.95

PLATE DORSAL 2.4X51MM 5H-90

Facility

$2,373.00

Hospital Charge Code	270661609
Hospital Revenue Code	278
Min. Negotiated Rate	$57.19
Max. Negotiated Rate	$1,186.50
Rate for Payer: Aetna Commercial	$901.74
Rate for Payer: Aetna Medicare Advantage	$711.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$474.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.12
Rate for Payer: Cigna Commercial	$1,186.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$522.06
Rate for Payer: Qualcare PPO/HMO/WC	$355.95
Rate for Payer: UnitedHealthcare Community & State	$57.19
Rate for Payer: Wellpoint Medicaid Managed Care	$62.88

PLATE DORS DIST RADI 3H-90

Facility

$2,506.00

Service Code	HCPCS C1713
Hospital Charge Code	270661613
Hospital Revenue Code	278
Min. Negotiated Rate	$375.90
Max. Negotiated Rate	$606.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$501.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$606.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$551.32
Rate for Payer: Qualcare PPO/HMO/WC	$375.90

PLATE DORS DIST RADI 3H-90

Facility

$2,506.00

Service Code	HCPCS C1713
Hospital Charge Code	270661613
Hospital Revenue Code	278
Min. Negotiated Rate	$60.39
Max. Negotiated Rate	$1,253.00
Rate for Payer: Aetna Commercial	$952.28
Rate for Payer: Aetna Medicare Advantage	$751.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$639.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$639.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$501.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$639.03
Rate for Payer: Cigna Commercial	$1,253.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$606.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$551.32
Rate for Payer: Qualcare PPO/HMO/WC	$375.90
Rate for Payer: UnitedHealthcare Community & State	$60.39
Rate for Payer: Wellpoint Medicaid Managed Care	$66.41

PLATE DPY 7H 143557

Facility

$310.45

Hospital Charge Code	270622979
Hospital Revenue Code	278
Min. Negotiated Rate	$7.48
Max. Negotiated Rate	$155.22
Rate for Payer: Aetna Commercial	$117.97
Rate for Payer: Aetna Medicare Advantage	$93.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.16
Rate for Payer: Cigna Commercial	$155.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.30
Rate for Payer: Qualcare PPO/HMO/WC	$46.57
Rate for Payer: UnitedHealthcare Community & State	$7.48
Rate for Payer: Wellpoint Medicaid Managed Care	$8.23

PLATE DPY 7H 143557

Facility

$310.45

Hospital Charge Code	270622979
Hospital Revenue Code	278
Min. Negotiated Rate	$46.57
Max. Negotiated Rate	$75.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.30
Rate for Payer: Qualcare PPO/HMO/WC	$46.57

PLATE DPY ACP 4.5 8H 14669800

Facility

$892.00

Hospital Charge Code	270622953
Hospital Revenue Code	278
Min. Negotiated Rate	$21.50
Max. Negotiated Rate	$446.00
Rate for Payer: Aetna Commercial	$338.96
Rate for Payer: Aetna Medicare Advantage	$267.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$227.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$227.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$178.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$227.46
Rate for Payer: Cigna Commercial	$446.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.24
Rate for Payer: Qualcare PPO/HMO/WC	$133.80
Rate for Payer: UnitedHealthcare Community & State	$21.50
Rate for Payer: Wellpoint Medicaid Managed Care	$23.64

PLATE DPY ACP 4.5 8H 14669800

Facility

$892.00

Hospital Charge Code	270622953
Hospital Revenue Code	278
Min. Negotiated Rate	$133.80
Max. Negotiated Rate	$215.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$178.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$196.24
Rate for Payer: Qualcare PPO/HMO/WC	$133.80

PLATE DSTI PI 8-HI ANTMCL POST

Facility

$5,472.50

Service Code	HCPCS C1713
Hospital Charge Code	270702044
Hospital Revenue Code	278
Min. Negotiated Rate	$131.89
Max. Negotiated Rate	$2,736.25
Rate for Payer: Aetna Commercial	$2,079.55
Rate for Payer: Aetna Medicare Advantage	$1,641.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,395.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,395.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,094.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,395.49
Rate for Payer: Cigna Commercial	$2,736.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,203.95
Rate for Payer: Qualcare PPO/HMO/WC	$820.88
Rate for Payer: UnitedHealthcare Community & State	$131.89
Rate for Payer: Wellpoint Medicaid Managed Care	$145.02

PLATE DSTI PI 8-HI ANTMCL POST

Facility

$5,472.50

Service Code	HCPCS C1713
Hospital Charge Code	270702044
Hospital Revenue Code	278
Min. Negotiated Rate	$820.88
Max. Negotiated Rate	$1,324.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,094.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,203.95
Rate for Payer: Qualcare PPO/HMO/WC	$820.88

PLATE DVR LFT WD DVRAWL

Facility

$5,005.00

Hospital Charge Code	270651364
Hospital Revenue Code	278
Min. Negotiated Rate	$750.75
Max. Negotiated Rate	$1,211.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,001.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,211.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,101.10
Rate for Payer: Qualcare PPO/HMO/WC	$750.75

PLATE DVR LFT WD DVRAWL

Facility

$5,005.00

Hospital Charge Code	270651364
Hospital Revenue Code	278
Min. Negotiated Rate	$120.62
Max. Negotiated Rate	$2,502.50
Rate for Payer: Aetna Commercial	$1,901.90
Rate for Payer: Aetna Medicare Advantage	$1,501.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,276.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,276.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,001.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,276.28
Rate for Payer: Cigna Commercial	$2,502.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,211.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,101.10
Rate for Payer: Qualcare PPO/HMO/WC	$750.75
Rate for Payer: UnitedHealthcare Community & State	$120.62
Rate for Payer: Wellpoint Medicaid Managed Care	$132.63

PLATE DVR LOCK MINI RT

Facility

$6,352.50

Service Code	HCPCS C1716
Hospital Charge Code	270702388
Hospital Revenue Code	278
Min. Negotiated Rate	$153.10
Max. Negotiated Rate	$2,155.71
Rate for Payer: Aetna Commercial	$1,624.38
Rate for Payer: Aetna Medicare Advantage	$1,934.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,155.71
Rate for Payer: Cigna Commercial	$1,197.08
Rate for Payer: Cigna Medicare Advantage	$597.20
Rate for Payer: Clover Medicare Advantage	$567.34
Rate for Payer: EmblemHealth Commercial	$1,791.60
Rate for Payer: Humana Medicare Advantage	$615.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$597.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,537.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,397.55
Rate for Payer: Qualcare PPO/HMO/WC	$952.88
Rate for Payer: UnitedHealthcare Community & State	$153.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$597.20
Rate for Payer: Wellcare Medicare Advantage	$597.20
Rate for Payer: Wellpoint Medicaid Managed Care	$168.34

PLATE DVR LOCK MINI RT

Facility

$6,352.50

Service Code	HCPCS C1716
Hospital Charge Code	270702388
Hospital Revenue Code	278
Min. Negotiated Rate	$952.88
Max. Negotiated Rate	$1,537.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,270.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,537.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,397.55
Rate for Payer: Qualcare PPO/HMO/WC	$952.88

PLATE DVR LOCK STANDARD

Facility

$5,500.00

Hospital Charge Code	270663844
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 DVR LOCK STANDARD

Facility

$5,500.00

Hospital Charge Code	270663844
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 DVR NARROW SHORT LEFT

Facility

$5,005.00

Hospital Charge Code	270648140
Hospital Revenue Code	278
Min. Negotiated Rate	$750.75
Max. Negotiated Rate	$1,211.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,001.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,211.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,101.10
Rate for Payer: Qualcare PPO/HMO/WC	$750.75

PLATE DVR NARROW SHORT LEFT

Facility

$5,005.00

Hospital Charge Code	270648140
Hospital Revenue Code	278
Min. Negotiated Rate	$120.62
Max. Negotiated Rate	$2,502.50
Rate for Payer: Aetna Commercial	$1,901.90
Rate for Payer: Aetna Medicare Advantage	$1,501.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,276.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,276.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,001.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,276.28
Rate for Payer: Cigna Commercial	$2,502.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,211.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,101.10
Rate for Payer: Qualcare PPO/HMO/WC	$750.75
Rate for Payer: UnitedHealthcare Community & State	$120.62
Rate for Payer: Wellpoint Medicaid Managed Care	$132.63

PLATE DVR WIDE HEAD RIGHT

Facility

$5,395.00

Hospital Charge Code	270671835
Hospital Revenue Code	278
Min. Negotiated Rate	$809.25
Max. Negotiated Rate	$1,305.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,079.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,305.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,186.90
Rate for Payer: Qualcare PPO/HMO/WC	$809.25

PLATE DVR WIDE HEAD RIGHT

Facility

$5,395.00

Hospital Charge Code	270671835
Hospital Revenue Code	278
Min. Negotiated Rate	$130.02
Max. Negotiated Rate	$2,697.50
Rate for Payer: Aetna Commercial	$2,050.10
Rate for Payer: Aetna Medicare Advantage	$1,618.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,375.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,375.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,079.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,375.72
Rate for Payer: Cigna Commercial	$2,697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,305.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,186.90
Rate for Payer: Qualcare PPO/HMO/WC	$809.25
Rate for Payer: UnitedHealthcare Community & State	$130.02
Rate for Payer: Wellpoint Medicaid Managed Care	$142.97

PLATE DVR WRIST SPANNING 180MM

Facility

$16,345.00

Service Code	HCPCS C1713
Hospital Charge Code	270699272
Hospital Revenue Code	278
Min. Negotiated Rate	$2,451.75
Max. Negotiated Rate	$3,955.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,269.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,955.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,595.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,451.75

Know your out-of-pocket cost for care.

All Charges