Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE DVR WRIST SPANNING 180MM

Facility

$16,345.00

Service Code	HCPCS C1713
Hospital Charge Code	270699272
Hospital Revenue Code	278
Min. Negotiated Rate	$393.91
Max. Negotiated Rate	$8,172.50
Rate for Payer: Aetna Commercial	$6,211.10
Rate for Payer: Aetna Medicare Advantage	$4,903.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,167.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,167.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,269.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,167.98
Rate for Payer: Cigna Commercial	$8,172.50
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
Rate for Payer: UnitedHealthcare Community & State	$393.91
Rate for Payer: Wellpoint Medicaid Managed Care	$433.14

PLATE ECT 1/2 TUB 12/119MM 7H

Facility

$205.65

Hospital Charge Code	270605559
Hospital Revenue Code	278
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$102.83
Rate for Payer: Aetna Commercial	$78.15
Rate for Payer: Aetna Medicare Advantage	$61.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.44
Rate for Payer: Cigna Commercial	$102.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$45.24
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
Rate for Payer: UnitedHealthcare Community & State	$4.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.45

PLATE ECT 1/2 TUB 12/119MM 7H

Facility

$205.65

Hospital Charge Code	270605559
Hospital Revenue Code	278
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$49.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$45.24
Rate for Payer: Qualcare PPO/HMO/WC	$30.85

PLATE ECT L BUTTRESS 4 HL

Facility

$905.65

Hospital Charge Code	270605558
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 ECT L BUTTRESS 4 HL

Facility

$905.65

Hospital Charge Code	270605558
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 ECT MINI-ST 3 HL

Facility

$81.00

Hospital Charge Code	1602630
Hospital Revenue Code	274
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$19.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$17.82
Rate for Payer: Qualcare PPO/HMO/WC	$12.15

PLATE ECT MINI-ST 3 HL

Facility

$81.00

Hospital Charge Code	1602630
Hospital Revenue Code	274
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$40.50
Rate for Payer: Aetna Commercial	$30.78
Rate for Payer: Aetna Medicare Advantage	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.66
Rate for Payer: Cigna Commercial	$40.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$17.82
Rate for Payer: Qualcare PPO/HMO/WC	$12.15
Rate for Payer: UnitedHealthcare Community & State	$1.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.15

PLATE ECT MINI-ST 4 HL

Facility

$87.00

Hospital Charge Code	1602648
Hospital Revenue Code	274
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$21.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.14
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

PLATE ECT MINI-ST 4 HL

Facility

$87.00

Hospital Charge Code	1602648
Hospital Revenue Code	274
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$43.50
Rate for Payer: Aetna Commercial	$33.06
Rate for Payer: Aetna Medicare Advantage	$26.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.18
Rate for Payer: Cigna Commercial	$43.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.14
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
Rate for Payer: UnitedHealthcare Community & State	$2.10
Rate for Payer: Wellpoint Medicaid Managed Care	$2.31

PLATE ECT MINI T 4H 2419-22-04

Facility

$159.25

Hospital Charge Code	270608057
Hospital Revenue Code	278
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$79.62
Rate for Payer: Aetna Commercial	$60.52
Rate for Payer: Aetna Medicare Advantage	$47.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.61
Rate for Payer: Cigna Commercial	$79.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$35.03
Rate for Payer: Qualcare PPO/HMO/WC	$23.89
Rate for Payer: UnitedHealthcare Community & State	$3.84
Rate for Payer: Wellpoint Medicaid Managed Care	$4.22

PLATE ECT MINI T 4H 2419-22-04

Facility

$159.25

Hospital Charge Code	270608057
Hospital Revenue Code	278
Min. Negotiated Rate	$23.89
Max. Negotiated Rate	$38.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$35.03
Rate for Payer: Qualcare PPO/HMO/WC	$23.89

PLATE ECT T LG 6H

Facility

$859.25

Hospital Charge Code	270606819
Hospital Revenue Code	278
Min. Negotiated Rate	$128.89
Max. Negotiated Rate	$207.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.03
Rate for Payer: Qualcare PPO/HMO/WC	$128.89

PLATE ECT T LG 6H

Facility

$859.25

Hospital Charge Code	270606819
Hospital Revenue Code	278
Min. Negotiated Rate	$20.71
Max. Negotiated Rate	$429.62
Rate for Payer: Aetna Commercial	$326.51
Rate for Payer: Aetna Medicare Advantage	$257.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.11
Rate for Payer: Cigna Commercial	$429.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.03
Rate for Payer: Qualcare PPO/HMO/WC	$128.89
Rate for Payer: UnitedHealthcare Community & State	$20.71
Rate for Payer: Wellpoint Medicaid Managed Care	$22.77

PLATE END MIS HA MINUTEMAN G3R

Facility

$40,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270693753
Hospital Revenue Code	278
Min. Negotiated Rate	$964.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$15,200.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,680.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Community & State	$964.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,060.00

PLATE END MIS HA MINUTEMAN G3R

Facility

$40,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270693753
Hospital Revenue Code	278
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$9,680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,680.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PLATE EXPRESSEW II AC DIVBRD

Facility

$1,020.00

Hospital Charge Code	270672122
Hospital Revenue Code	278
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$246.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$224.40
Rate for Payer: Qualcare PPO/HMO/WC	$153.00

PLATE EXPRESSEW II AC DIVBRD

Facility

$1,020.00

Hospital Charge Code	270672122
Hospital Revenue Code	278
Min. Negotiated Rate	$24.58
Max. Negotiated Rate	$510.00
Rate for Payer: Aetna Commercial	$387.60
Rate for Payer: Aetna Medicare Advantage	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$260.10
Rate for Payer: Cigna Commercial	$510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$224.40
Rate for Payer: Qualcare PPO/HMO/WC	$153.00
Rate for Payer: UnitedHealthcare Community & State	$24.58
Rate for Payer: Wellpoint Medicaid Managed Care	$27.03

PLATE EXTVOLAR DR 53MM 3 HOLE

Facility

$10,270.00

Service Code	HCPCS C1713
Hospital Charge Code	270703684
Hospital Revenue Code	278
Min. Negotiated Rate	$1,540.50
Max. Negotiated Rate	$2,485.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,054.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,485.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,259.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,540.50

PLATE EXTVOLAR DR 53MM 3 HOLE

Facility

$10,270.00

Service Code	HCPCS C1713
Hospital Charge Code	270703684
Hospital Revenue Code	278
Min. Negotiated Rate	$247.51
Max. Negotiated Rate	$5,135.00
Rate for Payer: Aetna Commercial	$3,902.60
Rate for Payer: Aetna Medicare Advantage	$3,081.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,618.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,618.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,054.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,618.85
Rate for Payer: Cigna Commercial	$5,135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,485.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,259.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,540.50
Rate for Payer: UnitedHealthcare Community & State	$247.51
Rate for Payer: Wellpoint Medicaid Managed Care	$272.15

PLATE FEM DIST LAT 12H 274MM

Facility

$16,190.30

Service Code	HCPCS C1713
Hospital Charge Code	270697352
Hospital Revenue Code	278
Min. Negotiated Rate	$390.19
Max. Negotiated Rate	$8,095.15
Rate for Payer: Aetna Commercial	$6,152.31
Rate for Payer: Aetna Medicare Advantage	$4,857.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,128.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,128.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,238.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,128.53
Rate for Payer: Cigna Commercial	$8,095.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,918.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,561.87
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.55
Rate for Payer: UnitedHealthcare Community & State	$390.19
Rate for Payer: Wellpoint Medicaid Managed Care	$429.04

PLATE FEM DIST LAT 12H 274MM

Facility

$16,190.30

Service Code	HCPCS C1713
Hospital Charge Code	270697352
Hospital Revenue Code	278
Min. Negotiated Rate	$2,428.55
Max. Negotiated Rate	$3,918.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,238.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,918.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,561.87
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.55

PLATE FEM DIST LAT RT 6H 166MM

Facility

$15,160.10

Service Code	HCPCS C1713
Hospital Charge Code	270697989
Hospital Revenue Code	278
Min. Negotiated Rate	$2,274.01
Max. Negotiated Rate	$3,668.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,032.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,668.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,335.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,274.01

PLATE FEM DIST LAT RT 6H 166MM

Facility

$15,160.10

Service Code	HCPCS C1713
Hospital Charge Code	270697989
Hospital Revenue Code	278
Min. Negotiated Rate	$365.36
Max. Negotiated Rate	$7,580.05
Rate for Payer: Aetna Commercial	$5,760.84
Rate for Payer: Aetna Medicare Advantage	$4,548.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,865.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,865.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,032.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,865.83
Rate for Payer: Cigna Commercial	$7,580.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,668.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,335.22
Rate for Payer: Qualcare PPO/HMO/WC	$2,274.01
Rate for Payer: UnitedHealthcare Community & State	$365.36
Rate for Payer: Wellpoint Medicaid Managed Care	$401.74

PLATE FEMORAL 10 HOLE DISTAL

Facility

$12,730.00

Hospital Charge Code	270663305
Hospital Revenue Code	278
Min. Negotiated Rate	$1,909.50
Max. Negotiated Rate	$3,080.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,546.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,080.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,800.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,909.50

PLATE FEMORAL 10 HOLE DISTAL

Facility

$12,730.00

Hospital Charge Code	270663305
Hospital Revenue Code	278
Min. Negotiated Rate	$306.79
Max. Negotiated Rate	$6,365.00
Rate for Payer: Aetna Commercial	$4,837.40
Rate for Payer: Aetna Medicare Advantage	$3,819.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,246.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,246.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,546.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,246.15
Rate for Payer: Cigna Commercial	$6,365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,080.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,800.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,909.50
Rate for Payer: UnitedHealthcare Community & State	$306.79
Rate for Payer: Wellpoint Medicaid Managed Care	$337.35

Know your out-of-pocket cost for care.

All Charges