Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE FIBULA VA-LCP 2.7MM LT3H

Facility

$4,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270695311
Hospital Revenue Code	278
Min. Negotiated Rate	$105.44
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,662.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Community & State	$105.44
Rate for Payer: Wellpoint Medicaid Managed Care	$115.94

PLATE FIBULA VA-LCP 2.7MM LT3H

Facility

$4,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270695311
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

PLATE FIRST TMT FUSION 2.4/ 2.

Facility

$4,541.75

Service Code	HCPCS C1713
Hospital Charge Code	270681819
Hospital Revenue Code	278
Min. Negotiated Rate	$681.26
Max. Negotiated Rate	$1,099.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$908.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,099.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$999.18
Rate for Payer: Qualcare PPO/HMO/WC	$681.26

PLATE FIRST TMT FUSION 2.4/ 2.

Facility

$4,541.75

Service Code	HCPCS C1713
Hospital Charge Code	270681819
Hospital Revenue Code	278
Min. Negotiated Rate	$109.46
Max. Negotiated Rate	$2,270.88
Rate for Payer: Aetna Commercial	$1,725.87
Rate for Payer: Aetna Medicare Advantage	$1,362.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,158.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,158.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$908.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,158.15
Rate for Payer: Cigna Commercial	$2,270.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,099.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$999.18
Rate for Payer: Qualcare PPO/HMO/WC	$681.26
Rate for Payer: UnitedHealthcare Community & State	$109.46
Rate for Payer: Wellpoint Medicaid Managed Care	$120.36

PLATE FOREFOOT UNIVERSAL 18MM

Facility

$6,279.10

Hospital Charge Code	270657193
Hospital Revenue Code	278
Min. Negotiated Rate	$151.33
Max. Negotiated Rate	$3,139.55
Rate for Payer: Aetna Commercial	$2,386.06
Rate for Payer: Aetna Medicare Advantage	$1,883.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,601.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,601.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,255.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,601.17
Rate for Payer: Cigna Commercial	$3,139.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,519.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,381.40
Rate for Payer: Qualcare PPO/HMO/WC	$941.87
Rate for Payer: UnitedHealthcare Community & State	$151.33
Rate for Payer: Wellpoint Medicaid Managed Care	$166.40

PLATE FOREFOOT UNIVERSAL 18MM

Facility

$6,279.10

Hospital Charge Code	270657193
Hospital Revenue Code	278
Min. Negotiated Rate	$941.87
Max. Negotiated Rate	$1,519.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,255.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,519.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,381.40
Rate for Payer: Qualcare PPO/HMO/WC	$941.87

PLATE,FRAGMENT DISTAL ULNA

Facility

$4,475.00

Hospital Charge Code	270668300
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,FRAGMENT DISTAL ULNA

Facility

$4,475.00

Hospital Charge Code	270668300
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, FRAGMENT PROTEAN DOUBLE

Facility

$4,475.00

Hospital Charge Code	270668298
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, FRAGMENT PROTEAN DOUBLE

Facility

$4,475.00

Hospital Charge Code	270668298
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 FRLOK COMP 10 HL 135 DEG

Facility

$1,685.00

Hospital Charge Code	1605393
Hospital Revenue Code	274
Min. Negotiated Rate	$40.61
Max. Negotiated Rate	$842.50
Rate for Payer: Aetna Commercial	$640.30
Rate for Payer: Aetna Medicare Advantage	$505.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$429.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$429.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$337.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$429.68
Rate for Payer: Cigna Commercial	$842.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$407.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$370.70
Rate for Payer: Qualcare PPO/HMO/WC	$252.75
Rate for Payer: UnitedHealthcare Community & State	$40.61
Rate for Payer: Wellpoint Medicaid Managed Care	$44.65

PLATE FRLOK COMP 10 HL 135 DEG

Facility

$1,685.00

Hospital Charge Code	1605393
Hospital Revenue Code	274
Min. Negotiated Rate	$252.75
Max. Negotiated Rate	$407.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$337.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$407.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$370.70
Rate for Payer: Qualcare PPO/HMO/WC	$252.75

PLATE FRLOK COMP 10 HL 150 DEG

Facility

$723.00

Hospital Charge Code	1605278
Hospital Revenue Code	274
Min. Negotiated Rate	$17.42
Max. Negotiated Rate	$361.50
Rate for Payer: Aetna Commercial	$274.74
Rate for Payer: Aetna Medicare Advantage	$216.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$144.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.37
Rate for Payer: Cigna Commercial	$361.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.06
Rate for Payer: Qualcare PPO/HMO/WC	$108.45
Rate for Payer: UnitedHealthcare Community & State	$17.42
Rate for Payer: Wellpoint Medicaid Managed Care	$19.16

PLATE FRLOK COMP 10 HL 150 DEG

Facility

$723.00

Hospital Charge Code	1605278
Hospital Revenue Code	274
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$174.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$144.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.06
Rate for Payer: Qualcare PPO/HMO/WC	$108.45

PLATE FRLOK COMP 12 HL 150 DEG

Facility

$723.00

Hospital Charge Code	1605286
Hospital Revenue Code	274
Min. Negotiated Rate	$17.42
Max. Negotiated Rate	$361.50
Rate for Payer: Aetna Commercial	$274.74
Rate for Payer: Aetna Medicare Advantage	$216.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$144.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.37
Rate for Payer: Cigna Commercial	$361.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.06
Rate for Payer: Qualcare PPO/HMO/WC	$108.45
Rate for Payer: UnitedHealthcare Community & State	$17.42
Rate for Payer: Wellpoint Medicaid Managed Care	$19.16

PLATE FRLOK COMP 12 HL 150 DEG

Facility

$723.00

Hospital Charge Code	1605286
Hospital Revenue Code	274
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$174.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$144.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.06
Rate for Payer: Qualcare PPO/HMO/WC	$108.45

PLATE FRLOK COMP 2 HL 135 DEG

Facility

$1,075.00

Hospital Charge Code	1605443
Hospital Revenue Code	274
Min. Negotiated Rate	$25.91
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$408.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25
Rate for Payer: UnitedHealthcare Community & State	$25.91
Rate for Payer: Wellpoint Medicaid Managed Care	$28.49

PLATE FRLOK COMP 2 HL 135 DEG

Facility

$1,075.00

Hospital Charge Code	1605443
Hospital Revenue Code	274
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

PLATE FRLOK COMP 2 HL 150 DEG

Facility

$723.00

Hospital Charge Code	1605310
Hospital Revenue Code	274
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$174.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$144.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.06
Rate for Payer: Qualcare PPO/HMO/WC	$108.45

PLATE FRLOK COMP 2 HL 150 DEG

Facility

$723.00

Hospital Charge Code	1605310
Hospital Revenue Code	274
Min. Negotiated Rate	$17.42
Max. Negotiated Rate	$361.50
Rate for Payer: Aetna Commercial	$274.74
Rate for Payer: Aetna Medicare Advantage	$216.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$144.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.37
Rate for Payer: Cigna Commercial	$361.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.06
Rate for Payer: Qualcare PPO/HMO/WC	$108.45
Rate for Payer: UnitedHealthcare Community & State	$17.42
Rate for Payer: Wellpoint Medicaid Managed Care	$19.16

PLATE FRLOK COMP 3 HL 135 DEG

Facility

$1,075.00

Hospital Charge Code	1605450
Hospital Revenue Code	274
Min. Negotiated Rate	$25.91
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$408.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25
Rate for Payer: UnitedHealthcare Community & State	$25.91
Rate for Payer: Wellpoint Medicaid Managed Care	$28.49

PLATE FRLOK COMP 3 HL 135 DEG

Facility

$1,075.00

Hospital Charge Code	1605450
Hospital Revenue Code	274
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

PLATE FRLOK COMP 3 HL 140 DEG

Facility

$1,075.00

Hospital Charge Code	1605385
Hospital Revenue Code	274
Min. Negotiated Rate	$25.91
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$408.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25
Rate for Payer: UnitedHealthcare Community & State	$25.91
Rate for Payer: Wellpoint Medicaid Managed Care	$28.49

PLATE FRLOK COMP 3 HL 140 DEG

Facility

$1,075.00

Hospital Charge Code	1605385
Hospital Revenue Code	274
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

PLATE FRLOK COMP 3 HL 145 DEG

Facility

$1,075.00

Hospital Charge Code	1605344
Hospital Revenue Code	274
Min. Negotiated Rate	$25.91
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$408.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25
Rate for Payer: UnitedHealthcare Community & State	$25.91
Rate for Payer: Wellpoint Medicaid Managed Care	$28.49

Know your out-of-pocket cost for care.

All Charges