Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE INTERBODIE 7MM

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270677682
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

PLATE INTERBODY CERES-C 10MM

Facility

$8,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270697007
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

PLATE INTERBODY CERES-C 10MM

Facility

$8,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270697007
Hospital Revenue Code	278
Min. Negotiated Rate	$192.80
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,760.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$192.80
Rate for Payer: Wellpoint Medicaid Managed Care	$212.00

PLATE INTERBODY CERES-C 6MM

Facility

$10,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270692485
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

PLATE INTERBODY CERES-C 6MM

Facility

$10,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270692485
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

PLATEISP 8MM X 34MM

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692541
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

PLATEISP 8MM X 34MM

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270692541
Hospital Revenue Code	278
Min. Negotiated Rate	$602.50
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$602.50
Rate for Payer: Wellpoint Medicaid Managed Care	$662.50

PLATE ISP-T FLARED PC 10X36MM

Facility

$20,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270694895
Hospital Revenue Code	278
Min. Negotiated Rate	$3,012.00
Max. Negotiated Rate	$4,859.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,016.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,859.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,417.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,012.00

PLATE ISP-T FLARED PC 10X36MM

Facility

$20,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270694895
Hospital Revenue Code	278
Min. Negotiated Rate	$483.93
Max. Negotiated Rate	$10,040.00
Rate for Payer: Aetna Commercial	$7,630.40
Rate for Payer: Aetna Medicare Advantage	$6,024.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,120.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,120.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,120.40
Rate for Payer: Cigna Commercial	$10,040.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,859.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,417.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,012.00
Rate for Payer: UnitedHealthcare Community & State	$483.93
Rate for Payer: Wellpoint Medicaid Managed Care	$532.12

PLATE ISP-T FLARED PC 12X38MM

Facility

$20,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270694897
Hospital Revenue Code	278
Min. Negotiated Rate	$483.93
Max. Negotiated Rate	$10,040.00
Rate for Payer: Aetna Commercial	$7,630.40
Rate for Payer: Aetna Medicare Advantage	$6,024.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,120.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,120.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,120.40
Rate for Payer: Cigna Commercial	$10,040.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,859.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,417.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,012.00
Rate for Payer: UnitedHealthcare Community & State	$483.93
Rate for Payer: Wellpoint Medicaid Managed Care	$532.12

PLATE ISP-T FLARED PC 12X38MM

Facility

$20,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270694897
Hospital Revenue Code	278
Min. Negotiated Rate	$3,012.00
Max. Negotiated Rate	$4,859.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,016.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,859.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,417.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,012.00

PLATE ISP-T FLARED PC 6X34MM

Facility

$20,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270694896
Hospital Revenue Code	278
Min. Negotiated Rate	$483.93
Max. Negotiated Rate	$10,040.00
Rate for Payer: Aetna Commercial	$7,630.40
Rate for Payer: Aetna Medicare Advantage	$6,024.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,120.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,120.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,120.40
Rate for Payer: Cigna Commercial	$10,040.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,859.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,417.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,012.00
Rate for Payer: UnitedHealthcare Community & State	$483.93
Rate for Payer: Wellpoint Medicaid Managed Care	$532.12

PLATE ISP-T FLARED PC 6X34MM

Facility

$20,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270694896
Hospital Revenue Code	278
Min. Negotiated Rate	$3,012.00
Max. Negotiated Rate	$4,859.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,016.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,859.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,417.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,012.00

PLATE KIT MSP SHORT LT 36.5MM

Facility

$5,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270696759
Hospital Revenue Code	278
Min. Negotiated Rate	$870.00
Max. Negotiated Rate	$1,403.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,403.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,276.00
Rate for Payer: Qualcare PPO/HMO/WC	$870.00

PLATE KIT MSP SHORT LT 36.5MM

Facility

$5,800.00

Service Code	HCPCS C1713
Hospital Charge Code	270696759
Hospital Revenue Code	278
Min. Negotiated Rate	$139.78
Max. Negotiated Rate	$2,900.00
Rate for Payer: Aetna Commercial	$2,204.00
Rate for Payer: Aetna Medicare Advantage	$1,740.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,479.00
Rate for Payer: Cigna Commercial	$2,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,403.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,276.00
Rate for Payer: Qualcare PPO/HMO/WC	$870.00
Rate for Payer: UnitedHealthcare Community & State	$139.78
Rate for Payer: Wellpoint Medicaid Managed Care	$153.70

PLATE LAG XL 3.0 MM TI

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270691749
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PLATE LAG XL 3.0 MM TI

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270691749
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

PLATE LAPIDUS

Facility

$9,965.00

Service Code	HCPCS C1713
Hospital Charge Code	270679879
Hospital Revenue Code	278
Min. Negotiated Rate	$1,494.75
Max. Negotiated Rate	$2,411.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,993.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,411.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,192.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,494.75

PLATE LAPIDUS

Facility

$9,965.00

Service Code	HCPCS C1713
Hospital Charge Code	270679879
Hospital Revenue Code	278
Min. Negotiated Rate	$240.16
Max. Negotiated Rate	$4,982.50
Rate for Payer: Aetna Commercial	$3,786.70
Rate for Payer: Aetna Medicare Advantage	$2,989.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,541.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,541.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,993.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,541.07
Rate for Payer: Cigna Commercial	$4,982.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,411.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,192.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,494.75
Rate for Payer: UnitedHealthcare Community & State	$240.16
Rate for Payer: Wellpoint Medicaid Managed Care	$264.07

PLATE LAPIDUS 0MM

Facility

$9,965.00

Service Code	HCPCS C1713
Hospital Charge Code	270683199
Hospital Revenue Code	278
Min. Negotiated Rate	$1,494.75
Max. Negotiated Rate	$2,411.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,993.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,411.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,192.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,494.75

PLATE LAPIDUS 0MM

Facility

$9,965.00

Service Code	HCPCS C1713
Hospital Charge Code	270683199
Hospital Revenue Code	278
Min. Negotiated Rate	$240.16
Max. Negotiated Rate	$4,982.50
Rate for Payer: Aetna Commercial	$3,786.70
Rate for Payer: Aetna Medicare Advantage	$2,989.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,541.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,541.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,993.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,541.07
Rate for Payer: Cigna Commercial	$4,982.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,411.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,192.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,494.75
Rate for Payer: UnitedHealthcare Community & State	$240.16
Rate for Payer: Wellpoint Medicaid Managed Care	$264.07

PLATE LAPIDUS 0MM STEP

Facility

$5,300.00

Hospital Charge Code	270676763
Hospital Revenue Code	278
Min. Negotiated Rate	$127.73
Max. Negotiated Rate	$2,650.00
Rate for Payer: Aetna Commercial	$2,014.00
Rate for Payer: Aetna Medicare Advantage	$1,590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,351.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,351.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,351.50
Rate for Payer: Cigna Commercial	$2,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,282.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,166.00
Rate for Payer: Qualcare PPO/HMO/WC	$795.00
Rate for Payer: UnitedHealthcare Community & State	$127.73
Rate for Payer: Wellpoint Medicaid Managed Care	$140.45

PLATE LAPIDUS 0MM STEP

Facility

$5,300.00

Hospital Charge Code	270676763
Hospital Revenue Code	278
Min. Negotiated Rate	$795.00
Max. Negotiated Rate	$1,282.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,282.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,166.00
Rate for Payer: Qualcare PPO/HMO/WC	$795.00

PLATE LAPIDUS 1MM

Facility

$7,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270675123
Hospital Revenue Code	278
Min. Negotiated Rate	$1,152.00
Max. Negotiated Rate	$1,858.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,536.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,858.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,689.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,152.00

PLATE LAPIDUS 1MM

Facility

$7,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270675123
Hospital Revenue Code	278
Min. Negotiated Rate	$185.09
Max. Negotiated Rate	$3,840.00
Rate for Payer: Aetna Commercial	$2,918.40
Rate for Payer: Aetna Medicare Advantage	$2,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,958.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,958.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,958.40
Rate for Payer: Cigna Commercial	$3,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,858.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,689.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,152.00
Rate for Payer: UnitedHealthcare Community & State	$185.09
Rate for Payer: Wellpoint Medicaid Managed Care	$203.52

Know your out-of-pocket cost for care.

All Charges