Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE LCP CLAV 3.5x105MM 6H RT

Facility

$4,047.90

Service Code	HCPCS C1713
Hospital Charge Code	270677248
Hospital Revenue Code	278
Min. Negotiated Rate	$607.18
Max. Negotiated Rate	$979.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$809.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$979.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$890.54
Rate for Payer: Qualcare PPO/HMO/WC	$607.18

PLATE LCP CLAV 3.5x105MM 6H RT

Facility

$4,047.90

Service Code	HCPCS C1713
Hospital Charge Code	270677248
Hospital Revenue Code	278
Min. Negotiated Rate	$97.55
Max. Negotiated Rate	$2,023.95
Rate for Payer: Aetna Commercial	$1,538.20
Rate for Payer: Aetna Medicare Advantage	$1,214.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,032.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,032.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$809.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,032.21
Rate for Payer: Cigna Commercial	$2,023.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$979.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$890.54
Rate for Payer: Qualcare PPO/HMO/WC	$607.18
Rate for Payer: UnitedHealthcare Community & State	$97.55
Rate for Payer: Wellpoint Medicaid Managed Care	$107.27

PLATE LCP CLAV 3.5x115MM 8H RT

Facility

$4,251.85

Service Code	HCPCS C1713
Hospital Charge Code	270677247
Hospital Revenue Code	278
Min. Negotiated Rate	$637.78
Max. Negotiated Rate	$1,028.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.41
Rate for Payer: Qualcare PPO/HMO/WC	$637.78

PLATE LCP CLAV 3.5x115MM 8H RT

Facility

$4,251.85

Service Code	HCPCS C1713
Hospital Charge Code	270677247
Hospital Revenue Code	278
Min. Negotiated Rate	$102.47
Max. Negotiated Rate	$2,125.93
Rate for Payer: Aetna Commercial	$1,615.70
Rate for Payer: Aetna Medicare Advantage	$1,275.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,084.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,084.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,084.22
Rate for Payer: Cigna Commercial	$2,125.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.41
Rate for Payer: Qualcare PPO/HMO/WC	$637.78
Rate for Payer: UnitedHealthcare Community & State	$102.47
Rate for Payer: Wellpoint Medicaid Managed Care	$112.67

PLATE LCP CLAV 3.5x120MM 6H LT

Facility

$4,044.80

Service Code	HCPCS C1713
Hospital Charge Code	270676301
Hospital Revenue Code	278
Min. Negotiated Rate	$606.72
Max. Negotiated Rate	$978.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$808.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$978.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$889.86
Rate for Payer: Qualcare PPO/HMO/WC	$606.72

PLATE LCP CLAV 3.5x120MM 6H LT

Facility

$4,044.80

Service Code	HCPCS C1713
Hospital Charge Code	270676301
Hospital Revenue Code	278
Min. Negotiated Rate	$97.48
Max. Negotiated Rate	$2,022.40
Rate for Payer: Aetna Commercial	$1,537.02
Rate for Payer: Aetna Medicare Advantage	$1,213.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,031.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,031.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$808.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,031.42
Rate for Payer: Cigna Commercial	$2,022.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$978.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$889.86
Rate for Payer: Qualcare PPO/HMO/WC	$606.72
Rate for Payer: UnitedHealthcare Community & State	$97.48
Rate for Payer: Wellpoint Medicaid Managed Care	$107.19

PLATE LCP CLAV 3.5x120MM 8H RT

Facility

$4,251.85

Service Code	HCPCS C1713
Hospital Charge Code	270665696
Hospital Revenue Code	278
Min. Negotiated Rate	$102.47
Max. Negotiated Rate	$2,125.93
Rate for Payer: Aetna Commercial	$1,615.70
Rate for Payer: Aetna Medicare Advantage	$1,275.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,084.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,084.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,084.22
Rate for Payer: Cigna Commercial	$2,125.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.41
Rate for Payer: Qualcare PPO/HMO/WC	$637.78
Rate for Payer: UnitedHealthcare Community & State	$102.47
Rate for Payer: Wellpoint Medicaid Managed Care	$112.67

PLATE LCP CLAV 3.5x120MM 8H RT

Facility

$4,251.85

Service Code	HCPCS C1713
Hospital Charge Code	270665696
Hospital Revenue Code	278
Min. Negotiated Rate	$637.78
Max. Negotiated Rate	$1,028.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.41
Rate for Payer: Qualcare PPO/HMO/WC	$637.78

PLATE LCP CLAV 3.5x69MM 3H LT/

Facility

$4,000.65

Service Code	HCPCS C1713
Hospital Charge Code	270681461
Hospital Revenue Code	278
Min. Negotiated Rate	$96.42
Max. Negotiated Rate	$2,000.33
Rate for Payer: Aetna Commercial	$1,520.25
Rate for Payer: Aetna Medicare Advantage	$1,200.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.17
Rate for Payer: Cigna Commercial	$2,000.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.14
Rate for Payer: Qualcare PPO/HMO/WC	$600.10
Rate for Payer: UnitedHealthcare Community & State	$96.42
Rate for Payer: Wellpoint Medicaid Managed Care	$106.02

PLATE LCP CLAV 3.5x69MM 3H LT/

Facility

$4,000.65

Service Code	HCPCS C1713
Hospital Charge Code	270681461
Hospital Revenue Code	278
Min. Negotiated Rate	$600.10
Max. Negotiated Rate	$968.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.14
Rate for Payer: Qualcare PPO/HMO/WC	$600.10

PLATE LCP CLAV 3.5x79MM 6H

Facility

$4,044.80

Service Code	HCPCS C1713
Hospital Charge Code	270676302
Hospital Revenue Code	278
Min. Negotiated Rate	$97.48
Max. Negotiated Rate	$2,022.40
Rate for Payer: Aetna Commercial	$1,537.02
Rate for Payer: Aetna Medicare Advantage	$1,213.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,031.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,031.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$808.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,031.42
Rate for Payer: Cigna Commercial	$2,022.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$978.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$889.86
Rate for Payer: Qualcare PPO/HMO/WC	$606.72
Rate for Payer: UnitedHealthcare Community & State	$97.48
Rate for Payer: Wellpoint Medicaid Managed Care	$107.19

PLATE LCP CLAV 3.5x79MM 6H

Facility

$4,044.80

Service Code	HCPCS C1713
Hospital Charge Code	270676302
Hospital Revenue Code	278
Min. Negotiated Rate	$606.72
Max. Negotiated Rate	$978.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$808.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$978.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$889.86
Rate for Payer: Qualcare PPO/HMO/WC	$606.72

PLATE LCP CLAV 3.5x85MM 6H RT

Facility

$3,840.85

Hospital Charge Code	270677754
Hospital Revenue Code	278
Min. Negotiated Rate	$576.13
Max. Negotiated Rate	$929.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$768.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$929.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$844.99
Rate for Payer: Qualcare PPO/HMO/WC	$576.13

PLATE LCP CLAV 3.5x85MM 6H RT

Facility

$4,047.90

Service Code	HCPCS C1713
Hospital Charge Code	270671684
Hospital Revenue Code	278
Min. Negotiated Rate	$97.55
Max. Negotiated Rate	$2,023.95
Rate for Payer: Aetna Commercial	$1,538.20
Rate for Payer: Aetna Medicare Advantage	$1,214.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,032.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,032.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$809.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,032.21
Rate for Payer: Cigna Commercial	$2,023.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$979.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$890.54
Rate for Payer: Qualcare PPO/HMO/WC	$607.18
Rate for Payer: UnitedHealthcare Community & State	$97.55
Rate for Payer: Wellpoint Medicaid Managed Care	$107.27

PLATE LCP CLAV 3.5x85MM 6H RT

Facility

$4,047.90

Service Code	HCPCS C1713
Hospital Charge Code	270671684
Hospital Revenue Code	278
Min. Negotiated Rate	$607.18
Max. Negotiated Rate	$979.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$809.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$979.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$890.54
Rate for Payer: Qualcare PPO/HMO/WC	$607.18

PLATE LCP CLAV 3.5x85MM 6H RT

Facility

$3,840.85

Hospital Charge Code	270677754
Hospital Revenue Code	278
Min. Negotiated Rate	$92.56
Max. Negotiated Rate	$1,920.42
Rate for Payer: Aetna Commercial	$1,459.52
Rate for Payer: Aetna Medicare Advantage	$1,152.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$979.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$979.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$768.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$979.42
Rate for Payer: Cigna Commercial	$1,920.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$929.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$844.99
Rate for Payer: Qualcare PPO/HMO/WC	$576.13
Rate for Payer: UnitedHealthcare Community & State	$92.56
Rate for Payer: Wellpoint Medicaid Managed Care	$101.78

PLATE LCP CLAV 3.5x94MM 5H RT

Facility

$3,797.60

Service Code	HCPCS C1713
Hospital Charge Code	270672277
Hospital Revenue Code	278
Min. Negotiated Rate	$569.64
Max. Negotiated Rate	$919.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$759.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$919.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$835.47
Rate for Payer: Qualcare PPO/HMO/WC	$569.64

PLATE LCP CLAV 3.5x94MM 5H RT

Facility

$3,797.60

Service Code	HCPCS C1713
Hospital Charge Code	270672277
Hospital Revenue Code	278
Min. Negotiated Rate	$91.52
Max. Negotiated Rate	$1,898.80
Rate for Payer: Aetna Commercial	$1,443.09
Rate for Payer: Aetna Medicare Advantage	$1,139.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$968.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$968.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$759.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$968.39
Rate for Payer: Cigna Commercial	$1,898.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$919.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$835.47
Rate for Payer: Qualcare PPO/HMO/WC	$569.64
Rate for Payer: UnitedHealthcare Community & State	$91.52
Rate for Payer: Wellpoint Medicaid Managed Care	$100.64

PLATE LCP CONDYLAR 7H 2.4x59MM

Facility

$2,499.80

Service Code	HCPCS C1713
Hospital Charge Code	270667136
Hospital Revenue Code	278
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,249.90
Rate for Payer: Aetna Commercial	$949.92
Rate for Payer: Aetna Medicare Advantage	$749.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$499.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.45
Rate for Payer: Cigna Commercial	$1,249.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$604.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$549.96
Rate for Payer: Qualcare PPO/HMO/WC	$374.97
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.24

PLATE LCP CONDYLAR 7H 2.4x59MM

Facility

$2,499.80

Service Code	HCPCS C1713
Hospital Charge Code	270667136
Hospital Revenue Code	278
Min. Negotiated Rate	$374.97
Max. Negotiated Rate	$604.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$499.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$604.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$549.96
Rate for Payer: Qualcare PPO/HMO/WC	$374.97

PLATE LCP DIA-2.4/3.5 5HOLE LF

Facility

$6,822.70

Service Code	HCPCS C1713
Hospital Charge Code	270679665
Hospital Revenue Code	278
Min. Negotiated Rate	$164.43
Max. Negotiated Rate	$3,411.35
Rate for Payer: Aetna Commercial	$2,592.63
Rate for Payer: Aetna Medicare Advantage	$2,046.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,739.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,739.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,364.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,739.79
Rate for Payer: Cigna Commercial	$3,411.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,651.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,500.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,023.40
Rate for Payer: UnitedHealthcare Community & State	$164.43
Rate for Payer: Wellpoint Medicaid Managed Care	$180.80

PLATE LCP DIA-2.4/3.5 5HOLE LF

Facility

$6,822.70

Service Code	HCPCS C1713
Hospital Charge Code	270679665
Hospital Revenue Code	278
Min. Negotiated Rate	$1,023.40
Max. Negotiated Rate	$1,651.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,364.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,651.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,500.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,023.40

PLATE LCP DIA-META 5HOLE RT

Facility

$6,822.70

Service Code	HCPCS C1713
Hospital Charge Code	270671709
Hospital Revenue Code	278
Min. Negotiated Rate	$1,023.40
Max. Negotiated Rate	$1,651.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,364.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,651.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,500.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,023.40

PLATE LCP DIA-META 5HOLE RT

Facility

$6,822.70

Service Code	HCPCS C1713
Hospital Charge Code	270671709
Hospital Revenue Code	278
Min. Negotiated Rate	$164.43
Max. Negotiated Rate	$3,411.35
Rate for Payer: Aetna Commercial	$2,592.63
Rate for Payer: Aetna Medicare Advantage	$2,046.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,739.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,739.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,364.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,739.79
Rate for Payer: Cigna Commercial	$3,411.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,651.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,500.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,023.40
Rate for Payer: UnitedHealthcare Community & State	$164.43
Rate for Payer: Wellpoint Medicaid Managed Care	$180.80

PLATE LCP DIA-META 7HOLE RT

Facility

$6,983.40

Service Code	HCPCS C1713
Hospital Charge Code	270671711
Hospital Revenue Code	278
Min. Negotiated Rate	$1,047.51
Max. Negotiated Rate	$1,689.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,396.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,689.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,536.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,047.51

Know your out-of-pocket cost for care.

All Charges