Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE LCP PROX 8HOLE 4.5MM

Facility

$6,665.15

Service Code	HCPCS C1713
Hospital Charge Code	270676321
Hospital Revenue Code	278
Min. Negotiated Rate	$160.63
Max. Negotiated Rate	$3,332.57
Rate for Payer: Aetna Commercial	$2,532.76
Rate for Payer: Aetna Medicare Advantage	$1,999.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,699.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,699.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,333.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,699.61
Rate for Payer: Cigna Commercial	$3,332.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,612.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,466.33
Rate for Payer: Qualcare PPO/HMO/WC	$999.77
Rate for Payer: UnitedHealthcare Community & State	$160.63
Rate for Payer: Wellpoint Medicaid Managed Care	$176.63

PLATE LCP PROX 8HOLE 4.5MM

Facility

$6,665.15

Service Code	HCPCS C1713
Hospital Charge Code	270676321
Hospital Revenue Code	278
Min. Negotiated Rate	$999.77
Max. Negotiated Rate	$1,612.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,333.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,612.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,466.33
Rate for Payer: Qualcare PPO/HMO/WC	$999.77

PLATE LCP RECON 3.5x140MM 10 H

Facility

$2,407.10

Service Code	HCPCS C1713
Hospital Charge Code	270645929
Hospital Revenue Code	278
Min. Negotiated Rate	$361.06
Max. Negotiated Rate	$582.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$481.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$582.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$529.56
Rate for Payer: Qualcare PPO/HMO/WC	$361.06

PLATE LCP RECON 3.5x140MM 10 H

Facility

$2,407.10

Service Code	HCPCS C1713
Hospital Charge Code	270645929
Hospital Revenue Code	278
Min. Negotiated Rate	$58.01
Max. Negotiated Rate	$1,203.55
Rate for Payer: Aetna Commercial	$914.70
Rate for Payer: Aetna Medicare Advantage	$722.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$613.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$613.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$481.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$613.81
Rate for Payer: Cigna Commercial	$1,203.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$582.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$529.56
Rate for Payer: Qualcare PPO/HMO/WC	$361.06
Rate for Payer: UnitedHealthcare Community & State	$58.01
Rate for Payer: Wellpoint Medicaid Managed Care	$63.79

PLATE LCP RECON 3.5x84MM 6H

Facility

$2,119.75

Service Code	HCPCS C1713
Hospital Charge Code	270641802
Hospital Revenue Code	278
Min. Negotiated Rate	$51.09
Max. Negotiated Rate	$1,059.88
Rate for Payer: Aetna Commercial	$805.50
Rate for Payer: Aetna Medicare Advantage	$635.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$540.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$540.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$423.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$540.54
Rate for Payer: Cigna Commercial	$1,059.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$512.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$466.35
Rate for Payer: Qualcare PPO/HMO/WC	$317.96
Rate for Payer: UnitedHealthcare Community & State	$51.09
Rate for Payer: Wellpoint Medicaid Managed Care	$56.17

PLATE LCP RECON 3.5x84MM 6H

Facility

$2,119.75

Service Code	HCPCS C1713
Hospital Charge Code	270641802
Hospital Revenue Code	278
Min. Negotiated Rate	$317.96
Max. Negotiated Rate	$512.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$423.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$512.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$466.35
Rate for Payer: Qualcare PPO/HMO/WC	$317.96

PLATE LCP RECON 3.5x98MM 7HOLE

Facility

$2,224.80

Service Code	HCPCS C1713
Hospital Charge Code	270641801
Hospital Revenue Code	278
Min. Negotiated Rate	$333.72
Max. Negotiated Rate	$538.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$444.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$538.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$489.46
Rate for Payer: Qualcare PPO/HMO/WC	$333.72

PLATE LCP RECON 3.5x98MM 7HOLE

Facility

$2,224.80

Service Code	HCPCS C1713
Hospital Charge Code	270641801
Hospital Revenue Code	278
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$1,112.40
Rate for Payer: Aetna Commercial	$845.42
Rate for Payer: Aetna Medicare Advantage	$667.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$567.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$567.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$444.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$567.32
Rate for Payer: Cigna Commercial	$1,112.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$538.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$489.46
Rate for Payer: Qualcare PPO/HMO/WC	$333.72
Rate for Payer: UnitedHealthcare Community & State	$53.62
Rate for Payer: Wellpoint Medicaid Managed Care	$58.96

PLATE LCP TIBIA 3.5MM 13HOLE L

Facility

$6,529.15

Service Code	HCPCS C1713
Hospital Charge Code	270644882
Hospital Revenue Code	278
Min. Negotiated Rate	$157.35
Max. Negotiated Rate	$3,264.57
Rate for Payer: Aetna Commercial	$2,481.08
Rate for Payer: Aetna Medicare Advantage	$1,958.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,664.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,664.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,305.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,664.93
Rate for Payer: Cigna Commercial	$3,264.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,580.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,436.41
Rate for Payer: Qualcare PPO/HMO/WC	$979.37
Rate for Payer: UnitedHealthcare Community & State	$157.35
Rate for Payer: Wellpoint Medicaid Managed Care	$173.02

PLATE LCP TIBIA 3.5MM 13HOLE L

Facility

$6,529.15

Service Code	HCPCS C1713
Hospital Charge Code	270644882
Hospital Revenue Code	278
Min. Negotiated Rate	$979.37
Max. Negotiated Rate	$1,580.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,305.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,580.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,436.41
Rate for Payer: Qualcare PPO/HMO/WC	$979.37

PLATE LCP TIBIA 3.5MM 4H LT ST

Facility

$6,090.40

Service Code	HCPCS C1713
Hospital Charge Code	270643261
Hospital Revenue Code	278
Min. Negotiated Rate	$146.78
Max. Negotiated Rate	$3,045.20
Rate for Payer: Aetna Commercial	$2,314.35
Rate for Payer: Aetna Medicare Advantage	$1,827.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,553.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,553.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,553.05
Rate for Payer: Cigna Commercial	$3,045.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,339.89
Rate for Payer: Qualcare PPO/HMO/WC	$913.56
Rate for Payer: UnitedHealthcare Community & State	$146.78
Rate for Payer: Wellpoint Medicaid Managed Care	$161.40

PLATE LCP TIBIA 3.5MM 4H LT ST

Facility

$6,090.40

Service Code	HCPCS C1713
Hospital Charge Code	270643261
Hospital Revenue Code	278
Min. Negotiated Rate	$913.56
Max. Negotiated Rate	$1,473.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,339.89
Rate for Payer: Qualcare PPO/HMO/WC	$913.56

PLATE LCP TIBIA 3.5MM 4H RT ST

Facility

$6,238.70

Service Code	HCPCS C1713
Hospital Charge Code	270646927
Hospital Revenue Code	278
Min. Negotiated Rate	$935.80
Max. Negotiated Rate	$1,509.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,247.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,509.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,372.51
Rate for Payer: Qualcare PPO/HMO/WC	$935.80

PLATE LCP TIBIA 3.5MM 4H RT ST

Facility

$6,238.70

Service Code	HCPCS C1713
Hospital Charge Code	270646927
Hospital Revenue Code	278
Min. Negotiated Rate	$150.35
Max. Negotiated Rate	$3,119.35
Rate for Payer: Aetna Commercial	$2,370.71
Rate for Payer: Aetna Medicare Advantage	$1,871.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,590.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,590.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,247.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,590.87
Rate for Payer: Cigna Commercial	$3,119.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,509.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,372.51
Rate for Payer: Qualcare PPO/HMO/WC	$935.80
Rate for Payer: UnitedHealthcare Community & State	$150.35
Rate for Payer: Wellpoint Medicaid Managed Care	$165.33

PLATE LCP TIBIA 3.5MM 6H LFT

Facility

$5,951.35

Service Code	HCPCS C1713
Hospital Charge Code	270643933
Hospital Revenue Code	278
Min. Negotiated Rate	$143.43
Max. Negotiated Rate	$2,975.68
Rate for Payer: Aetna Commercial	$2,261.51
Rate for Payer: Aetna Medicare Advantage	$1,785.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,517.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,517.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,190.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,517.59
Rate for Payer: Cigna Commercial	$2,975.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,440.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,309.30
Rate for Payer: Qualcare PPO/HMO/WC	$892.70
Rate for Payer: UnitedHealthcare Community & State	$143.43
Rate for Payer: Wellpoint Medicaid Managed Care	$157.71

PLATE LCP TIBIA 3.5MM 6H LFT

Facility

$5,951.35

Service Code	HCPCS C1713
Hospital Charge Code	270643933
Hospital Revenue Code	278
Min. Negotiated Rate	$892.70
Max. Negotiated Rate	$1,440.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,190.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,440.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,309.30
Rate for Payer: Qualcare PPO/HMO/WC	$892.70

PLATE LCP TIBIA 3.5MM 8H RT ST

Facility

$6,214.00

Service Code	HCPCS C1713
Hospital Charge Code	270646922
Hospital Revenue Code	278
Min. Negotiated Rate	$149.76
Max. Negotiated Rate	$3,107.00
Rate for Payer: Aetna Commercial	$2,361.32
Rate for Payer: Aetna Medicare Advantage	$1,864.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,584.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,584.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,242.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,584.57
Rate for Payer: Cigna Commercial	$3,107.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,503.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,367.08
Rate for Payer: Qualcare PPO/HMO/WC	$932.10
Rate for Payer: UnitedHealthcare Community & State	$149.76
Rate for Payer: Wellpoint Medicaid Managed Care	$164.67

PLATE LCP TIBIA 3.5MM 8H RT ST

Facility

$6,214.00

Service Code	HCPCS C1713
Hospital Charge Code	270646922
Hospital Revenue Code	278
Min. Negotiated Rate	$932.10
Max. Negotiated Rate	$1,503.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,242.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,503.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,367.08
Rate for Payer: Qualcare PPO/HMO/WC	$932.10

PLATE LCP TIBIA 3.5x116 5HOLE

Facility

$6,081.10

Service Code	HCPCS C1713
Hospital Charge Code	270642939
Hospital Revenue Code	278
Min. Negotiated Rate	$146.55
Max. Negotiated Rate	$3,040.55
Rate for Payer: Aetna Commercial	$2,310.82
Rate for Payer: Aetna Medicare Advantage	$1,824.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,550.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,550.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,216.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,550.68
Rate for Payer: Cigna Commercial	$3,040.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,471.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,337.84
Rate for Payer: Qualcare PPO/HMO/WC	$912.16
Rate for Payer: UnitedHealthcare Community & State	$146.55
Rate for Payer: Wellpoint Medicaid Managed Care	$161.15

PLATE LCP TIBIA 3.5x116 5HOLE

Facility

$6,081.10

Service Code	HCPCS C1713
Hospital Charge Code	270642939
Hospital Revenue Code	278
Min. Negotiated Rate	$912.16
Max. Negotiated Rate	$1,471.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,216.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,471.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,337.84
Rate for Payer: Qualcare PPO/HMO/WC	$912.16

PLATE LCP TIBIA 4H/L 93MM STER

Facility

$6,039.00

Hospital Charge Code	270675550
Hospital Revenue Code	278
Min. Negotiated Rate	$905.85
Max. Negotiated Rate	$1,461.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,207.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,461.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,328.58
Rate for Payer: Qualcare PPO/HMO/WC	$905.85

PLATE LCP TIBIA 4H/L 93MM STER

Facility

$6,039.00

Hospital Charge Code	270675550
Hospital Revenue Code	278
Min. Negotiated Rate	$145.54
Max. Negotiated Rate	$3,019.50
Rate for Payer: Aetna Commercial	$2,294.82
Rate for Payer: Aetna Medicare Advantage	$1,811.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,539.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,539.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,207.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,539.94
Rate for Payer: Cigna Commercial	$3,019.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,461.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,328.58
Rate for Payer: Qualcare PPO/HMO/WC	$905.85
Rate for Payer: UnitedHealthcare Community & State	$145.54
Rate for Payer: Wellpoint Medicaid Managed Care	$160.03

PLATE LCP TIBIAL 3.5MM 6H119MM

Facility

$8,300.20

Service Code	HCPCS C1713
Hospital Charge Code	270695644
Hospital Revenue Code	278
Min. Negotiated Rate	$1,245.03
Max. Negotiated Rate	$2,008.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,660.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,008.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,826.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,245.03

PLATE LCP TIBIAL 3.5MM 6H119MM

Facility

$8,300.20

Service Code	HCPCS C1713
Hospital Charge Code	270695644
Hospital Revenue Code	278
Min. Negotiated Rate	$200.03
Max. Negotiated Rate	$4,150.10
Rate for Payer: Aetna Commercial	$3,154.08
Rate for Payer: Aetna Medicare Advantage	$2,490.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,116.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,116.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,660.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,116.55
Rate for Payer: Cigna Commercial	$4,150.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,008.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,826.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,245.03
Rate for Payer: UnitedHealthcare Community & State	$200.03
Rate for Payer: Wellpoint Medicaid Managed Care	$219.96

PLATE LCP TITA 3.5x190m 14HOLE

Facility

$5,475.00

Hospital Charge Code	270667948
Hospital Revenue Code	272
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$821.25
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

Know your out-of-pocket cost for care.

All Charges