Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE LORDTIC 30MM

Facility

$6,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270690567
Hospital Revenue Code	278
Min. Negotiated Rate	$159.06
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$2,508.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.00
Rate for Payer: UnitedHealthcare Community & State	$159.06
Rate for Payer: Wellpoint Medicaid Managed Care	$174.90

PLATE LOW PRO 2 HOLE 15MM

Facility

$375.00

Service Code	HCPCS C1713
Hospital Charge Code	270704118
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

PLATE LOW PRO 2 HOLE 15MM

Facility

$375.00

Service Code	HCPCS C1713
Hospital Charge Code	270704118
Hospital Revenue Code	278
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

PLATE LOW PROFILE COTTON 6MM

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270674305
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$874.50
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

PLATE LOW PROFILE COTTON 6MM

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270674305
Hospital Revenue Code	278
Min. Negotiated Rate	$95.80
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,510.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$874.50
Rate for Payer: Qualcare PPO/HMO/WC	$596.25
Rate for Payer: UnitedHealthcare Community & State	$95.80
Rate for Payer: Wellpoint Medicaid Managed Care	$105.34

PLATE LOW PROFILE LAPIDUS 4 HO

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270685384
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 LOW PROFILE LAPIDUS 4 HO

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270685384
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 LP-PRO MTPCONT STD.TI

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270690794
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 LP-PRO MTPCONT STD.TI

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270690794
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 LTL 9-H RT 1312-18-201

Facility

$6,415.00

Hospital Charge Code	270658886
Hospital Revenue Code	278
Min. Negotiated Rate	$962.25
Max. Negotiated Rate	$1,552.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,283.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,552.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,411.30
Rate for Payer: Qualcare PPO/HMO/WC	$962.25

PLATE LTL 9-H RT 1312-18-201

Facility

$6,415.00

Hospital Charge Code	270658886
Hospital Revenue Code	278
Min. Negotiated Rate	$154.60
Max. Negotiated Rate	$3,207.50
Rate for Payer: Aetna Commercial	$2,437.70
Rate for Payer: Aetna Medicare Advantage	$1,924.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,635.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,635.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,283.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,635.83
Rate for Payer: Cigna Commercial	$3,207.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,552.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,411.30
Rate for Payer: Qualcare PPO/HMO/WC	$962.25
Rate for Payer: UnitedHealthcare Community & State	$154.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.00

PLATE LUMBAR 24MM

Facility

$40,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697266
Hospital Revenue Code	278
Min. Negotiated Rate	$6,112.50
Max. Negotiated Rate	$9,861.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,861.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,965.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,112.50

PLATE LUMBAR 24MM

Facility

$40,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697266
Hospital Revenue Code	278
Min. Negotiated Rate	$982.08
Max. Negotiated Rate	$20,375.00
Rate for Payer: Aetna Commercial	$15,485.00
Rate for Payer: Aetna Medicare Advantage	$12,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,391.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,391.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,391.25
Rate for Payer: Cigna Commercial	$20,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,861.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,965.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,112.50
Rate for Payer: UnitedHealthcare Community & State	$982.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,079.88

PLATE LUMBAR LAT 2 SCR 17MM

Facility

$20,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695203
Hospital Revenue Code	278
Min. Negotiated Rate	$500.07
Max. Negotiated Rate	$10,375.00
Rate for Payer: Aetna Commercial	$7,885.00
Rate for Payer: Aetna Medicare Advantage	$6,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,291.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,291.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,291.25
Rate for Payer: Cigna Commercial	$10,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,021.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,565.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,112.50
Rate for Payer: UnitedHealthcare Community & State	$500.07
Rate for Payer: Wellpoint Medicaid Managed Care	$549.88

PLATE LUMBAR LAT 2 SCR 17MM

Facility

$20,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695203
Hospital Revenue Code	278
Min. Negotiated Rate	$3,112.50
Max. Negotiated Rate	$5,021.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,021.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,565.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,112.50

PLATE LUMBAR LATERAL 15MM

Facility

$20,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695245
Hospital Revenue Code	278
Min. Negotiated Rate	$500.07
Max. Negotiated Rate	$10,375.00
Rate for Payer: Aetna Commercial	$7,885.00
Rate for Payer: Aetna Medicare Advantage	$6,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,291.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,291.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,291.25
Rate for Payer: Cigna Commercial	$10,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,021.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,565.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,112.50
Rate for Payer: UnitedHealthcare Community & State	$500.07
Rate for Payer: Wellpoint Medicaid Managed Care	$549.88

PLATE LUMBAR LATERAL 15MM

Facility

$20,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695245
Hospital Revenue Code	278
Min. Negotiated Rate	$3,112.50
Max. Negotiated Rate	$5,021.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,021.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,565.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,112.50

PLATEMATRIXNEUROCRANIAL12MM2H

Facility

$560.00

Service Code	HCPCS C1713
Hospital Charge Code	270695476
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$280.00
Rate for Payer: Aetna Commercial	$212.80
Rate for Payer: Aetna Medicare Advantage	$168.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.80
Rate for Payer: Cigna Commercial	$280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$123.20
Rate for Payer: Qualcare PPO/HMO/WC	$84.00
Rate for Payer: UnitedHealthcare Community & State	$13.50
Rate for Payer: Wellpoint Medicaid Managed Care	$14.84

PLATEMATRIXNEUROCRANIAL12MM2H

Facility

$560.00

Service Code	HCPCS C1713
Hospital Charge Code	270695476
Hospital Revenue Code	278
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$135.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$123.20
Rate for Payer: Qualcare PPO/HMO/WC	$84.00

PLATE MATRIXNEURO DBL Y 18MM6H

Facility

$2,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270695275
Hospital Revenue Code	278
Min. Negotiated Rate	$307.50
Max. Negotiated Rate	$496.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$496.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$451.00
Rate for Payer: Qualcare PPO/HMO/WC	$307.50

PLATE MATRIXNEURO DBL Y 18MM6H

Facility

$2,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270695275
Hospital Revenue Code	278
Min. Negotiated Rate	$49.41
Max. Negotiated Rate	$1,025.00
Rate for Payer: Aetna Commercial	$779.00
Rate for Payer: Aetna Medicare Advantage	$615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.75
Rate for Payer: Cigna Commercial	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$496.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$451.00
Rate for Payer: Qualcare PPO/HMO/WC	$307.50
Rate for Payer: UnitedHealthcare Community & State	$49.41
Rate for Payer: Wellpoint Medicaid Managed Care	$54.33

PLATE MATRIXNEURO TI STR 4H

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	270698656
Hospital Revenue Code	278
Min. Negotiated Rate	$103.50
Max. Negotiated Rate	$166.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.80
Rate for Payer: Qualcare PPO/HMO/WC	$103.50

PLATE MATRIXNEURO TI STR 4H

Facility

$690.00

Service Code	HCPCS C1713
Hospital Charge Code	270698656
Hospital Revenue Code	278
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$345.00
Rate for Payer: Aetna Commercial	$262.20
Rate for Payer: Aetna Medicare Advantage	$207.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.95
Rate for Payer: Cigna Commercial	$345.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.80
Rate for Payer: Qualcare PPO/HMO/WC	$103.50
Rate for Payer: UnitedHealthcare Community & State	$16.63
Rate for Payer: Wellpoint Medicaid Managed Care	$18.29

PLATE MAXFORCE MTP 0-0 RT

Facility

$625.00

Service Code	HCPCS C1713
Hospital Charge Code	270698095
Hospital Revenue Code	278
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

PLATE MAXFORCE MTP 0-0 RT

Facility

$625.00

Service Code	HCPCS C1713
Hospital Charge Code	270698095
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

Know your out-of-pocket cost for care.

All Charges