Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE METAPHYSEAL 4.5MM 10H

Facility

$12,115.00

Service Code	HCPCS C1713
Hospital Charge Code	270700091
Hospital Revenue Code	278
Min. Negotiated Rate	$1,817.25
Max. Negotiated Rate	$2,931.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,423.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,931.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,665.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,817.25

PLATE METAPHYSEAL 4.5MM 10H

Facility

$12,115.00

Service Code	HCPCS C1713
Hospital Charge Code	270700091
Hospital Revenue Code	278
Min. Negotiated Rate	$291.97
Max. Negotiated Rate	$6,057.50
Rate for Payer: Aetna Commercial	$4,603.70
Rate for Payer: Aetna Medicare Advantage	$3,634.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,089.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,089.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,423.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,089.32
Rate for Payer: Cigna Commercial	$6,057.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,931.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,665.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,817.25
Rate for Payer: UnitedHealthcare Community & State	$291.97
Rate for Payer: Wellpoint Medicaid Managed Care	$321.05

PLATE METAPHYSEAL 6H 3.5x86MM

Facility

$3,902.00

Service Code	HCPCS C1713
Hospital Charge Code	270660390
Hospital Revenue Code	278
Min. Negotiated Rate	$94.04
Max. Negotiated Rate	$1,951.00
Rate for Payer: Aetna Commercial	$1,482.76
Rate for Payer: Aetna Medicare Advantage	$1,170.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$995.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$995.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$780.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$995.01
Rate for Payer: Cigna Commercial	$1,951.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$944.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$858.44
Rate for Payer: Qualcare PPO/HMO/WC	$585.30
Rate for Payer: UnitedHealthcare Community & State	$94.04
Rate for Payer: Wellpoint Medicaid Managed Care	$103.40

PLATE METAPHYSEAL 6H 3.5x86MM

Facility

$3,902.00

Service Code	HCPCS C1713
Hospital Charge Code	270660390
Hospital Revenue Code	278
Min. Negotiated Rate	$585.30
Max. Negotiated Rate	$944.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$780.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$944.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$858.44
Rate for Payer: Qualcare PPO/HMO/WC	$585.30

PLATE METATARSAL 4H STRAIGHT

Facility

$3,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270697018
Hospital Revenue Code	278
Min. Negotiated Rate	$93.99
Max. Negotiated Rate	$1,950.00
Rate for Payer: Aetna Commercial	$1,482.00
Rate for Payer: Aetna Medicare Advantage	$1,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$994.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$994.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$994.50
Rate for Payer: Cigna Commercial	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$943.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$858.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.00
Rate for Payer: UnitedHealthcare Community & State	$93.99
Rate for Payer: Wellpoint Medicaid Managed Care	$103.35

PLATE METATARSAL 4H STRAIGHT

Facility

$3,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270697018
Hospital Revenue Code	278
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$943.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$943.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$858.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.00

PLATE METATASAL WEDG 2MM LEFT

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270678717
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 METATASAL WEDG 2MM LEFT

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270678717
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 MINI LOCKED LEFT 24x43MM

Facility

$5,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270673610
Hospital Revenue Code	278
Min. Negotiated Rate	$858.00
Max. Negotiated Rate	$1,384.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,384.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,258.40
Rate for Payer: Qualcare PPO/HMO/WC	$858.00

PLATE MINI LOCKED LEFT 24x43MM

Facility

$5,720.00

Service Code	HCPCS C1713
Hospital Charge Code	270673610
Hospital Revenue Code	278
Min. Negotiated Rate	$137.85
Max. Negotiated Rate	$2,860.00
Rate for Payer: Aetna Commercial	$2,173.60
Rate for Payer: Aetna Medicare Advantage	$1,716.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,458.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,458.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,458.60
Rate for Payer: Cigna Commercial	$2,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,384.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,258.40
Rate for Payer: Qualcare PPO/HMO/WC	$858.00
Rate for Payer: UnitedHealthcare Community & State	$137.85
Rate for Payer: Wellpoint Medicaid Managed Care	$151.58

PLATE MINI-STRAIGHT 5-HOLE

Facility

$92.00

Hospital Charge Code	1602655
Hospital Revenue Code	274
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$46.00
Rate for Payer: Aetna Commercial	$34.96
Rate for Payer: Aetna Medicare Advantage	$27.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.46
Rate for Payer: Cigna Commercial	$46.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$13.80
Rate for Payer: UnitedHealthcare Community & State	$2.22
Rate for Payer: Wellpoint Medicaid Managed Care	$2.44

PLATE MINI-STRAIGHT 5-HOLE

Facility

$92.00

Hospital Charge Code	1602655
Hospital Revenue Code	274
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$22.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$13.80

PLATE MINI-STRAIGHT 6-HOLE

Facility

$92.00

Hospital Charge Code	1602663
Hospital Revenue Code	274
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$46.00
Rate for Payer: Aetna Commercial	$34.96
Rate for Payer: Aetna Medicare Advantage	$27.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.46
Rate for Payer: Cigna Commercial	$46.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$13.80
Rate for Payer: UnitedHealthcare Community & State	$2.22
Rate for Payer: Wellpoint Medicaid Managed Care	$2.44

PLATE MINI-STRAIGHT 6-HOLE

Facility

$92.00

Hospital Charge Code	1602663
Hospital Revenue Code	274
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$22.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$13.80

PLATE MLP TENSION 4HOLE 2mm

Facility

$2,445.00

Hospital Charge Code	270662332
Hospital Revenue Code	278
Min. Negotiated Rate	$58.92
Max. Negotiated Rate	$1,222.50
Rate for Payer: Aetna Commercial	$929.10
Rate for Payer: Aetna Medicare Advantage	$733.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$623.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$623.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$489.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$623.48
Rate for Payer: Cigna Commercial	$1,222.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$591.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$537.90
Rate for Payer: Qualcare PPO/HMO/WC	$366.75
Rate for Payer: UnitedHealthcare Community & State	$58.92
Rate for Payer: Wellpoint Medicaid Managed Care	$64.79

PLATE MLP TENSION 4HOLE 2mm

Facility

$2,445.00

Hospital Charge Code	270662332
Hospital Revenue Code	278
Min. Negotiated Rate	$366.75
Max. Negotiated Rate	$591.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$489.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$591.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$537.90
Rate for Payer: Qualcare PPO/HMO/WC	$366.75

PLATE MNTR H/H X-CONN 28MM

Facility

$5,180.00

Service Code	HCPCS C1713
Hospital Charge Code	270663780
Hospital Revenue Code	278
Min. Negotiated Rate	$124.84
Max. Negotiated Rate	$2,590.00
Rate for Payer: Aetna Commercial	$1,968.40
Rate for Payer: Aetna Medicare Advantage	$1,554.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,320.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,320.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,320.90
Rate for Payer: Cigna Commercial	$2,590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,253.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,139.60
Rate for Payer: Qualcare PPO/HMO/WC	$777.00
Rate for Payer: UnitedHealthcare Community & State	$124.84
Rate for Payer: Wellpoint Medicaid Managed Care	$137.27

PLATE MNTR H/H X-CONN 28MM

Facility

$5,180.00

Service Code	HCPCS C1713
Hospital Charge Code	270663780
Hospital Revenue Code	278
Min. Negotiated Rate	$777.00
Max. Negotiated Rate	$1,253.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,253.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,139.60
Rate for Payer: Qualcare PPO/HMO/WC	$777.00

PLATE MNTR H/H X-CONN 35MM

Facility

$5,180.00

Hospital Charge Code	270663784
Hospital Revenue Code	278
Min. Negotiated Rate	$124.84
Max. Negotiated Rate	$2,590.00
Rate for Payer: Aetna Commercial	$1,968.40
Rate for Payer: Aetna Medicare Advantage	$1,554.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,320.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,320.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,320.90
Rate for Payer: Cigna Commercial	$2,590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,253.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,139.60
Rate for Payer: Qualcare PPO/HMO/WC	$777.00
Rate for Payer: UnitedHealthcare Community & State	$124.84
Rate for Payer: Wellpoint Medicaid Managed Care	$137.27

PLATE MNTR H/H X-CONN 35MM

Facility

$5,180.00

Hospital Charge Code	270663784
Hospital Revenue Code	278
Min. Negotiated Rate	$777.00
Max. Negotiated Rate	$1,253.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,253.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,139.60
Rate for Payer: Qualcare PPO/HMO/WC	$777.00

PLATE MNTR OC SMALL

Facility

$15,990.00

Service Code	HCPCS C1713
Hospital Charge Code	270677388
Hospital Revenue Code	278
Min. Negotiated Rate	$2,398.50
Max. Negotiated Rate	$3,869.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,198.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,869.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,517.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,398.50

PLATE MNTR OC SMALL

Facility

$15,990.00

Service Code	HCPCS C1713
Hospital Charge Code	270677388
Hospital Revenue Code	278
Min. Negotiated Rate	$385.36
Max. Negotiated Rate	$7,995.00
Rate for Payer: Aetna Commercial	$6,076.20
Rate for Payer: Aetna Medicare Advantage	$4,797.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,077.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,077.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,077.45
Rate for Payer: Cigna Commercial	$7,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,869.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,517.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,398.50
Rate for Payer: UnitedHealthcare Community & State	$385.36
Rate for Payer: Wellpoint Medicaid Managed Care	$423.74

PLATE MODULUS XLIF DS 10MM

Facility

$15,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697064
Hospital Revenue Code	278
Min. Negotiated Rate	$2,362.50
Max. Negotiated Rate	$3,811.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,811.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,465.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50

PLATE MODULUS XLIF DS 10MM

Facility

$15,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697064
Hospital Revenue Code	278
Min. Negotiated Rate	$379.57
Max. Negotiated Rate	$7,875.00
Rate for Payer: Aetna Commercial	$5,985.00
Rate for Payer: Aetna Medicare Advantage	$4,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,016.25
Rate for Payer: Cigna Commercial	$7,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,811.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,465.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50
Rate for Payer: UnitedHealthcare Community & State	$379.57
Rate for Payer: Wellpoint Medicaid Managed Care	$417.38

PLATEMODULUSXLIFDUALSIDE 8MM

Facility

$15,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697554
Hospital Revenue Code	278
Min. Negotiated Rate	$379.57
Max. Negotiated Rate	$7,875.00
Rate for Payer: Aetna Commercial	$5,985.00
Rate for Payer: Aetna Medicare Advantage	$4,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,016.25
Rate for Payer: Cigna Commercial	$7,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,811.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,465.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,362.50
Rate for Payer: UnitedHealthcare Community & State	$379.57
Rate for Payer: Wellpoint Medicaid Managed Care	$417.38

Know your out-of-pocket cost for care.

All Charges