Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATEMODULUSXLIFDUALSIDE 8MM

Facility

$15,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697554
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 MOD 12MM

Facility

$15,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695492
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 MOD 12MM

Facility

$15,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695492
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

PLATEMONET4HWIDEEXTRA7MM$$N/C

Facility

$9,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270696627
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$2,286.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,079.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50

PLATEMONET4HWIDEEXTRA7MM$$N/C

Facility

$9,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270696627
Hospital Revenue Code	278
Min. Negotiated Rate	$227.75
Max. Negotiated Rate	$4,725.00
Rate for Payer: Aetna Commercial	$3,591.00
Rate for Payer: Aetna Medicare Advantage	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,409.75
Rate for Payer: Cigna Commercial	$4,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,079.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50
Rate for Payer: UnitedHealthcare Community & State	$227.75
Rate for Payer: Wellpoint Medicaid Managed Care	$250.43

PLATE MONEY XWIDE 4H 8MM

Facility

$9,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270697689
Hospital Revenue Code	278
Min. Negotiated Rate	$227.75
Max. Negotiated Rate	$4,725.00
Rate for Payer: Aetna Commercial	$3,591.00
Rate for Payer: Aetna Medicare Advantage	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,409.75
Rate for Payer: Cigna Commercial	$4,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,079.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50
Rate for Payer: UnitedHealthcare Community & State	$227.75
Rate for Payer: Wellpoint Medicaid Managed Care	$250.43

PLATE MONEY XWIDE 4H 8MM

Facility

$9,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270697689
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$2,286.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,079.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50

PLATE MONO PYRENEES 42 MM

Facility

$6,535.00

Service Code	HCPCS C1713
Hospital Charge Code	270698871
Hospital Revenue Code	278
Min. Negotiated Rate	$157.49
Max. Negotiated Rate	$3,267.50
Rate for Payer: Aetna Commercial	$2,483.30
Rate for Payer: Aetna Medicare Advantage	$1,960.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,666.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,666.42
Rate for Payer: Cigna Commercial	$3,267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,437.70
Rate for Payer: Qualcare PPO/HMO/WC	$980.25
Rate for Payer: UnitedHealthcare Community & State	$157.49
Rate for Payer: Wellpoint Medicaid Managed Care	$173.18

PLATE MONO PYRENEES 42 MM

Facility

$6,535.00

Service Code	HCPCS C1713
Hospital Charge Code	270698871
Hospital Revenue Code	278
Min. Negotiated Rate	$980.25
Max. Negotiated Rate	$1,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,307.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,581.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,437.70
Rate for Payer: Qualcare PPO/HMO/WC	$980.25

PLATE MPJ 1ST 7D SMALL RIGHT

Facility

$9,155.00

Service Code	HCPCS C1713
Hospital Charge Code	270694684
Hospital Revenue Code	278
Min. Negotiated Rate	$1,373.25
Max. Negotiated Rate	$2,215.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,831.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,215.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,014.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,373.25

PLATE MPJ 1ST 7D SMALL RIGHT

Facility

$9,155.00

Service Code	HCPCS C1713
Hospital Charge Code	270694684
Hospital Revenue Code	278
Min. Negotiated Rate	$220.64
Max. Negotiated Rate	$4,577.50
Rate for Payer: Aetna Commercial	$3,478.90
Rate for Payer: Aetna Medicare Advantage	$2,746.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,334.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,334.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,831.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,334.53
Rate for Payer: Cigna Commercial	$4,577.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,215.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,014.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,373.25
Rate for Payer: UnitedHealthcare Community & State	$220.64
Rate for Payer: Wellpoint Medicaid Managed Care	$242.61

PLATE MPJ SMALL LT 0DEG

Facility

$9,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270693322
Hospital Revenue Code	278
Min. Negotiated Rate	$227.14
Max. Negotiated Rate	$4,712.50
Rate for Payer: Aetna Commercial	$3,581.50
Rate for Payer: Aetna Medicare Advantage	$2,827.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,403.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,403.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,403.38
Rate for Payer: Cigna Commercial	$4,712.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,280.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,073.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.75
Rate for Payer: UnitedHealthcare Community & State	$227.14
Rate for Payer: Wellpoint Medicaid Managed Care	$249.76

PLATE MPJ SMALL LT 0DEG

Facility

$9,425.00

Service Code	HCPCS C1713
Hospital Charge Code	270693322
Hospital Revenue Code	278
Min. Negotiated Rate	$1,413.75
Max. Negotiated Rate	$2,280.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,280.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,073.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,413.75

PLATE MTP 5 DEG MED LT

Facility

$6,503.75

Service Code	HCPCS C1713
Hospital Charge Code	270701184
Hospital Revenue Code	278
Min. Negotiated Rate	$975.56
Max. Negotiated Rate	$1,573.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.83
Rate for Payer: Qualcare PPO/HMO/WC	$975.56

PLATE MTP 5 DEG MED LT

Facility

$6,503.75

Service Code	HCPCS C1713
Hospital Charge Code	270701184
Hospital Revenue Code	278
Min. Negotiated Rate	$156.74
Max. Negotiated Rate	$3,251.88
Rate for Payer: Aetna Commercial	$2,471.43
Rate for Payer: Aetna Medicare Advantage	$1,951.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,658.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,658.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,658.46
Rate for Payer: Cigna Commercial	$3,251.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.83
Rate for Payer: Qualcare PPO/HMO/WC	$975.56
Rate for Payer: UnitedHealthcare Community & State	$156.74
Rate for Payer: Wellpoint Medicaid Managed Care	$172.35

PLATE MTP CP, RIGHT

Facility

$10,270.00

Hospital Charge Code	270667537
Hospital Revenue Code	278
Min. Negotiated Rate	$247.51
Max. Negotiated Rate	$5,135.00
Rate for Payer: Aetna Commercial	$3,902.60
Rate for Payer: Aetna Medicare Advantage	$3,081.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,618.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,618.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,054.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,618.85
Rate for Payer: Cigna Commercial	$5,135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,485.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,259.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,540.50
Rate for Payer: UnitedHealthcare Community & State	$247.51
Rate for Payer: Wellpoint Medicaid Managed Care	$272.15

PLATE MTP CP, RIGHT

Facility

$10,270.00

Hospital Charge Code	270667537
Hospital Revenue Code	278
Min. Negotiated Rate	$1,540.50
Max. Negotiated Rate	$2,485.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,054.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,485.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,259.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,540.50

PLATE MTP FUSION 10 MM

Facility

$5,465.20

Service Code	HCPCS C1713
Hospital Charge Code	270689910
Hospital Revenue Code	278
Min. Negotiated Rate	$819.78
Max. Negotiated Rate	$1,322.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,093.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,322.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,202.34
Rate for Payer: Qualcare PPO/HMO/WC	$819.78

PLATE MTP FUSION 10 MM

Facility

$5,465.20

Service Code	HCPCS C1713
Hospital Charge Code	270689910
Hospital Revenue Code	278
Min. Negotiated Rate	$131.71
Max. Negotiated Rate	$2,732.60
Rate for Payer: Aetna Commercial	$2,076.78
Rate for Payer: Aetna Medicare Advantage	$1,639.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,393.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,393.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,093.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,393.63
Rate for Payer: Cigna Commercial	$2,732.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,322.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,202.34
Rate for Payer: Qualcare PPO/HMO/WC	$819.78
Rate for Payer: UnitedHealthcare Community & State	$131.71
Rate for Payer: Wellpoint Medicaid Managed Care	$144.83

PLATE MTP FUSION LG/5 DEG/LEFT

Facility

$4,839.00

Service Code	HCPCS C1713
Hospital Charge Code	270676586
Hospital Revenue Code	278
Min. Negotiated Rate	$725.85
Max. Negotiated Rate	$1,171.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$967.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,064.58
Rate for Payer: Qualcare PPO/HMO/WC	$725.85

PLATE MTP FUSION LG/5 DEG/LEFT

Facility

$4,839.00

Service Code	HCPCS C1713
Hospital Charge Code	270676586
Hospital Revenue Code	278
Min. Negotiated Rate	$116.62
Max. Negotiated Rate	$2,419.50
Rate for Payer: Aetna Commercial	$1,838.82
Rate for Payer: Aetna Medicare Advantage	$1,451.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,233.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,233.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$967.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,233.94
Rate for Payer: Cigna Commercial	$2,419.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,064.58
Rate for Payer: Qualcare PPO/HMO/WC	$725.85
Rate for Payer: UnitedHealthcare Community & State	$116.62
Rate for Payer: Wellpoint Medicaid Managed Care	$128.23

PLATE MTP FUSION RIGHT

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270682558
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 MTP FUSION RIGHT

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270682558
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 MTP FUSION SM/0 DEG/LT S

Facility

$4,281.00

Service Code	HCPCS C1713
Hospital Charge Code	270675950
Hospital Revenue Code	278
Min. Negotiated Rate	$103.17
Max. Negotiated Rate	$2,140.50
Rate for Payer: Aetna Commercial	$1,626.78
Rate for Payer: Aetna Medicare Advantage	$1,284.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,091.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,091.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,091.65
Rate for Payer: Cigna Commercial	$2,140.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$941.82
Rate for Payer: Qualcare PPO/HMO/WC	$642.15
Rate for Payer: UnitedHealthcare Community & State	$103.17
Rate for Payer: Wellpoint Medicaid Managed Care	$113.45

PLATE MTP FUSION SM/0 DEG/LT S

Facility

$4,281.00

Service Code	HCPCS C1713
Hospital Charge Code	270675950
Hospital Revenue Code	278
Min. Negotiated Rate	$642.15
Max. Negotiated Rate	$1,036.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$941.82
Rate for Payer: Qualcare PPO/HMO/WC	$642.15

Know your out-of-pocket cost for care.

All Charges