Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE OC 31 MM

Facility

$15,990.00

Service Code	HCPCS C1713
Hospital Charge Code	270687811
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 OC 31 MM

Facility

$15,990.00

Service Code	HCPCS C1713
Hospital Charge Code	270687811
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 OCCIPITAL SMALL

Facility

$21,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270697874
Hospital Revenue Code	278
Min. Negotiated Rate	$529.60
Max. Negotiated Rate	$10,987.50
Rate for Payer: Aetna Commercial	$8,350.50
Rate for Payer: Aetna Medicare Advantage	$6,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,603.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,603.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,603.62
Rate for Payer: Cigna Commercial	$10,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,317.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,834.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,296.25
Rate for Payer: UnitedHealthcare Community & State	$529.60
Rate for Payer: Wellpoint Medicaid Managed Care	$582.34

PLATE OCCIPITAL SMALL

Facility

$21,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270697874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,296.25
Max. Negotiated Rate	$5,317.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,317.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,834.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,296.25

PLATE OCCIPTAL Y-SHAPE 40-50MM

Facility

$30,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270696791
Hospital Revenue Code	278
Min. Negotiated Rate	$4,560.00
Max. Negotiated Rate	$7,356.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,356.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,560.00

PLATE OCCIPTAL Y-SHAPE 40-50MM

Facility

$30,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270696791
Hospital Revenue Code	278
Min. Negotiated Rate	$732.64
Max. Negotiated Rate	$15,200.00
Rate for Payer: Aetna Commercial	$11,552.00
Rate for Payer: Aetna Medicare Advantage	$9,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,752.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,752.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,752.00
Rate for Payer: Cigna Commercial	$15,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,356.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,560.00
Rate for Payer: UnitedHealthcare Community & State	$732.64
Rate for Payer: Wellpoint Medicaid Managed Care	$805.60

PLATE OLC 10-H SM 1312-18-600

Facility

$6,050.00

Hospital Charge Code	270658887
Hospital Revenue Code	278
Min. Negotiated Rate	$145.81
Max. Negotiated Rate	$3,025.00
Rate for Payer: Aetna Commercial	$2,299.00
Rate for Payer: Aetna Medicare Advantage	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,542.75
Rate for Payer: Cigna Commercial	$3,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$907.50
Rate for Payer: UnitedHealthcare Community & State	$145.81
Rate for Payer: Wellpoint Medicaid Managed Care	$160.32

PLATE OLC 10-H SM 1312-18-600

Facility

$6,050.00

Hospital Charge Code	270658887
Hospital Revenue Code	278
Min. Negotiated Rate	$907.50
Max. Negotiated Rate	$1,464.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$907.50

PLATE OLCRNN 10HL LFT S 629350

Facility

$9,250.00

Hospital Charge Code	270648600
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

PLATE OLCRNN 10HL LFT S 629350

Facility

$9,250.00

Hospital Charge Code	270648600
Hospital Revenue Code	278
Min. Negotiated Rate	$222.93
Max. Negotiated Rate	$4,625.00
Rate for Payer: Aetna Commercial	$3,515.00
Rate for Payer: Aetna Medicare Advantage	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.75
Rate for Payer: Cigna Commercial	$4,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50
Rate for Payer: UnitedHealthcare Community & State	$222.93
Rate for Payer: Wellpoint Medicaid Managed Care	$245.12

PLATE OLEC 13HOLE LOCK PLLE013

Facility

$3,750.00

Hospital Charge Code	270641009
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

PLATE OLEC 13HOLE LOCK PLLE013

Facility

$3,750.00

Hospital Charge Code	270641009
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

PLATE OLECRANON

Facility

$15,620.00

Service Code	HCPCS C1713
Hospital Charge Code	270705395
Hospital Revenue Code	278
Min. Negotiated Rate	$376.44
Max. Negotiated Rate	$7,810.00
Rate for Payer: Aetna Commercial	$5,935.60
Rate for Payer: Aetna Medicare Advantage	$4,686.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,983.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,983.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,124.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,983.10
Rate for Payer: Cigna Commercial	$7,810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,780.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,436.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,343.00
Rate for Payer: UnitedHealthcare Community & State	$376.44
Rate for Payer: Wellpoint Medicaid Managed Care	$413.93

PLATE OLECRANON

Facility

$13,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270705394
Hospital Revenue Code	278
Min. Negotiated Rate	$1,953.75
Max. Negotiated Rate	$3,152.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,152.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,865.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,953.75

PLATE OLECRANON

Facility

$15,620.00

Service Code	HCPCS C1713
Hospital Charge Code	270705395
Hospital Revenue Code	278
Min. Negotiated Rate	$2,343.00
Max. Negotiated Rate	$3,780.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,124.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,780.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,436.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,343.00

PLATE OLECRANON

Facility

$13,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270705394
Hospital Revenue Code	278
Min. Negotiated Rate	$313.90
Max. Negotiated Rate	$6,512.50
Rate for Payer: Aetna Commercial	$4,949.50
Rate for Payer: Aetna Medicare Advantage	$3,907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,321.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,321.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,321.38
Rate for Payer: Cigna Commercial	$6,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,152.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,865.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,953.75
Rate for Payer: UnitedHealthcare Community & State	$313.90
Rate for Payer: Wellpoint Medicaid Managed Care	$345.16

PLATE OLECRANON 10 HOLE

Facility

$6,770.00

Hospital Charge Code	270668017
Hospital Revenue Code	278
Min. Negotiated Rate	$1,015.50
Max. Negotiated Rate	$1,638.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,354.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,638.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,489.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,015.50

PLATE OLECRANON 10 HOLE

Facility

$6,770.00

Hospital Charge Code	270668017
Hospital Revenue Code	278
Min. Negotiated Rate	$163.16
Max. Negotiated Rate	$3,385.00
Rate for Payer: Aetna Commercial	$2,572.60
Rate for Payer: Aetna Medicare Advantage	$2,031.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,726.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,726.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,354.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,726.35
Rate for Payer: Cigna Commercial	$3,385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,638.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,489.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,015.50
Rate for Payer: UnitedHealthcare Community & State	$163.16
Rate for Payer: Wellpoint Medicaid Managed Care	$179.41

PLATE OLECRANON 10 HOLE SMALL

Facility

$6,050.00

Hospital Charge Code	270701882
Hospital Revenue Code	278
Min. Negotiated Rate	$145.81
Max. Negotiated Rate	$3,025.00
Rate for Payer: Aetna Commercial	$2,299.00
Rate for Payer: Aetna Medicare Advantage	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,542.75
Rate for Payer: Cigna Commercial	$3,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$907.50
Rate for Payer: UnitedHealthcare Community & State	$145.81
Rate for Payer: Wellpoint Medicaid Managed Care	$160.32

PLATE OLECRANON 10 HOLE SMALL

Facility

$6,050.00

Hospital Charge Code	270701882
Hospital Revenue Code	278
Min. Negotiated Rate	$907.50
Max. Negotiated Rate	$1,464.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,464.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$907.50

PLATE OLECRANON 13H LARGE

Facility

$6,770.00

Hospital Charge Code	270669272
Hospital Revenue Code	278
Min. Negotiated Rate	$1,015.50
Max. Negotiated Rate	$1,638.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,354.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,638.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,489.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,015.50

PLATE OLECRANON 13H LARGE

Facility

$6,770.00

Hospital Charge Code	270669272
Hospital Revenue Code	278
Min. Negotiated Rate	$163.16
Max. Negotiated Rate	$3,385.00
Rate for Payer: Aetna Commercial	$2,572.60
Rate for Payer: Aetna Medicare Advantage	$2,031.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,726.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,726.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,354.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,726.35
Rate for Payer: Cigna Commercial	$3,385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,638.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,489.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,015.50
Rate for Payer: UnitedHealthcare Community & State	$163.16
Rate for Payer: Wellpoint Medicaid Managed Care	$179.41

PLATE OLECRANON 3.5x138 6H RT

Facility

$4,217.85

Service Code	HCPCS C1713
Hospital Charge Code	270641314
Hospital Revenue Code	278
Min. Negotiated Rate	$632.68
Max. Negotiated Rate	$1,020.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$843.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,020.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$927.93
Rate for Payer: Qualcare PPO/HMO/WC	$632.68

PLATE OLECRANON 3.5x138 6H RT

Facility

$4,217.85

Service Code	HCPCS C1713
Hospital Charge Code	270641314
Hospital Revenue Code	278
Min. Negotiated Rate	$101.65
Max. Negotiated Rate	$2,108.93
Rate for Payer: Aetna Commercial	$1,602.78
Rate for Payer: Aetna Medicare Advantage	$1,265.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,075.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,075.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$843.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,075.55
Rate for Payer: Cigna Commercial	$2,108.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,020.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$927.93
Rate for Payer: Qualcare PPO/HMO/WC	$632.68
Rate for Payer: UnitedHealthcare Community & State	$101.65
Rate for Payer: Wellpoint Medicaid Managed Care	$111.77

PLATE OLECRANON 8HL LFT 629348

Facility

$9,250.00

Hospital Charge Code	270648597
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

Know your out-of-pocket cost for care.

All Charges