Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE OLECRANON 8HL LFT 629348

Facility

$9,250.00

Hospital Charge Code	270648597
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 OLECRAN STD 11 HOLE LEFT

Facility

$11,155.00

Service Code	HCPCS C1713
Hospital Charge Code	270697231
Hospital Revenue Code	278
Min. Negotiated Rate	$268.84
Max. Negotiated Rate	$5,577.50
Rate for Payer: Aetna Commercial	$4,238.90
Rate for Payer: Aetna Medicare Advantage	$3,346.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,844.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,844.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,231.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,844.53
Rate for Payer: Cigna Commercial	$5,577.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,699.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,454.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,673.25
Rate for Payer: UnitedHealthcare Community & State	$268.84
Rate for Payer: Wellpoint Medicaid Managed Care	$295.61

PLATE OLECRAN STD 11 HOLE LEFT

Facility

$11,155.00

Service Code	HCPCS C1713
Hospital Charge Code	270697231
Hospital Revenue Code	278
Min. Negotiated Rate	$1,673.25
Max. Negotiated Rate	$2,699.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,231.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,699.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,454.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,673.25

PLATE OLECRN 10-H LOCK 2111110

Facility

$4,995.00

Hospital Charge Code	270643578
Hospital Revenue Code	278
Min. Negotiated Rate	$749.25
Max. Negotiated Rate	$1,208.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,098.90
Rate for Payer: Qualcare PPO/HMO/WC	$749.25

PLATE OLECRN 10-H LOCK 2111110

Facility

$4,995.00

Hospital Charge Code	270643578
Hospital Revenue Code	278
Min. Negotiated Rate	$120.38
Max. Negotiated Rate	$2,497.50
Rate for Payer: Aetna Commercial	$1,898.10
Rate for Payer: Aetna Medicare Advantage	$1,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,273.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,273.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,273.72
Rate for Payer: Cigna Commercial	$2,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,098.90
Rate for Payer: Qualcare PPO/HMO/WC	$749.25
Rate for Payer: UnitedHealthcare Community & State	$120.38
Rate for Payer: Wellpoint Medicaid Managed Care	$132.37

PLATE ONE-THIRD TU 3HOLE 3.5mm

Facility

$1,081.50

Service Code	HCPCS C1713
Hospital Charge Code	270678636
Hospital Revenue Code	278
Min. Negotiated Rate	$162.22
Max. Negotiated Rate	$261.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$237.93
Rate for Payer: Qualcare PPO/HMO/WC	$162.22

PLATE ONE-THIRD TU 3HOLE 3.5mm

Facility

$1,081.50

Service Code	HCPCS C1713
Hospital Charge Code	270678636
Hospital Revenue Code	278
Min. Negotiated Rate	$26.06
Max. Negotiated Rate	$540.75
Rate for Payer: Aetna Commercial	$410.97
Rate for Payer: Aetna Medicare Advantage	$324.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.78
Rate for Payer: Cigna Commercial	$540.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$237.93
Rate for Payer: Qualcare PPO/HMO/WC	$162.22
Rate for Payer: UnitedHealthcare Community & State	$26.06
Rate for Payer: Wellpoint Medicaid Managed Care	$28.66

PLATE OPENING WEDGE 0 MM

Facility

$6,930.00

Service Code	HCPCS C1713
Hospital Charge Code	270679185
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,677.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50

PLATE OPENING WEDGE 0 MM

Facility

$6,930.00

Service Code	HCPCS C1713
Hospital Charge Code	270679185
Hospital Revenue Code	278
Min. Negotiated Rate	$167.01
Max. Negotiated Rate	$3,465.00
Rate for Payer: Aetna Commercial	$2,633.40
Rate for Payer: Aetna Medicare Advantage	$2,079.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,767.15
Rate for Payer: Cigna Commercial	$3,465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50
Rate for Payer: UnitedHealthcare Community & State	$167.01
Rate for Payer: Wellpoint Medicaid Managed Care	$183.65

PLATE OPENING WEDGE 5MM

Facility

$6,930.00

Service Code	HCPCS C1713
Hospital Charge Code	270663146
Hospital Revenue Code	278
Min. Negotiated Rate	$167.01
Max. Negotiated Rate	$3,465.00
Rate for Payer: Aetna Commercial	$2,633.40
Rate for Payer: Aetna Medicare Advantage	$2,079.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,767.15
Rate for Payer: Cigna Commercial	$3,465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50
Rate for Payer: UnitedHealthcare Community & State	$167.01
Rate for Payer: Wellpoint Medicaid Managed Care	$183.65

PLATE OPENING WEDGE 5MM

Facility

$6,930.00

Service Code	HCPCS C1713
Hospital Charge Code	270663146
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,677.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50

PLATE OPEN WEDGE 3MM

Facility

$8,540.00

Service Code	HCPCS C1713
Hospital Charge Code	270700341
Hospital Revenue Code	278
Min. Negotiated Rate	$205.81
Max. Negotiated Rate	$4,270.00
Rate for Payer: Aetna Commercial	$3,245.20
Rate for Payer: Aetna Medicare Advantage	$2,562.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,177.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,177.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,708.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,177.70
Rate for Payer: Cigna Commercial	$4,270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,066.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,878.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,281.00
Rate for Payer: UnitedHealthcare Community & State	$205.81
Rate for Payer: Wellpoint Medicaid Managed Care	$226.31

PLATE OPEN WEDGE 3MM

Facility

$8,540.00

Service Code	HCPCS C1713
Hospital Charge Code	270700341
Hospital Revenue Code	278
Min. Negotiated Rate	$1,281.00
Max. Negotiated Rate	$2,066.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,708.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,066.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,878.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,281.00

PLATE OPEN WEDGE 4.5

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270679764
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 OPEN WEDGE 4.5

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270679764
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 OPEN WEDGE 4.5MM LEFT

Facility

$5,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270656537
Hospital Revenue Code	278
Min. Negotiated Rate	$852.00
Max. Negotiated Rate	$1,374.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,136.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,374.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,249.60
Rate for Payer: Qualcare PPO/HMO/WC	$852.00

PLATE OPEN WEDGE 4.5MM LEFT

Facility

$5,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270656537
Hospital Revenue Code	278
Min. Negotiated Rate	$136.89
Max. Negotiated Rate	$2,840.00
Rate for Payer: Aetna Commercial	$2,158.40
Rate for Payer: Aetna Medicare Advantage	$1,704.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,448.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,448.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,136.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,448.40
Rate for Payer: Cigna Commercial	$2,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,374.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,249.60
Rate for Payer: Qualcare PPO/HMO/WC	$852.00
Rate for Payer: UnitedHealthcare Community & State	$136.89
Rate for Payer: Wellpoint Medicaid Managed Care	$150.52

PLATE OPEN WEDGE 4MM LEFT

Facility

$5,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270653100
Hospital Revenue Code	278
Min. Negotiated Rate	$136.89
Max. Negotiated Rate	$2,840.00
Rate for Payer: Aetna Commercial	$2,158.40
Rate for Payer: Aetna Medicare Advantage	$1,704.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,448.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,448.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,136.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,448.40
Rate for Payer: Cigna Commercial	$2,840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,374.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,249.60
Rate for Payer: Qualcare PPO/HMO/WC	$852.00
Rate for Payer: UnitedHealthcare Community & State	$136.89
Rate for Payer: Wellpoint Medicaid Managed Care	$150.52

PLATE OPEN WEDGE 4MM LEFT

Facility

$5,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270653100
Hospital Revenue Code	278
Min. Negotiated Rate	$852.00
Max. Negotiated Rate	$1,374.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,136.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,374.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,249.60
Rate for Payer: Qualcare PPO/HMO/WC	$852.00

PLATE OPEN WEDGE 5mm RIGHT

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270679885
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 OPEN WEDGE 5mm RIGHT

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270679885
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 ORBITALFL 0.3m SM 017106

Facility

$3,135.00

Hospital Charge Code	270642177
Hospital Revenue Code	278
Min. Negotiated Rate	$470.25
Max. Negotiated Rate	$758.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$627.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$758.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$689.70
Rate for Payer: Qualcare PPO/HMO/WC	$470.25

PLATE ORBITALFL 0.3m SM 017106

Facility

$3,135.00

Hospital Charge Code	270642177
Hospital Revenue Code	278
Min. Negotiated Rate	$75.55
Max. Negotiated Rate	$1,567.50
Rate for Payer: Aetna Commercial	$1,191.30
Rate for Payer: Aetna Medicare Advantage	$940.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$799.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$799.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$627.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$799.42
Rate for Payer: Cigna Commercial	$1,567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$758.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$689.70
Rate for Payer: Qualcare PPO/HMO/WC	$470.25
Rate for Payer: UnitedHealthcare Community & State	$75.55
Rate for Payer: Wellpoint Medicaid Managed Care	$83.08

PLATE ORTHO 6 CALC SLIDE

Facility

$7,490.00

Hospital Charge Code	270677101
Hospital Revenue Code	278
Min. Negotiated Rate	$180.51
Max. Negotiated Rate	$3,745.00
Rate for Payer: Aetna Commercial	$2,846.20
Rate for Payer: Aetna Medicare Advantage	$2,247.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,909.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,909.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,498.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,909.95
Rate for Payer: Cigna Commercial	$3,745.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,812.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,647.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,123.50
Rate for Payer: UnitedHealthcare Community & State	$180.51
Rate for Payer: Wellpoint Medicaid Managed Care	$198.49

PLATE ORTHO 6 CALC SLIDE

Facility

$7,490.00

Hospital Charge Code	270677101
Hospital Revenue Code	278
Min. Negotiated Rate	$1,123.50
Max. Negotiated Rate	$1,812.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,498.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,812.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,647.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,123.50

Know your out-of-pocket cost for care.

All Charges