Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE ORTHOLOC 3DI TIBIA SM

Facility

$7,435.00

Service Code	HCPCS C1713
Hospital Charge Code	270700813
Hospital Revenue Code	278
Min. Negotiated Rate	$179.18
Max. Negotiated Rate	$3,717.50
Rate for Payer: Aetna Commercial	$2,825.30
Rate for Payer: Aetna Medicare Advantage	$2,230.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,895.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,895.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,487.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,895.92
Rate for Payer: Cigna Commercial	$3,717.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,799.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,635.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,115.25
Rate for Payer: UnitedHealthcare Community & State	$179.18
Rate for Payer: Wellpoint Medicaid Managed Care	$197.03

PLATE ORTHOLOC 3DI TIBIA SM

Facility

$7,435.00

Service Code	HCPCS C1713
Hospital Charge Code	270700813
Hospital Revenue Code	278
Min. Negotiated Rate	$1,115.25
Max. Negotiated Rate	$1,799.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,487.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,799.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,635.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,115.25

PLATE ORTHOLOC LG LP HOOK 3DI

Facility

$13,575.00

Service Code	HCPCS C1713
Hospital Charge Code	270700519
Hospital Revenue Code	278
Min. Negotiated Rate	$327.16
Max. Negotiated Rate	$6,787.50
Rate for Payer: Aetna Commercial	$5,158.50
Rate for Payer: Aetna Medicare Advantage	$4,072.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,461.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,461.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,461.62
Rate for Payer: Cigna Commercial	$6,787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,285.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,986.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,036.25
Rate for Payer: UnitedHealthcare Community & State	$327.16
Rate for Payer: Wellpoint Medicaid Managed Care	$359.74

PLATE ORTHOLOC LG LP HOOK 3DI

Facility

$13,575.00

Service Code	HCPCS C1713
Hospital Charge Code	270700519
Hospital Revenue Code	278
Min. Negotiated Rate	$2,036.25
Max. Negotiated Rate	$3,285.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,285.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,986.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,036.25

PLATE PEG TIBIAL SZ 2 59702502

Facility

$5,987.00

Hospital Charge Code	270630186
Hospital Revenue Code	278
Min. Negotiated Rate	$144.29
Max. Negotiated Rate	$2,993.50
Rate for Payer: Aetna Commercial	$2,275.06
Rate for Payer: Aetna Medicare Advantage	$1,796.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,526.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,526.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,197.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,526.68
Rate for Payer: Cigna Commercial	$2,993.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,448.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,317.14
Rate for Payer: Qualcare PPO/HMO/WC	$898.05
Rate for Payer: UnitedHealthcare Community & State	$144.29
Rate for Payer: Wellpoint Medicaid Managed Care	$158.66

PLATE PEG TIBIAL SZ 2 59702502

Facility

$5,987.00

Hospital Charge Code	270630186
Hospital Revenue Code	278
Min. Negotiated Rate	$898.05
Max. Negotiated Rate	$1,448.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,197.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,448.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,317.14
Rate for Payer: Qualcare PPO/HMO/WC	$898.05

PLATE PERIARTICULAR 23470206

Facility

$2,911.60

Hospital Charge Code	270632307
Hospital Revenue Code	278
Min. Negotiated Rate	$436.74
Max. Negotiated Rate	$704.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$582.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$704.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$640.55
Rate for Payer: Qualcare PPO/HMO/WC	$436.74

PLATE PERIARTICULAR 23470206

Facility

$2,911.60

Hospital Charge Code	270632307
Hospital Revenue Code	278
Min. Negotiated Rate	$70.17
Max. Negotiated Rate	$1,455.80
Rate for Payer: Aetna Commercial	$1,106.41
Rate for Payer: Aetna Medicare Advantage	$873.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$742.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$742.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$582.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$742.46
Rate for Payer: Cigna Commercial	$1,455.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$704.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$640.55
Rate for Payer: Qualcare PPO/HMO/WC	$436.74
Rate for Payer: UnitedHealthcare Community & State	$70.17
Rate for Payer: Wellpoint Medicaid Managed Care	$77.16

PLATE PERIATCLAR 8HRT 23471708

Facility

$2,130.45

Hospital Charge Code	270632915
Hospital Revenue Code	278
Min. Negotiated Rate	$51.34
Max. Negotiated Rate	$1,065.22
Rate for Payer: Aetna Commercial	$809.57
Rate for Payer: Aetna Medicare Advantage	$639.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$543.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$543.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$426.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$543.26
Rate for Payer: Cigna Commercial	$1,065.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$515.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$468.70
Rate for Payer: Qualcare PPO/HMO/WC	$319.57
Rate for Payer: UnitedHealthcare Community & State	$51.34
Rate for Payer: Wellpoint Medicaid Managed Care	$56.46

PLATE PERIATCLAR 8HRT 23471708

Facility

$2,130.45

Hospital Charge Code	270632915
Hospital Revenue Code	278
Min. Negotiated Rate	$319.57
Max. Negotiated Rate	$515.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$426.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$515.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$468.70
Rate for Payer: Qualcare PPO/HMO/WC	$319.57

PLATE PHERES LEUKOREDUCE IRRAD

Facility

$7,142.26

Service Code	HCPCS P9037
Hospital Charge Code	3101515
Hospital Revenue Code	390
Min. Negotiated Rate	$172.13
Max. Negotiated Rate	$2,856.86
Rate for Payer: Aetna Commercial	$2,152.72
Rate for Payer: Aetna Medicare Advantage	$2,564.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,856.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,856.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$791.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,856.86
Rate for Payer: Cigna Commercial	$1,586.44
Rate for Payer: Cigna Medicare Advantage	$791.44
Rate for Payer: Clover Medicare Advantage	$751.87
Rate for Payer: EmblemHealth Commercial	$2,374.32
Rate for Payer: Humana Medicare Advantage	$815.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$791.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,142.68
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,071.34
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$172.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$791.44
Rate for Payer: Wellcare Medicare Advantage	$791.44
Rate for Payer: Wellpoint Medicaid Managed Care	$189.27

PLATE PHERES LEUKOREDUCE IRRAD

Facility

$7,142.26

Service Code	HCPCS P9037
Hospital Charge Code	3101515
Hospital Revenue Code	390
Min. Negotiated Rate	$1,071.34
Max. Negotiated Rate	$1,071.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,071.34

PLATE PIA 4H NO WEDGE 16MM

Facility

$5,200.00

Hospital Charge Code	270660761
Hospital Revenue Code	278
Min. Negotiated Rate	$125.32
Max. Negotiated Rate	$2,600.00
Rate for Payer: Aetna Commercial	$1,976.00
Rate for Payer: Aetna Medicare Advantage	$1,560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,326.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,326.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,326.00
Rate for Payer: Cigna Commercial	$2,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,144.00
Rate for Payer: Qualcare PPO/HMO/WC	$780.00
Rate for Payer: UnitedHealthcare Community & State	$125.32
Rate for Payer: Wellpoint Medicaid Managed Care	$137.80

PLATE PIA 4H NO WEDGE 16MM

Facility

$5,200.00

Hospital Charge Code	270660761
Hospital Revenue Code	278
Min. Negotiated Rate	$780.00
Max. Negotiated Rate	$1,258.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,040.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,144.00
Rate for Payer: Qualcare PPO/HMO/WC	$780.00

PLATE PLANTAR 2.7MM

Facility

$8,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270696039
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$2,171.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,974.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

PLATE PLANTAR 2.7MM

Facility

$8,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270696039
Hospital Revenue Code	278
Min. Negotiated Rate	$216.30
Max. Negotiated Rate	$4,487.50
Rate for Payer: Aetna Commercial	$3,410.50
Rate for Payer: Aetna Medicare Advantage	$2,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.62
Rate for Payer: Cigna Commercial	$4,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,974.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25
Rate for Payer: UnitedHealthcare Community & State	$216.30
Rate for Payer: Wellpoint Medicaid Managed Care	$237.84

PLATE PLANTAR GRAVITY PLANTAR

Facility

$7,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270701068
Hospital Revenue Code	278
Min. Negotiated Rate	$1,070.25
Max. Negotiated Rate	$1,726.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,427.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,726.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,569.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,070.25

PLATE PLANTAR GRAVITY PLANTAR

Facility

$7,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270701068
Hospital Revenue Code	278
Min. Negotiated Rate	$171.95
Max. Negotiated Rate	$3,567.50
Rate for Payer: Aetna Commercial	$2,711.30
Rate for Payer: Aetna Medicare Advantage	$2,140.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,819.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,819.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,427.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,819.42
Rate for Payer: Cigna Commercial	$3,567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,726.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,569.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,070.25
Rate for Payer: UnitedHealthcare Community & State	$171.95
Rate for Payer: Wellpoint Medicaid Managed Care	$189.08

PLATE PLANTAR LAPIDUS RIGHT

Facility

$7,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270676694
Hospital Revenue Code	278
Min. Negotiated Rate	$180.15
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,840.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,808.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,644.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25
Rate for Payer: UnitedHealthcare Community & State	$180.15
Rate for Payer: Wellpoint Medicaid Managed Care	$198.09

PLATE PLANTAR LAPIDUS RIGHT

Facility

$7,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270676694
Hospital Revenue Code	278
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$1,808.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,808.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,644.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

PLATE POR FLARED 8MMX34MM

Facility

$25,100.00

Service Code	HCPCS C1713
Hospital Charge Code	270692941
Hospital Revenue Code	278
Min. Negotiated Rate	$604.91
Max. Negotiated Rate	$12,550.00
Rate for Payer: Aetna Commercial	$9,538.00
Rate for Payer: Aetna Medicare Advantage	$7,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,400.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,400.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,400.50
Rate for Payer: Cigna Commercial	$12,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,074.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,522.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,765.00
Rate for Payer: UnitedHealthcare Community & State	$604.91
Rate for Payer: Wellpoint Medicaid Managed Care	$665.15

PLATE POR FLARED 8MMX34MM

Facility

$25,100.00

Service Code	HCPCS C1713
Hospital Charge Code	270692941
Hospital Revenue Code	278
Min. Negotiated Rate	$3,765.00
Max. Negotiated Rate	$6,074.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,020.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,074.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,522.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,765.00

PLATE POSTE.LATERAL 6HL

Facility

$2,321.25

Hospital Charge Code	270657056
Hospital Revenue Code	278
Min. Negotiated Rate	$55.94
Max. Negotiated Rate	$1,160.62
Rate for Payer: Aetna Commercial	$882.08
Rate for Payer: Aetna Medicare Advantage	$696.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$591.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$591.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$464.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$591.92
Rate for Payer: Cigna Commercial	$1,160.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$510.68
Rate for Payer: Qualcare PPO/HMO/WC	$348.19
Rate for Payer: UnitedHealthcare Community & State	$55.94
Rate for Payer: Wellpoint Medicaid Managed Care	$61.51

PLATE POSTE.LATERAL 6HL

Facility

$2,321.25

Hospital Charge Code	270657056
Hospital Revenue Code	278
Min. Negotiated Rate	$348.19
Max. Negotiated Rate	$561.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$464.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$510.68
Rate for Payer: Qualcare PPO/HMO/WC	$348.19

PLATE POW 3.0 MM LOCKING

Facility

$3,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270684783
Hospital Revenue Code	278
Min. Negotiated Rate	$92.78
Max. Negotiated Rate	$1,925.00
Rate for Payer: Aetna Commercial	$1,463.00
Rate for Payer: Aetna Medicare Advantage	$1,155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$981.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$981.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$981.75
Rate for Payer: Cigna Commercial	$1,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$931.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$577.50
Rate for Payer: UnitedHealthcare Community & State	$92.78
Rate for Payer: Wellpoint Medicaid Managed Care	$102.03

Know your out-of-pocket cost for care.

All Charges