Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE QTR TUBULAR 5HOLE 39MM

Facility

$377.00

Service Code	HCPCS C1713
Hospital Charge Code	270651854
Hospital Revenue Code	278
Min. Negotiated Rate	$9.09
Max. Negotiated Rate	$188.50
Rate for Payer: Aetna Commercial	$143.26
Rate for Payer: Aetna Medicare Advantage	$113.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.14
Rate for Payer: Cigna Commercial	$188.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.94
Rate for Payer: Qualcare PPO/HMO/WC	$56.55
Rate for Payer: UnitedHealthcare Community & State	$9.09
Rate for Payer: Wellpoint Medicaid Managed Care	$9.99

PLATE QTR TUBULAR 5HOLE 39MM

Facility

$377.00

Service Code	HCPCS C1713
Hospital Charge Code	270651854
Hospital Revenue Code	278
Min. Negotiated Rate	$56.55
Max. Negotiated Rate	$91.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.94
Rate for Payer: Qualcare PPO/HMO/WC	$56.55

PLATE QTR TUBULAR 6HOLE 47MM

Facility

$407.90

Service Code	HCPCS C1713
Hospital Charge Code	270604319
Hospital Revenue Code	278
Min. Negotiated Rate	$9.83
Max. Negotiated Rate	$203.95
Rate for Payer: Aetna Commercial	$155.00
Rate for Payer: Aetna Medicare Advantage	$122.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.01
Rate for Payer: Cigna Commercial	$203.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$89.74
Rate for Payer: Qualcare PPO/HMO/WC	$61.19
Rate for Payer: UnitedHealthcare Community & State	$9.83
Rate for Payer: Wellpoint Medicaid Managed Care	$10.81

PLATE QTR TUBULAR 6HOLE 47MM

Facility

$407.90

Service Code	HCPCS C1713
Hospital Charge Code	270604319
Hospital Revenue Code	278
Min. Negotiated Rate	$61.19
Max. Negotiated Rate	$98.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$89.74
Rate for Payer: Qualcare PPO/HMO/WC	$61.19

PLATE QTR TUBULAR 7HOLE 55MM

Facility

$435.70

Service Code	HCPCS C1713
Hospital Charge Code	270604320
Hospital Revenue Code	278
Min. Negotiated Rate	$65.36
Max. Negotiated Rate	$105.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$95.85
Rate for Payer: Qualcare PPO/HMO/WC	$65.36

PLATE QTR TUBULAR 7HOLE 55MM

Facility

$435.70

Service Code	HCPCS C1713
Hospital Charge Code	270604320
Hospital Revenue Code	278
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$217.85
Rate for Payer: Aetna Commercial	$165.57
Rate for Payer: Aetna Medicare Advantage	$130.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.10
Rate for Payer: Cigna Commercial	$217.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$95.85
Rate for Payer: Qualcare PPO/HMO/WC	$65.36
Rate for Payer: UnitedHealthcare Community & State	$10.50
Rate for Payer: Wellpoint Medicaid Managed Care	$11.55

PLATE QTR TUBULAR 8HOLE 63MM

Facility

$448.05

Service Code	HCPCS C1713
Hospital Charge Code	270651855
Hospital Revenue Code	278
Min. Negotiated Rate	$67.21
Max. Negotiated Rate	$108.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$98.57
Rate for Payer: Qualcare PPO/HMO/WC	$67.21

PLATE QTR TUBULAR 8HOLE 63MM

Facility

$448.05

Service Code	HCPCS C1713
Hospital Charge Code	270651855
Hospital Revenue Code	278
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$224.03
Rate for Payer: Aetna Commercial	$170.26
Rate for Payer: Aetna Medicare Advantage	$134.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.25
Rate for Payer: Cigna Commercial	$224.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$98.57
Rate for Payer: Qualcare PPO/HMO/WC	$67.21
Rate for Payer: UnitedHealthcare Community & State	$10.80
Rate for Payer: Wellpoint Medicaid Managed Care	$11.87

PLATE QUARTER-TUBULAR 3 HOLE

Facility

$333.00

Hospital Charge Code	270656726
Hospital Revenue Code	278
Min. Negotiated Rate	$49.95
Max. Negotiated Rate	$80.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$73.26
Rate for Payer: Qualcare PPO/HMO/WC	$49.95

PLATE QUARTER-TUBULAR 3 HOLE

Facility

$333.00

Hospital Charge Code	270656726
Hospital Revenue Code	278
Min. Negotiated Rate	$8.03
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna Commercial	$126.54
Rate for Payer: Aetna Medicare Advantage	$99.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.92
Rate for Payer: Cigna Commercial	$166.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$73.26
Rate for Payer: Qualcare PPO/HMO/WC	$49.95
Rate for Payer: UnitedHealthcare Community & State	$8.03
Rate for Payer: Wellpoint Medicaid Managed Care	$8.82

PLATE QUARTER-TUBULAR 7 HOLE

Facility

$621.00

Hospital Charge Code	270656317
Hospital Revenue Code	278
Min. Negotiated Rate	$93.15
Max. Negotiated Rate	$150.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$136.62
Rate for Payer: Qualcare PPO/HMO/WC	$93.15

PLATE QUARTER-TUBULAR 7 HOLE

Facility

$621.00

Hospital Charge Code	270656317
Hospital Revenue Code	278
Min. Negotiated Rate	$14.97
Max. Negotiated Rate	$310.50
Rate for Payer: Aetna Commercial	$235.98
Rate for Payer: Aetna Medicare Advantage	$186.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.35
Rate for Payer: Cigna Commercial	$310.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$136.62
Rate for Payer: Qualcare PPO/HMO/WC	$93.15
Rate for Payer: UnitedHealthcare Community & State	$14.97
Rate for Payer: Wellpoint Medicaid Managed Care	$16.46

PLATE QUARTER-TUBULAR 8 HOLE

Facility

$453.00

Hospital Charge Code	270657224
Hospital Revenue Code	278
Min. Negotiated Rate	$67.95
Max. Negotiated Rate	$109.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.66
Rate for Payer: Qualcare PPO/HMO/WC	$67.95

PLATE QUARTER-TUBULAR 8 HOLE

Facility

$453.00

Hospital Charge Code	270657224
Hospital Revenue Code	278
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$226.50
Rate for Payer: Aetna Commercial	$172.14
Rate for Payer: Aetna Medicare Advantage	$135.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.52
Rate for Payer: Cigna Commercial	$226.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.66
Rate for Payer: Qualcare PPO/HMO/WC	$67.95
Rate for Payer: UnitedHealthcare Community & State	$10.92
Rate for Payer: Wellpoint Medicaid Managed Care	$12.00

PLATE RADIUS LCP

Facility

$5,115.00

Service Code	HCPCS C1713
Hospital Charge Code	270687279
Hospital Revenue Code	278
Min. Negotiated Rate	$123.27
Max. Negotiated Rate	$2,557.50
Rate for Payer: Aetna Commercial	$1,943.70
Rate for Payer: Aetna Medicare Advantage	$1,534.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,304.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,304.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,023.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,304.33
Rate for Payer: Cigna Commercial	$2,557.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,237.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,125.30
Rate for Payer: Qualcare PPO/HMO/WC	$767.25
Rate for Payer: UnitedHealthcare Community & State	$123.27
Rate for Payer: Wellpoint Medicaid Managed Care	$135.55

PLATE RADIUS LCP

Facility

$5,115.00

Service Code	HCPCS C1713
Hospital Charge Code	270687279
Hospital Revenue Code	278
Min. Negotiated Rate	$767.25
Max. Negotiated Rate	$1,237.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,023.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,237.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,125.30
Rate for Payer: Qualcare PPO/HMO/WC	$767.25

PLATE RECESSES 14MM 8DEG

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705409
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

PLATE RECESSES 14MM 8DEG

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705409
Hospital Revenue Code	278
Min. Negotiated Rate	$289.20
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

PLATE RECON 2.7MM 10H

Facility

$1,044.00

Hospital Charge Code	270604344
Hospital Revenue Code	278
Min. Negotiated Rate	$25.16
Max. Negotiated Rate	$522.00
Rate for Payer: Aetna Commercial	$396.72
Rate for Payer: Aetna Medicare Advantage	$313.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$208.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.22
Rate for Payer: Cigna Commercial	$522.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$229.68
Rate for Payer: Qualcare PPO/HMO/WC	$156.60
Rate for Payer: UnitedHealthcare Community & State	$25.16
Rate for Payer: Wellpoint Medicaid Managed Care	$27.67

PLATE RECON 2.7MM 10H

Facility

$1,044.00

Hospital Charge Code	270604344
Hospital Revenue Code	278
Min. Negotiated Rate	$156.60
Max. Negotiated Rate	$252.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$208.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$229.68
Rate for Payer: Qualcare PPO/HMO/WC	$156.60

PLATE RECON 2.7MM 12H

Facility

$1,234.45

Hospital Charge Code	270604345
Hospital Revenue Code	278
Min. Negotiated Rate	$185.17
Max. Negotiated Rate	$298.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$246.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$271.58
Rate for Payer: Qualcare PPO/HMO/WC	$185.17

PLATE RECON 2.7MM 12H

Facility

$1,234.45

Hospital Charge Code	270604345
Hospital Revenue Code	278
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$617.23
Rate for Payer: Aetna Commercial	$469.09
Rate for Payer: Aetna Medicare Advantage	$370.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$314.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$314.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$246.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$314.78
Rate for Payer: Cigna Commercial	$617.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$298.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$271.58
Rate for Payer: Qualcare PPO/HMO/WC	$185.17
Rate for Payer: UnitedHealthcare Community & State	$29.75
Rate for Payer: Wellpoint Medicaid Managed Care	$32.71

PLATE RECON 2.7MM 14H

Facility

$1,342.45

Hospital Charge Code	270604346
Hospital Revenue Code	278
Min. Negotiated Rate	$32.35
Max. Negotiated Rate	$671.23
Rate for Payer: Aetna Commercial	$510.13
Rate for Payer: Aetna Medicare Advantage	$402.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$268.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.32
Rate for Payer: Cigna Commercial	$671.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$295.34
Rate for Payer: Qualcare PPO/HMO/WC	$201.37
Rate for Payer: UnitedHealthcare Community & State	$32.35
Rate for Payer: Wellpoint Medicaid Managed Care	$35.57

PLATE RECON 2.7MM 14H

Facility

$1,342.45

Hospital Charge Code	270604346
Hospital Revenue Code	278
Min. Negotiated Rate	$201.37
Max. Negotiated Rate	$324.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$268.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$295.34
Rate for Payer: Qualcare PPO/HMO/WC	$201.37

PLATE RECON 2.7MM 16H

Facility

$1,456.00

Hospital Charge Code	270604347
Hospital Revenue Code	278
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$728.00
Rate for Payer: Aetna Commercial	$553.28
Rate for Payer: Aetna Medicare Advantage	$436.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$371.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$371.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$291.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$371.28
Rate for Payer: Cigna Commercial	$728.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$352.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$320.32
Rate for Payer: Qualcare PPO/HMO/WC	$218.40
Rate for Payer: UnitedHealthcare Community & State	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$38.58

Know your out-of-pocket cost for care.

All Charges