Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE SEMI TUBULAR 3-HOLE***

Facility

$98.00

Hospital Charge Code	1602424
Hospital Revenue Code	274
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$21.56
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Community & State	$2.36
Rate for Payer: Wellpoint Medicaid Managed Care	$2.60

PLATE SEMI TUBULAR 4-HOLE***

Facility

$103.00

Hospital Charge Code	1602432
Hospital Revenue Code	274
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$51.50
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$22.66
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Community & State	$2.48
Rate for Payer: Wellpoint Medicaid Managed Care	$2.73

PLATE SEMI TUBULAR 4-HOLE***

Facility

$103.00

Hospital Charge Code	1602432
Hospital Revenue Code	274
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$24.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$22.66
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

PLATE SEMI TUBULAR 5-HOLE***

Facility

$109.00

Hospital Charge Code	1602440
Hospital Revenue Code	274
Min. Negotiated Rate	$16.35
Max. Negotiated Rate	$26.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$23.98
Rate for Payer: Qualcare PPO/HMO/WC	$16.35

PLATE SEMI TUBULAR 5-HOLE***

Facility

$109.00

Hospital Charge Code	1602440
Hospital Revenue Code	274
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$54.50
Rate for Payer: Aetna Commercial	$41.42
Rate for Payer: Aetna Medicare Advantage	$32.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.80
Rate for Payer: Cigna Commercial	$54.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$23.98
Rate for Payer: Qualcare PPO/HMO/WC	$16.35
Rate for Payer: UnitedHealthcare Community & State	$2.63
Rate for Payer: Wellpoint Medicaid Managed Care	$2.89

PLATE SEMI TUBULAR 6-HOLE***

Facility

$117.00

Hospital Charge Code	1602457
Hospital Revenue Code	274
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna Commercial	$44.46
Rate for Payer: Aetna Medicare Advantage	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.84
Rate for Payer: Cigna Commercial	$58.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$25.74
Rate for Payer: Qualcare PPO/HMO/WC	$17.55
Rate for Payer: UnitedHealthcare Community & State	$2.82
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

PLATE SEMI TUBULAR 6-HOLE***

Facility

$117.00

Hospital Charge Code	1602457
Hospital Revenue Code	274
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$28.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$25.74
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

PLATE SEMI TUBULAR 7-HOLE***

Facility

$123.00

Hospital Charge Code	1602465
Hospital Revenue Code	274
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$61.50
Rate for Payer: Aetna Commercial	$46.74
Rate for Payer: Aetna Medicare Advantage	$36.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.36
Rate for Payer: Cigna Commercial	$61.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$27.06
Rate for Payer: Qualcare PPO/HMO/WC	$18.45
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: Wellpoint Medicaid Managed Care	$3.26

PLATE SEMI TUBULAR 7-HOLE***

Facility

$123.00

Hospital Charge Code	1602465
Hospital Revenue Code	274
Min. Negotiated Rate	$18.45
Max. Negotiated Rate	$29.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$27.06
Rate for Payer: Qualcare PPO/HMO/WC	$18.45

PLATE SEMI TUBULAR 8-HOLE***

Facility

$136.00

Hospital Charge Code	1602473
Hospital Revenue Code	274
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$68.00
Rate for Payer: Aetna Commercial	$51.68
Rate for Payer: Aetna Medicare Advantage	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.68
Rate for Payer: Cigna Commercial	$68.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$29.92
Rate for Payer: Qualcare PPO/HMO/WC	$20.40
Rate for Payer: UnitedHealthcare Community & State	$3.28
Rate for Payer: Wellpoint Medicaid Managed Care	$3.60

PLATE SEMI TUBULAR 8-HOLE***

Facility

$136.00

Hospital Charge Code	1602473
Hospital Revenue Code	274
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$32.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$29.92
Rate for Payer: Qualcare PPO/HMO/WC	$20.40

PLATE SEMI TUBULAR 9-HOLE***

Facility

$145.00

Hospital Charge Code	1602481
Hospital Revenue Code	274
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$72.50
Rate for Payer: Aetna Commercial	$55.10
Rate for Payer: Aetna Medicare Advantage	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.98
Rate for Payer: Cigna Commercial	$72.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$31.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.75
Rate for Payer: UnitedHealthcare Community & State	$3.49
Rate for Payer: Wellpoint Medicaid Managed Care	$3.84

PLATE SEMI TUBULAR 9-HOLE***

Facility

$145.00

Hospital Charge Code	1602481
Hospital Revenue Code	274
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$31.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

PLATE SHOULDER 4HOLE LT SSP-L4

Facility

$5,704.00

Hospital Charge Code	270635023
Hospital Revenue Code	278
Min. Negotiated Rate	$855.60
Max. Negotiated Rate	$1,380.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,140.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,380.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,254.88
Rate for Payer: Qualcare PPO/HMO/WC	$855.60

PLATE SHOULDER 4HOLE LT SSP-L4

Facility

$5,704.00

Hospital Charge Code	270635023
Hospital Revenue Code	278
Min. Negotiated Rate	$137.47
Max. Negotiated Rate	$2,852.00
Rate for Payer: Aetna Commercial	$2,167.52
Rate for Payer: Aetna Medicare Advantage	$1,711.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,454.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,454.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,140.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,454.52
Rate for Payer: Cigna Commercial	$2,852.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,380.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,254.88
Rate for Payer: Qualcare PPO/HMO/WC	$855.60
Rate for Payer: UnitedHealthcare Community & State	$137.47
Rate for Payer: Wellpoint Medicaid Managed Care	$151.16

PLATE SHOULDER 4HOLE RT SSPR4

Facility

$5,704.00

Hospital Charge Code	270634956
Hospital Revenue Code	278
Min. Negotiated Rate	$137.47
Max. Negotiated Rate	$2,852.00
Rate for Payer: Aetna Commercial	$2,167.52
Rate for Payer: Aetna Medicare Advantage	$1,711.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,454.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,454.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,140.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,454.52
Rate for Payer: Cigna Commercial	$2,852.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,380.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,254.88
Rate for Payer: Qualcare PPO/HMO/WC	$855.60
Rate for Payer: UnitedHealthcare Community & State	$137.47
Rate for Payer: Wellpoint Medicaid Managed Care	$151.16

PLATE SHOULDER 4HOLE RT SSPR4

Facility

$5,704.00

Hospital Charge Code	270634956
Hospital Revenue Code	278
Min. Negotiated Rate	$855.60
Max. Negotiated Rate	$1,380.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,140.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,380.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,254.88
Rate for Payer: Qualcare PPO/HMO/WC	$855.60

PLATE SKY 2 LEVEL TI 18MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270676512
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

PLATE SKY 2 LEVEL TI 18MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270676512
Hospital Revenue Code	278
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

PLATE SKY 2 LEVEL TI 20MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270676511
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

PLATE SKY 2 LEVEL TI 20MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270676511
Hospital Revenue Code	278
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

PLATE SKY 2 LEVEL TI 30MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270679877
Hospital Revenue Code	278
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

PLATE SKY 2 LEVEL TI 30MM

Facility

$6,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270679877
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

PLATE SKY 2 LEVEL TI 38MM

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270674901
Hospital Revenue Code	278
Min. Negotiated Rate	$162.68
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$162.68
Rate for Payer: Wellpoint Medicaid Managed Care	$178.88

PLATE SKY 2 LEVEL TI 38MM

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270674901
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

Know your out-of-pocket cost for care.

All Charges