Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE SLIM 34MM HP 34 MM

Facility

$15,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270694191
Hospital Revenue Code	278
Min. Negotiated Rate	$374.75
Max. Negotiated Rate	$7,775.00
Rate for Payer: Aetna Commercial	$5,909.00
Rate for Payer: Aetna Medicare Advantage	$4,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,965.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,965.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,965.25
Rate for Payer: Cigna Commercial	$7,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,763.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,421.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.50
Rate for Payer: UnitedHealthcare Community & State	$374.75
Rate for Payer: Wellpoint Medicaid Managed Care	$412.07

PLATE SLIM 3 LEVEL 49MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695651
Hospital Revenue Code	278
Min. Negotiated Rate	$463.93
Max. Negotiated Rate	$9,625.00
Rate for Payer: Aetna Commercial	$7,315.00
Rate for Payer: Aetna Medicare Advantage	$5,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,908.75
Rate for Payer: Cigna Commercial	$9,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50
Rate for Payer: UnitedHealthcare Community & State	$463.93
Rate for Payer: Wellpoint Medicaid Managed Care	$510.12

PLATE SLIM 3 LEVEL 49MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695651
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$4,658.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

PLATE SLIM 3 LEVEL 52MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695652
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$4,658.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

PLATE SLIM 3 LEVEL 52MM

Facility

$19,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695652
Hospital Revenue Code	278
Min. Negotiated Rate	$463.93
Max. Negotiated Rate	$9,625.00
Rate for Payer: Aetna Commercial	$7,315.00
Rate for Payer: Aetna Medicare Advantage	$5,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,908.75
Rate for Payer: Cigna Commercial	$9,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50
Rate for Payer: UnitedHealthcare Community & State	$463.93
Rate for Payer: Wellpoint Medicaid Managed Care	$510.12

PLATE SLIM MEDIAL 15H

Facility

$14,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270698469
Hospital Revenue Code	278
Min. Negotiated Rate	$347.04
Max. Negotiated Rate	$7,200.00
Rate for Payer: Aetna Commercial	$5,472.00
Rate for Payer: Aetna Medicare Advantage	$4,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,672.00
Rate for Payer: Cigna Commercial	$7,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,484.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,168.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,160.00
Rate for Payer: UnitedHealthcare Community & State	$347.04
Rate for Payer: Wellpoint Medicaid Managed Care	$381.60

PLATE SLIM MEDIAL 15H

Facility

$14,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270698469
Hospital Revenue Code	278
Min. Negotiated Rate	$2,160.00
Max. Negotiated Rate	$3,484.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,484.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,168.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,160.00

PLATE SMALL MEDAIL

Facility

$4,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270686751
Hospital Revenue Code	278
Min. Negotiated Rate	$105.08
Max. Negotiated Rate	$2,180.00
Rate for Payer: Aetna Commercial	$1,656.80
Rate for Payer: Aetna Medicare Advantage	$1,308.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,111.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,111.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,111.80
Rate for Payer: Cigna Commercial	$2,180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,055.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$959.20
Rate for Payer: Qualcare PPO/HMO/WC	$654.00
Rate for Payer: UnitedHealthcare Community & State	$105.08
Rate for Payer: Wellpoint Medicaid Managed Care	$115.54

PLATE SMALL MEDAIL

Facility

$4,360.00

Service Code	HCPCS C1713
Hospital Charge Code	270686751
Hospital Revenue Code	278
Min. Negotiated Rate	$654.00
Max. Negotiated Rate	$1,055.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$872.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,055.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$959.20
Rate for Payer: Qualcare PPO/HMO/WC	$654.00

PLATE SMALL RT 3.5X4.5

Facility

$12,751.20

Service Code	HCPCS C1713
Hospital Charge Code	270693767
Hospital Revenue Code	278
Min. Negotiated Rate	$307.30
Max. Negotiated Rate	$6,375.60
Rate for Payer: Aetna Commercial	$4,845.46
Rate for Payer: Aetna Medicare Advantage	$3,825.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,251.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,251.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,550.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,251.56
Rate for Payer: Cigna Commercial	$6,375.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,085.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,805.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.68
Rate for Payer: UnitedHealthcare Community & State	$307.30
Rate for Payer: Wellpoint Medicaid Managed Care	$337.91

PLATE SMALL RT 3.5X4.5

Facility

$12,751.20

Service Code	HCPCS C1713
Hospital Charge Code	270693767
Hospital Revenue Code	278
Min. Negotiated Rate	$1,912.68
Max. Negotiated Rate	$3,085.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,550.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,085.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,805.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.68

PLATE SM T 3 HOLE

Facility

$190.00

Hospital Charge Code	1602697
Hospital Revenue Code	274
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$45.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$41.80
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

PLATE SM T 3 HOLE

Facility

$190.00

Hospital Charge Code	1602697
Hospital Revenue Code	274
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$95.00
Rate for Payer: Aetna Commercial	$72.20
Rate for Payer: Aetna Medicare Advantage	$57.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.45
Rate for Payer: Cigna Commercial	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$41.80
Rate for Payer: Qualcare PPO/HMO/WC	$28.50
Rate for Payer: UnitedHealthcare Community & State	$4.58
Rate for Payer: Wellpoint Medicaid Managed Care	$5.04

PLATE SM T 4 HOLE

Facility

$201.00

Hospital Charge Code	1602705
Hospital Revenue Code	274
Min. Negotiated Rate	$30.15
Max. Negotiated Rate	$48.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$44.22
Rate for Payer: Qualcare PPO/HMO/WC	$30.15

PLATE SM T 4 HOLE

Facility

$201.00

Hospital Charge Code	1602705
Hospital Revenue Code	274
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$100.50
Rate for Payer: Aetna Commercial	$76.38
Rate for Payer: Aetna Medicare Advantage	$60.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.26
Rate for Payer: Cigna Commercial	$100.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$44.22
Rate for Payer: Qualcare PPO/HMO/WC	$30.15
Rate for Payer: UnitedHealthcare Community & State	$4.84
Rate for Payer: Wellpoint Medicaid Managed Care	$5.33

PLATE SM T 5 HOLE

Facility

$223.00

Hospital Charge Code	1602713
Hospital Revenue Code	274
Min. Negotiated Rate	$33.45
Max. Negotiated Rate	$53.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.06
Rate for Payer: Qualcare PPO/HMO/WC	$33.45

PLATE SM T 5 HOLE

Facility

$223.00

Hospital Charge Code	1602713
Hospital Revenue Code	274
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$111.50
Rate for Payer: Aetna Commercial	$84.74
Rate for Payer: Aetna Medicare Advantage	$66.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.87
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.06
Rate for Payer: Qualcare PPO/HMO/WC	$33.45
Rate for Payer: UnitedHealthcare Community & State	$5.37
Rate for Payer: Wellpoint Medicaid Managed Care	$5.91

PLATE SPINAL ACP 1LEV 12MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694440
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

PLATE SPINAL ACP 1LEV 12MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694440
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

PLATE SPINAL ACP 1 LEVELX11MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694441
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

PLATE SPINAL ACP 1 LEVELX11MM

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694441
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

PLATE SPINAL FIXAT 2LEVEL 34MM

Facility

$17,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270694320
Hospital Revenue Code	278
Min. Negotiated Rate	$415.73
Max. Negotiated Rate	$8,625.00
Rate for Payer: Aetna Commercial	$6,555.00
Rate for Payer: Aetna Medicare Advantage	$5,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,398.75
Rate for Payer: Cigna Commercial	$8,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50
Rate for Payer: UnitedHealthcare Community & State	$415.73
Rate for Payer: Wellpoint Medicaid Managed Care	$457.12

PLATE SPINAL FIXAT 2LEVEL 34MM

Facility

$17,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270694320
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.50
Max. Negotiated Rate	$4,174.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50

PLATE SPOON 5-HOLE

Facility

$446.00

Hospital Charge Code	1602754
Hospital Revenue Code	274
Min. Negotiated Rate	$10.75
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$169.48
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$98.12
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Community & State	$10.75
Rate for Payer: Wellpoint Medicaid Managed Care	$11.82

PLATE SPOON 5-HOLE

Facility

$446.00

Hospital Charge Code	1602754
Hospital Revenue Code	274
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$107.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$98.12
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

Know your out-of-pocket cost for care.

All Charges