Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE SPOON 6-H

Facility

$479.00

Hospital Charge Code	1602762
Hospital Revenue Code	274
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$239.50
Rate for Payer: Aetna Commercial	$182.02
Rate for Payer: Aetna Medicare Advantage	$143.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.14
Rate for Payer: Cigna Commercial	$239.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$105.38
Rate for Payer: Qualcare PPO/HMO/WC	$71.85
Rate for Payer: UnitedHealthcare Community & State	$11.54
Rate for Payer: Wellpoint Medicaid Managed Care	$12.69

PLATE SPOON 6-H

Facility

$479.00

Hospital Charge Code	1602762
Hospital Revenue Code	274
Min. Negotiated Rate	$71.85
Max. Negotiated Rate	$115.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$105.38
Rate for Payer: Qualcare PPO/HMO/WC	$71.85

PLATE STANDARD 4 HOLE RIGHT

Facility

$4,475.00

Hospital Charge Code	270664369
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 STANDARD 4 HOLE RIGHT

Facility

$4,475.00

Hospital Charge Code	270664369
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 STANDARD LARGE

Facility

$5,287.75

Service Code	HCPCS C1713
Hospital Charge Code	270693998
Hospital Revenue Code	278
Min. Negotiated Rate	$793.16
Max. Negotiated Rate	$1,279.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,057.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,279.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,163.31
Rate for Payer: Qualcare PPO/HMO/WC	$793.16

PLATE STANDARD LARGE

Facility

$5,287.75

Service Code	HCPCS C1713
Hospital Charge Code	270693998
Hospital Revenue Code	278
Min. Negotiated Rate	$127.43
Max. Negotiated Rate	$2,643.88
Rate for Payer: Aetna Commercial	$2,009.35
Rate for Payer: Aetna Medicare Advantage	$1,586.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,348.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,348.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,057.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,348.38
Rate for Payer: Cigna Commercial	$2,643.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,279.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,163.31
Rate for Payer: Qualcare PPO/HMO/WC	$793.16
Rate for Payer: UnitedHealthcare Community & State	$127.43
Rate for Payer: Wellpoint Medicaid Managed Care	$140.13

PLATE STANDARD RIGHT DVR

Facility

$5,550.00

Hospital Charge Code	270664021
Hospital Revenue Code	278
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$1,343.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,221.00
Rate for Payer: Qualcare PPO/HMO/WC	$832.50

PLATE STANDARD RIGHT DVR

Facility

$5,550.00

Hospital Charge Code	270664021
Hospital Revenue Code	278
Min. Negotiated Rate	$133.75
Max. Negotiated Rate	$2,775.00
Rate for Payer: Aetna Commercial	$2,109.00
Rate for Payer: Aetna Medicare Advantage	$1,665.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,415.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,415.25
Rate for Payer: Cigna Commercial	$2,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,343.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,221.00
Rate for Payer: Qualcare PPO/HMO/WC	$832.50
Rate for Payer: UnitedHealthcare Community & State	$133.75
Rate for Payer: Wellpoint Medicaid Managed Care	$147.07

PLATE START TIBIAL 2.5/ 3.5 MM

Facility

$16,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270687281
Hospital Revenue Code	278
Min. Negotiated Rate	$400.06
Max. Negotiated Rate	$8,300.00
Rate for Payer: Aetna Commercial	$6,308.00
Rate for Payer: Aetna Medicare Advantage	$4,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,233.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,233.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,233.00
Rate for Payer: Cigna Commercial	$8,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,017.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,652.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,490.00
Rate for Payer: UnitedHealthcare Community & State	$400.06
Rate for Payer: Wellpoint Medicaid Managed Care	$439.90

PLATE START TIBIAL 2.5/ 3.5 MM

Facility

$16,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270687281
Hospital Revenue Code	278
Min. Negotiated Rate	$2,490.00
Max. Negotiated Rate	$4,017.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,017.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,652.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,490.00

PLATE STR 1.6MM 10 HOLE

Facility

$4,094.25

Hospital Charge Code	270703048
Hospital Revenue Code	278
Min. Negotiated Rate	$98.67
Max. Negotiated Rate	$2,047.12
Rate for Payer: Aetna Commercial	$1,555.82
Rate for Payer: Aetna Medicare Advantage	$1,228.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,044.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,044.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$818.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,044.03
Rate for Payer: Cigna Commercial	$2,047.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$990.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$900.74
Rate for Payer: Qualcare PPO/HMO/WC	$614.14
Rate for Payer: UnitedHealthcare Community & State	$98.67
Rate for Payer: Wellpoint Medicaid Managed Care	$108.50

PLATE STR 1.6MM 10 HOLE

Facility

$4,094.25

Hospital Charge Code	270703048
Hospital Revenue Code	278
Min. Negotiated Rate	$614.14
Max. Negotiated Rate	$990.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$818.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$990.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$900.74
Rate for Payer: Qualcare PPO/HMO/WC	$614.14

PLATE STR 1.6 MM 6 HOLE

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270689947
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 STR 1.6 MM 6 HOLE

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270689947
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 STR 2.0 MM 6 HOLE REIN

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270689950
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 STR 2.0 MM 6 HOLE REIN

Facility

$3,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270689950
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 STR 2.0x17MM 3HOLE

Facility

$241.90

Service Code	HCPCS C1713
Hospital Charge Code	270651723
Hospital Revenue Code	278
Min. Negotiated Rate	$36.28
Max. Negotiated Rate	$58.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$53.22
Rate for Payer: Qualcare PPO/HMO/WC	$36.28

PLATE STR 2.0x17MM 3HOLE

Facility

$241.90

Service Code	HCPCS C1713
Hospital Charge Code	270651723
Hospital Revenue Code	278
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$120.95
Rate for Payer: Aetna Commercial	$91.92
Rate for Payer: Aetna Medicare Advantage	$72.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.68
Rate for Payer: Cigna Commercial	$120.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$53.22
Rate for Payer: Qualcare PPO/HMO/WC	$36.28
Rate for Payer: UnitedHealthcare Community & State	$5.83
Rate for Payer: Wellpoint Medicaid Managed Care	$6.41

PLATE STR 2.0x23MM 4HOLE

Facility

$258.00

Service Code	HCPCS C1713
Hospital Charge Code	270604328
Hospital Revenue Code	278
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$62.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$56.76
Rate for Payer: Qualcare PPO/HMO/WC	$38.70

PLATE STR 2.0x23MM 4HOLE

Facility

$258.00

Service Code	HCPCS C1713
Hospital Charge Code	270604328
Hospital Revenue Code	278
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$129.00
Rate for Payer: Aetna Commercial	$98.04
Rate for Payer: Aetna Medicare Advantage	$77.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.79
Rate for Payer: Cigna Commercial	$129.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$56.76
Rate for Payer: Qualcare PPO/HMO/WC	$38.70
Rate for Payer: UnitedHealthcare Community & State	$6.22
Rate for Payer: Wellpoint Medicaid Managed Care	$6.84

PLATE STR 2.0x29MM 5HOLE

Facility

$276.55

Service Code	HCPCS C1713
Hospital Charge Code	270651724
Hospital Revenue Code	278
Min. Negotiated Rate	$6.66
Max. Negotiated Rate	$138.28
Rate for Payer: Aetna Commercial	$105.09
Rate for Payer: Aetna Medicare Advantage	$82.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.52
Rate for Payer: Cigna Commercial	$138.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$60.84
Rate for Payer: Qualcare PPO/HMO/WC	$41.48
Rate for Payer: UnitedHealthcare Community & State	$6.66
Rate for Payer: Wellpoint Medicaid Managed Care	$7.33

PLATE STR 2.0x29MM 5HOLE

Facility

$276.55

Service Code	HCPCS C1713
Hospital Charge Code	270651724
Hospital Revenue Code	278
Min. Negotiated Rate	$41.48
Max. Negotiated Rate	$66.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$60.84
Rate for Payer: Qualcare PPO/HMO/WC	$41.48

PLATE STR 6 HOLE 2.0MM STERILE

Facility

$2,542.95

Service Code	HCPCS C1713
Hospital Charge Code	270686759
Hospital Revenue Code	278
Min. Negotiated Rate	$381.44
Max. Negotiated Rate	$615.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$508.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$615.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$559.45
Rate for Payer: Qualcare PPO/HMO/WC	$381.44

PLATE STR 6 HOLE 2.0MM STERILE

Facility

$2,542.95

Service Code	HCPCS C1713
Hospital Charge Code	270686759
Hospital Revenue Code	278
Min. Negotiated Rate	$61.29
Max. Negotiated Rate	$1,271.47
Rate for Payer: Aetna Commercial	$966.32
Rate for Payer: Aetna Medicare Advantage	$762.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$648.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$648.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$508.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$648.45
Rate for Payer: Cigna Commercial	$1,271.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$615.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$559.45
Rate for Payer: Qualcare PPO/HMO/WC	$381.44
Rate for Payer: UnitedHealthcare Community & State	$61.29
Rate for Payer: Wellpoint Medicaid Managed Care	$67.39

PLATE STRAIGHT 1.5MM 12HOLE

Facility

$1,053.70

Service Code	HCPCS C1713
Hospital Charge Code	270654814
Hospital Revenue Code	278
Min. Negotiated Rate	$158.06
Max. Negotiated Rate	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$231.81
Rate for Payer: Qualcare PPO/HMO/WC	$158.06

Know your out-of-pocket cost for care.

All Charges