Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE THIRD TUBULAR LCK SS 12H

Facility

$1,500.00

Hospital Charge Code	270671906
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

PLATE THIRD TUBULAR LKG TI 8H

Facility

$1,436.50

Service Code	HCPCS C1713
Hospital Charge Code	270699386
Hospital Revenue Code	278
Min. Negotiated Rate	$215.47
Max. Negotiated Rate	$347.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$287.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$316.03
Rate for Payer: Qualcare PPO/HMO/WC	$215.47

PLATE THIRD TUBULAR LKG TI 8H

Facility

$1,436.50

Service Code	HCPCS C1713
Hospital Charge Code	270699386
Hospital Revenue Code	278
Min. Negotiated Rate	$34.62
Max. Negotiated Rate	$718.25
Rate for Payer: Aetna Commercial	$545.87
Rate for Payer: Aetna Medicare Advantage	$430.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$366.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$366.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$287.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$366.31
Rate for Payer: Cigna Commercial	$718.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$316.03
Rate for Payer: Qualcare PPO/HMO/WC	$215.47
Rate for Payer: UnitedHealthcare Community & State	$34.62
Rate for Payer: Wellpoint Medicaid Managed Care	$38.07

PLATE THIRD TUBULAR LOCK SS 4H

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270671903
Hospital Revenue Code	278
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

PLATE THIRD TUBULAR LOCK SS 4H

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270671903
Hospital Revenue Code	278
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

PLATE THIRD TUBULAR LOCK SS 5H

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270671904
Hospital Revenue Code	278
Min. Negotiated Rate	$28.32
Max. Negotiated Rate	$587.50
Rate for Payer: Aetna Commercial	$446.50
Rate for Payer: Aetna Medicare Advantage	$352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.62
Rate for Payer: Cigna Commercial	$587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.25
Rate for Payer: UnitedHealthcare Community & State	$28.32
Rate for Payer: Wellpoint Medicaid Managed Care	$31.14

PLATE THIRD TUBULAR LOCK SS 5H

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270671904
Hospital Revenue Code	278
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$284.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

PLATE THIRD TUBULAR LOCK SS 6H

Facility

$1,200.00

Hospital Charge Code	270671905
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

PLATE THIRD TUBULAR LOCK SS 6H

Facility

$1,200.00

Hospital Charge Code	270671905
Hospital Revenue Code	278
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$264.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.00
Rate for Payer: UnitedHealthcare Community & State	$28.92
Rate for Payer: Wellpoint Medicaid Managed Care	$31.80

PLATE THIRD TUBULAR LOCK SS 7H

Facility

$1,275.00

Hospital Charge Code	270667560
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$280.50
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

PLATE THIRD TUBULAR LOCK SS 7H

Facility

$1,275.00

Hospital Charge Code	270667560
Hospital Revenue Code	278
Min. Negotiated Rate	$30.73
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$484.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$280.50
Rate for Payer: Qualcare PPO/HMO/WC	$191.25
Rate for Payer: UnitedHealthcare Community & State	$30.73
Rate for Payer: Wellpoint Medicaid Managed Care	$33.79

PLATE THIRD TUBULAR LOCK SS 8H

Facility

$1,325.00

Hospital Charge Code	270665076
Hospital Revenue Code	278
Min. Negotiated Rate	$31.93
Max. Negotiated Rate	$662.50
Rate for Payer: Aetna Commercial	$503.50
Rate for Payer: Aetna Medicare Advantage	$397.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.88
Rate for Payer: Cigna Commercial	$662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.50
Rate for Payer: Qualcare PPO/HMO/WC	$198.75
Rate for Payer: UnitedHealthcare Community & State	$31.93
Rate for Payer: Wellpoint Medicaid Managed Care	$35.11

PLATE THIRD TUBULAR LOCK SS 8H

Facility

$1,325.00

Hospital Charge Code	270665076
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$320.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.50
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

PLATETIB3.5MMVA-LCP4H87MMRT

Facility

$8,831.20

Service Code	HCPCS C1713
Hospital Charge Code	270697561
Hospital Revenue Code	278
Min. Negotiated Rate	$212.83
Max. Negotiated Rate	$4,415.60
Rate for Payer: Aetna Commercial	$3,355.86
Rate for Payer: Aetna Medicare Advantage	$2,649.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,251.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,251.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,766.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,251.96
Rate for Payer: Cigna Commercial	$4,415.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,137.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,942.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,324.68
Rate for Payer: UnitedHealthcare Community & State	$212.83
Rate for Payer: Wellpoint Medicaid Managed Care	$234.03

PLATETIB3.5MMVA-LCP4H87MMRT

Facility

$8,831.20

Service Code	HCPCS C1713
Hospital Charge Code	270697561
Hospital Revenue Code	278
Min. Negotiated Rate	$1,324.68
Max. Negotiated Rate	$2,137.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,766.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,137.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,942.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,324.68

PLATE TIB 6-HOLE/118m LT240039

Facility

$5,485.85

Hospital Charge Code	270635680
Hospital Revenue Code	278
Min. Negotiated Rate	$822.88
Max. Negotiated Rate	$1,327.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,097.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,327.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,206.89
Rate for Payer: Qualcare PPO/HMO/WC	$822.88

PLATE TIB 6-HOLE/118m LT240039

Facility

$5,485.85

Hospital Charge Code	270635680
Hospital Revenue Code	278
Min. Negotiated Rate	$132.21
Max. Negotiated Rate	$2,742.93
Rate for Payer: Aetna Commercial	$2,084.62
Rate for Payer: Aetna Medicare Advantage	$1,645.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,398.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,398.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,097.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,398.89
Rate for Payer: Cigna Commercial	$2,742.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,327.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,206.89
Rate for Payer: Qualcare PPO/HMO/WC	$822.88
Rate for Payer: UnitedHealthcare Community & State	$132.21
Rate for Payer: Wellpoint Medicaid Managed Care	$145.38

PLATE TIBAL 5HLE 115 RGT 27155

Facility

$6,232.00

Hospital Charge Code	270643353
Hospital Revenue Code	278
Min. Negotiated Rate	$934.80
Max. Negotiated Rate	$1,508.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,246.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,508.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,371.04
Rate for Payer: Qualcare PPO/HMO/WC	$934.80

PLATE TIBAL 5HLE 115 RGT 27155

Facility

$6,232.00

Hospital Charge Code	270643353
Hospital Revenue Code	278
Min. Negotiated Rate	$150.19
Max. Negotiated Rate	$3,116.00
Rate for Payer: Aetna Commercial	$2,368.16
Rate for Payer: Aetna Medicare Advantage	$1,869.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,589.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,589.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,246.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,589.16
Rate for Payer: Cigna Commercial	$3,116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,508.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,371.04
Rate for Payer: Qualcare PPO/HMO/WC	$934.80
Rate for Payer: UnitedHealthcare Community & State	$150.19
Rate for Payer: Wellpoint Medicaid Managed Care	$165.15

PLATE TIBAL 5HLE 115 RGT 27580

Facility

$1,155.00

Hospital Charge Code	270643354
Hospital Revenue Code	278
Min. Negotiated Rate	$27.84
Max. Negotiated Rate	$577.50
Rate for Payer: Aetna Commercial	$438.90
Rate for Payer: Aetna Medicare Advantage	$346.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$294.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$294.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$231.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$294.52
Rate for Payer: Cigna Commercial	$577.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$173.25
Rate for Payer: UnitedHealthcare Community & State	$27.84
Rate for Payer: Wellpoint Medicaid Managed Care	$30.61

PLATE TIBAL 5HLE 115 RGT 27580

Facility

$1,155.00

Hospital Charge Code	270643354
Hospital Revenue Code	278
Min. Negotiated Rate	$173.25
Max. Negotiated Rate	$279.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$231.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$173.25

PLATE TIB CRUCIATE 83M 141236

Facility

$7,565.00

Hospital Charge Code	270640764
Hospital Revenue Code	278
Min. Negotiated Rate	$1,134.75
Max. Negotiated Rate	$1,830.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,513.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,830.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,664.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,134.75

PLATE TIB CRUCIATE 83M 141236

Facility

$7,565.00

Hospital Charge Code	270640764
Hospital Revenue Code	278
Min. Negotiated Rate	$182.32
Max. Negotiated Rate	$3,782.50
Rate for Payer: Aetna Commercial	$2,874.70
Rate for Payer: Aetna Medicare Advantage	$2,269.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,929.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,929.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,513.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,929.08
Rate for Payer: Cigna Commercial	$3,782.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,830.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,664.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,134.75
Rate for Payer: UnitedHealthcare Community & State	$182.32
Rate for Payer: Wellpoint Medicaid Managed Care	$200.47

PLATE TIBI 12H LT MED 23470812

Facility

$3,129.85

Hospital Charge Code	270632095
Hospital Revenue Code	278
Min. Negotiated Rate	$75.43
Max. Negotiated Rate	$1,564.92
Rate for Payer: Aetna Commercial	$1,189.34
Rate for Payer: Aetna Medicare Advantage	$938.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$798.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$798.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$798.11
Rate for Payer: Cigna Commercial	$1,564.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$757.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$688.57
Rate for Payer: Qualcare PPO/HMO/WC	$469.48
Rate for Payer: UnitedHealthcare Community & State	$75.43
Rate for Payer: Wellpoint Medicaid Managed Care	$82.94

PLATE TIBI 12H LT MED 23470812

Facility

$3,129.85

Hospital Charge Code	270632095
Hospital Revenue Code	278
Min. Negotiated Rate	$469.48
Max. Negotiated Rate	$757.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$757.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$688.57
Rate for Payer: Qualcare PPO/HMO/WC	$469.48

Know your out-of-pocket cost for care.

All Charges