Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE TIBIA VA LCP 3.5 X147 MM

Facility

$93.35

Service Code	HCPCS C1713
Hospital Charge Code	270691497
Hospital Revenue Code	278
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$22.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$20.54
Rate for Payer: Qualcare PPO/HMO/WC	$14.00

PLATE TIB PROX 3.5x145MM 8H LT

Facility

$6,565.90

Service Code	HCPCS C1713
Hospital Charge Code	270680906
Hospital Revenue Code	278
Min. Negotiated Rate	$984.88
Max. Negotiated Rate	$1,588.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,313.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,588.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,444.50
Rate for Payer: Qualcare PPO/HMO/WC	$984.88

PLATE TIB PROX 3.5x145MM 8H LT

Facility

$6,565.90

Service Code	HCPCS C1713
Hospital Charge Code	270680906
Hospital Revenue Code	278
Min. Negotiated Rate	$158.24
Max. Negotiated Rate	$3,282.95
Rate for Payer: Aetna Commercial	$2,495.04
Rate for Payer: Aetna Medicare Advantage	$1,969.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,674.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,674.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,313.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,674.30
Rate for Payer: Cigna Commercial	$3,282.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,588.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,444.50
Rate for Payer: Qualcare PPO/HMO/WC	$984.88
Rate for Payer: UnitedHealthcare Community & State	$158.24
Rate for Payer: Wellpoint Medicaid Managed Care	$174.00

PLATE TIB PROX MED TI 5H 84MM

Facility

$11,140.30

Service Code	HCPCS C1713
Hospital Charge Code	270699450
Hospital Revenue Code	278
Min. Negotiated Rate	$268.48
Max. Negotiated Rate	$5,570.15
Rate for Payer: Aetna Commercial	$4,233.31
Rate for Payer: Aetna Medicare Advantage	$3,342.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,840.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,840.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,228.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,840.78
Rate for Payer: Cigna Commercial	$5,570.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,695.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,450.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.05
Rate for Payer: UnitedHealthcare Community & State	$268.48
Rate for Payer: Wellpoint Medicaid Managed Care	$295.22

PLATE TIB PROX MED TI 5H 84MM

Facility

$11,140.30

Service Code	HCPCS C1713
Hospital Charge Code	270699450
Hospital Revenue Code	278
Min. Negotiated Rate	$1,671.05
Max. Negotiated Rate	$2,695.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,228.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,695.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,450.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.05

PLATE TIB PRX SM 3.5x177 10H R

Facility

$8,007.70

Service Code	HCPCS C1713
Hospital Charge Code	270681563
Hospital Revenue Code	278
Min. Negotiated Rate	$1,201.15
Max. Negotiated Rate	$1,937.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,601.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,937.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,761.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,201.15

PLATE TIB PRX SM 3.5x177 10H R

Facility

$8,007.70

Service Code	HCPCS C1713
Hospital Charge Code	270681563
Hospital Revenue Code	278
Min. Negotiated Rate	$192.99
Max. Negotiated Rate	$4,003.85
Rate for Payer: Aetna Commercial	$3,042.93
Rate for Payer: Aetna Medicare Advantage	$2,402.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,041.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,041.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,601.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,041.96
Rate for Payer: Cigna Commercial	$4,003.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,937.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,761.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,201.15
Rate for Payer: UnitedHealthcare Community & State	$192.99
Rate for Payer: Wellpoint Medicaid Managed Care	$212.20

PLATE TIB SLP 9.0 AR13200ST090

Facility

$5,183.25

Hospital Charge Code	270636941
Hospital Revenue Code	278
Min. Negotiated Rate	$124.92
Max. Negotiated Rate	$2,591.62
Rate for Payer: Aetna Commercial	$1,969.63
Rate for Payer: Aetna Medicare Advantage	$1,554.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,321.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,321.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,321.73
Rate for Payer: Cigna Commercial	$2,591.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,254.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,140.32
Rate for Payer: Qualcare PPO/HMO/WC	$777.49
Rate for Payer: UnitedHealthcare Community & State	$124.92
Rate for Payer: Wellpoint Medicaid Managed Care	$137.36

PLATE TIB SLP 9.0 AR13200ST090

Facility

$5,183.25

Hospital Charge Code	270636941
Hospital Revenue Code	278
Min. Negotiated Rate	$777.49
Max. Negotiated Rate	$1,254.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,036.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,254.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,140.32
Rate for Payer: Qualcare PPO/HMO/WC	$777.49

PLATE TI FIBULA LKG 4 HOLE RT

Facility

$3,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270692739
Hospital Revenue Code	278
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

PLATE TI FIBULA LKG 4 HOLE RT

Facility

$3,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270692739
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

PLATE TI INTERSPINOUS 6X34MM

Facility

$20,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270697851
Hospital Revenue Code	278
Min. Negotiated Rate	$3,012.00
Max. Negotiated Rate	$4,859.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,016.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,859.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,417.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,012.00

PLATE TI INTERSPINOUS 6X34MM

Facility

$20,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270697851
Hospital Revenue Code	278
Min. Negotiated Rate	$483.93
Max. Negotiated Rate	$10,040.00
Rate for Payer: Aetna Commercial	$7,630.40
Rate for Payer: Aetna Medicare Advantage	$6,024.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,120.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,120.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,120.40
Rate for Payer: Cigna Commercial	$10,040.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,859.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,417.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,012.00
Rate for Payer: UnitedHealthcare Community & State	$483.93
Rate for Payer: Wellpoint Medicaid Managed Care	$532.12

PLATE TI LISS 5 HOLE RT 156MM

Facility

$6,804.00

Hospital Charge Code	270671201
Hospital Revenue Code	278
Min. Negotiated Rate	$163.98
Max. Negotiated Rate	$3,402.00
Rate for Payer: Aetna Commercial	$2,585.52
Rate for Payer: Aetna Medicare Advantage	$2,041.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,735.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,735.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,360.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,735.02
Rate for Payer: Cigna Commercial	$3,402.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,646.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,496.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.60
Rate for Payer: UnitedHealthcare Community & State	$163.98
Rate for Payer: Wellpoint Medicaid Managed Care	$180.31

PLATE TI LISS 5 HOLE RT 156MM

Facility

$6,804.00

Hospital Charge Code	270671201
Hospital Revenue Code	278
Min. Negotiated Rate	$1,020.60
Max. Negotiated Rate	$1,646.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,360.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,646.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,496.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.60

PLATE TI LISS 9 HOLE RT 236MM

Facility

$6,804.00

Hospital Charge Code	270671202
Hospital Revenue Code	278
Min. Negotiated Rate	$163.98
Max. Negotiated Rate	$3,402.00
Rate for Payer: Aetna Commercial	$2,585.52
Rate for Payer: Aetna Medicare Advantage	$2,041.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,735.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,735.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,360.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,735.02
Rate for Payer: Cigna Commercial	$3,402.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,646.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,496.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.60
Rate for Payer: UnitedHealthcare Community & State	$163.98
Rate for Payer: Wellpoint Medicaid Managed Care	$180.31

PLATE TI LISS 9 HOLE RT 236MM

Facility

$6,804.00

Hospital Charge Code	270671202
Hospital Revenue Code	278
Min. Negotiated Rate	$1,020.60
Max. Negotiated Rate	$1,646.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,360.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,646.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,496.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,020.60

PLATE TI MATRIXNEURO ADAPT 20H

Facility

$5,185.00

Service Code	HCPCS C1713
Hospital Charge Code	270700169
Hospital Revenue Code	278
Min. Negotiated Rate	$777.75
Max. Negotiated Rate	$1,254.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,037.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,254.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,140.70
Rate for Payer: Qualcare PPO/HMO/WC	$777.75

PLATE TI MATRIXNEURO ADAPT 20H

Facility

$5,185.00

Service Code	HCPCS C1713
Hospital Charge Code	270700169
Hospital Revenue Code	278
Min. Negotiated Rate	$124.96
Max. Negotiated Rate	$2,592.50
Rate for Payer: Aetna Commercial	$1,970.30
Rate for Payer: Aetna Medicare Advantage	$1,555.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,037.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,322.17
Rate for Payer: Cigna Commercial	$2,592.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,254.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,140.70
Rate for Payer: Qualcare PPO/HMO/WC	$777.75
Rate for Payer: UnitedHealthcare Community & State	$124.96
Rate for Payer: Wellpoint Medicaid Managed Care	$137.40

PLATETIMATRIXNEURODBL 6H21MM

Facility

$2,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270697739
Hospital Revenue Code	278
Min. Negotiated Rate	$321.00
Max. Negotiated Rate	$517.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$428.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$517.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$470.80
Rate for Payer: Qualcare PPO/HMO/WC	$321.00

PLATETIMATRIXNEURODBL 6H21MM

Facility

$2,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270697739
Hospital Revenue Code	278
Min. Negotiated Rate	$51.57
Max. Negotiated Rate	$1,070.00
Rate for Payer: Aetna Commercial	$813.20
Rate for Payer: Aetna Medicare Advantage	$642.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$545.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$545.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$428.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$545.70
Rate for Payer: Cigna Commercial	$1,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$517.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$470.80
Rate for Payer: Qualcare PPO/HMO/WC	$321.00
Rate for Payer: UnitedHealthcare Community & State	$51.57
Rate for Payer: Wellpoint Medicaid Managed Care	$56.71

PLATE TI MATRIXNEURODBLY6H21MM

Facility

$2,340.00

Service Code	HCPCS C1713
Hospital Charge Code	270700166
Hospital Revenue Code	278
Min. Negotiated Rate	$56.39
Max. Negotiated Rate	$1,170.00
Rate for Payer: Aetna Commercial	$889.20
Rate for Payer: Aetna Medicare Advantage	$702.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$596.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$596.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$468.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$596.70
Rate for Payer: Cigna Commercial	$1,170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$566.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$514.80
Rate for Payer: Qualcare PPO/HMO/WC	$351.00
Rate for Payer: UnitedHealthcare Community & State	$56.39
Rate for Payer: Wellpoint Medicaid Managed Care	$62.01

PLATE TI MATRIXNEURODBLY6H21MM

Facility

$2,340.00

Service Code	HCPCS C1713
Hospital Charge Code	270700166
Hospital Revenue Code	278
Min. Negotiated Rate	$351.00
Max. Negotiated Rate	$566.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$468.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$566.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$514.80
Rate for Payer: Qualcare PPO/HMO/WC	$351.00

PLATE TI MATRIXNEURO STRUT 8H

Facility

$5,760.00

Service Code	HCPCS C1713
Hospital Charge Code	270700167
Hospital Revenue Code	278
Min. Negotiated Rate	$138.82
Max. Negotiated Rate	$2,880.00
Rate for Payer: Aetna Commercial	$2,188.80
Rate for Payer: Aetna Medicare Advantage	$1,728.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,468.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,468.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,152.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,468.80
Rate for Payer: Cigna Commercial	$2,880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,393.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,267.20
Rate for Payer: Qualcare PPO/HMO/WC	$864.00
Rate for Payer: UnitedHealthcare Community & State	$138.82
Rate for Payer: Wellpoint Medicaid Managed Care	$152.64

PLATE TI MATRIXNEURO STRUT 8H

Facility

$5,760.00

Service Code	HCPCS C1713
Hospital Charge Code	270700167
Hospital Revenue Code	278
Min. Negotiated Rate	$864.00
Max. Negotiated Rate	$1,393.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,152.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,393.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,267.20
Rate for Payer: Qualcare PPO/HMO/WC	$864.00

Know your out-of-pocket cost for care.

All Charges