Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE TITAN H 2.0mm

Facility

$930.10

Service Code	HCPCS C1713
Hospital Charge Code	270603546
Hospital Revenue Code	278
Min. Negotiated Rate	$139.51
Max. Negotiated Rate	$225.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$186.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$204.62
Rate for Payer: Qualcare PPO/HMO/WC	$139.51

PLATE TITAN STR 1.5mm 20HOLE

Facility

$1,022.80

Service Code	HCPCS C1713
Hospital Charge Code	270604091
Hospital Revenue Code	278
Min. Negotiated Rate	$24.65
Max. Negotiated Rate	$511.40
Rate for Payer: Aetna Commercial	$388.66
Rate for Payer: Aetna Medicare Advantage	$306.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$260.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$260.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$204.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$260.81
Rate for Payer: Cigna Commercial	$511.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.02
Rate for Payer: Qualcare PPO/HMO/WC	$153.42
Rate for Payer: UnitedHealthcare Community & State	$24.65
Rate for Payer: Wellpoint Medicaid Managed Care	$27.10

PLATE TITAN STR 1.5mm 20HOLE

Facility

$1,022.80

Service Code	HCPCS C1713
Hospital Charge Code	270604091
Hospital Revenue Code	278
Min. Negotiated Rate	$153.42
Max. Negotiated Rate	$247.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$204.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.02
Rate for Payer: Qualcare PPO/HMO/WC	$153.42

PLATE TITAN STR 2.0mm 20HOLE

Facility

$1,072.25

Service Code	HCPCS C1713
Hospital Charge Code	270603535
Hospital Revenue Code	278
Min. Negotiated Rate	$160.84
Max. Negotiated Rate	$259.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$235.90
Rate for Payer: Qualcare PPO/HMO/WC	$160.84

PLATE TITAN STR 2.0mm 20HOLE

Facility

$1,072.25

Service Code	HCPCS C1713
Hospital Charge Code	270603535
Hospital Revenue Code	278
Min. Negotiated Rate	$25.84
Max. Negotiated Rate	$536.12
Rate for Payer: Aetna Commercial	$407.45
Rate for Payer: Aetna Medicare Advantage	$321.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.42
Rate for Payer: Cigna Commercial	$536.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$235.90
Rate for Payer: Qualcare PPO/HMO/WC	$160.84
Rate for Payer: UnitedHealthcare Community & State	$25.84
Rate for Payer: Wellpoint Medicaid Managed Care	$28.41

PLATE TIT CLOVRLF 3HOLE 441.83

Facility

$728.00

Hospital Charge Code	1605583
Hospital Revenue Code	274
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$176.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$160.16
Rate for Payer: Qualcare PPO/HMO/WC	$109.20

PLATE TIT CLOVRLF 3HOLE 441.83

Facility

$728.00

Hospital Charge Code	1605583
Hospital Revenue Code	274
Min. Negotiated Rate	$17.54
Max. Negotiated Rate	$364.00
Rate for Payer: Aetna Commercial	$276.64
Rate for Payer: Aetna Medicare Advantage	$218.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$185.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$185.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$185.64
Rate for Payer: Cigna Commercial	$364.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$160.16
Rate for Payer: Qualcare PPO/HMO/WC	$109.20
Rate for Payer: UnitedHealthcare Community & State	$17.54
Rate for Payer: Wellpoint Medicaid Managed Care	$19.29

PLATE TITIUM ADATON 20 449.020

Facility

$1,682.45

Hospital Charge Code	270625802
Hospital Revenue Code	278
Min. Negotiated Rate	$40.55
Max. Negotiated Rate	$841.23
Rate for Payer: Aetna Commercial	$639.33
Rate for Payer: Aetna Medicare Advantage	$504.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$429.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$429.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$336.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$429.02
Rate for Payer: Cigna Commercial	$841.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$407.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$370.14
Rate for Payer: Qualcare PPO/HMO/WC	$252.37
Rate for Payer: UnitedHealthcare Community & State	$40.55
Rate for Payer: Wellpoint Medicaid Managed Care	$44.58

PLATE TITIUM ADATON 20 449.020

Facility

$1,682.45

Hospital Charge Code	270625802
Hospital Revenue Code	278
Min. Negotiated Rate	$252.37
Max. Negotiated Rate	$407.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$336.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$407.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$370.14
Rate for Payer: Qualcare PPO/HMO/WC	$252.37

PLATE TITIUM BD 2.0 29m 449024

Facility

$1,094.45

Hospital Charge Code	270625801
Hospital Revenue Code	278
Min. Negotiated Rate	$164.17
Max. Negotiated Rate	$264.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$218.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$264.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$240.78
Rate for Payer: Qualcare PPO/HMO/WC	$164.17

PLATE TITIUM BD 2.0 29m 449024

Facility

$1,094.45

Hospital Charge Code	270625801
Hospital Revenue Code	278
Min. Negotiated Rate	$26.38
Max. Negotiated Rate	$547.23
Rate for Payer: Aetna Commercial	$415.89
Rate for Payer: Aetna Medicare Advantage	$328.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$218.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.08
Rate for Payer: Cigna Commercial	$547.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$264.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$240.78
Rate for Payer: Qualcare PPO/HMO/WC	$164.17
Rate for Payer: UnitedHealthcare Community & State	$26.38
Rate for Payer: Wellpoint Medicaid Managed Care	$29.00

PLATE TITN CLVRLF 4 HL 441.84

Facility

$778.00

Hospital Charge Code	1605591
Hospital Revenue Code	274
Min. Negotiated Rate	$116.70
Max. Negotiated Rate	$188.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$171.16
Rate for Payer: Qualcare PPO/HMO/WC	$116.70

PLATE TITN CLVRLF 4 HL 441.84

Facility

$778.00

Hospital Charge Code	1605591
Hospital Revenue Code	274
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$389.00
Rate for Payer: Aetna Commercial	$295.64
Rate for Payer: Aetna Medicare Advantage	$233.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.39
Rate for Payer: Cigna Commercial	$389.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$171.16
Rate for Payer: Qualcare PPO/HMO/WC	$116.70
Rate for Payer: UnitedHealthcare Community & State	$18.75
Rate for Payer: Wellpoint Medicaid Managed Care	$20.62

PLATE TITN SHT 2.7MM 3H***

Facility

$119.80

Hospital Charge Code	270604076
Hospital Revenue Code	279
Min. Negotiated Rate	$17.97
Max. Negotiated Rate	$17.97
Rate for Payer: Qualcare PPO/HMO/WC	$17.97

PLATE TITN SHT 2.7MM 3H***

Facility

$119.80

Hospital Charge Code	270604076
Hospital Revenue Code	279
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$59.90
Rate for Payer: Aetna Commercial	$45.52
Rate for Payer: Aetna Medicare Advantage	$35.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.55
Rate for Payer: Cigna Commercial	$59.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.94
Rate for Payer: Oxford Commercial	$23.96
Rate for Payer: Qualcare PPO/HMO/WC	$17.97
Rate for Payer: UnitedHealthcare Commercial	$23.96
Rate for Payer: UnitedHealthcare Community & State	$2.89
Rate for Payer: Wellpoint Medicaid Managed Care	$3.17

PLATE T LCP 2.0MM 3HOLE/7HOLE

Facility

$1,788.00

Service Code	HCPCS C1713
Hospital Charge Code	270676476
Hospital Revenue Code	278
Min. Negotiated Rate	$43.09
Max. Negotiated Rate	$894.00
Rate for Payer: Aetna Commercial	$679.44
Rate for Payer: Aetna Medicare Advantage	$536.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$455.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$455.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$357.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$455.94
Rate for Payer: Cigna Commercial	$894.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$432.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$393.36
Rate for Payer: Qualcare PPO/HMO/WC	$268.20
Rate for Payer: UnitedHealthcare Community & State	$43.09
Rate for Payer: Wellpoint Medicaid Managed Care	$47.38

PLATE T LCP 2.0MM 3HOLE/7HOLE

Facility

$1,788.00

Service Code	HCPCS C1713
Hospital Charge Code	270676476
Hospital Revenue Code	278
Min. Negotiated Rate	$268.20
Max. Negotiated Rate	$432.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$357.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$432.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$393.36
Rate for Payer: Qualcare PPO/HMO/WC	$268.20

PLATE TM RVS SHOULDER 20MM

Facility

$18,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270695306
Hospital Revenue Code	278
Min. Negotiated Rate	$2,805.00
Max. Negotiated Rate	$4,525.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,740.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,525.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,114.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,805.00

PLATE TM RVS SHOULDER 20MM

Facility

$18,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270695306
Hospital Revenue Code	278
Min. Negotiated Rate	$450.67
Max. Negotiated Rate	$9,350.00
Rate for Payer: Aetna Commercial	$7,106.00
Rate for Payer: Aetna Medicare Advantage	$5,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,768.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,768.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,740.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,768.50
Rate for Payer: Cigna Commercial	$9,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,525.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,114.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,805.00
Rate for Payer: UnitedHealthcare Community & State	$450.67
Rate for Payer: Wellpoint Medicaid Managed Care	$495.55

PLATE T NARROW 7 HOLE 2.3x15MM

Facility

$3,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270657974
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$816.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$742.50
Rate for Payer: Qualcare PPO/HMO/WC	$506.25

PLATE T NARROW 7 HOLE 2.3x15MM

Facility

$3,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270657974
Hospital Revenue Code	278
Min. Negotiated Rate	$81.34
Max. Negotiated Rate	$1,687.50
Rate for Payer: Aetna Commercial	$1,282.50
Rate for Payer: Aetna Medicare Advantage	$1,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.62
Rate for Payer: Cigna Commercial	$1,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$742.50
Rate for Payer: Qualcare PPO/HMO/WC	$506.25
Rate for Payer: UnitedHealthcare Community & State	$81.34
Rate for Payer: Wellpoint Medicaid Managed Care	$89.44

PLATE T OBLIQUE 3HEAD 3SHAFT

Facility

$518.00

Hospital Charge Code	1603885
Hospital Revenue Code	274
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$259.00
Rate for Payer: Aetna Commercial	$196.84
Rate for Payer: Aetna Medicare Advantage	$155.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.09
Rate for Payer: Cigna Commercial	$259.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$113.96
Rate for Payer: Qualcare PPO/HMO/WC	$77.70
Rate for Payer: UnitedHealthcare Community & State	$12.48
Rate for Payer: Wellpoint Medicaid Managed Care	$13.73

PLATE T OBLIQUE 3HEAD 3SHAFT

Facility

$518.00

Hospital Charge Code	1603885
Hospital Revenue Code	274
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$125.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$113.96
Rate for Payer: Qualcare PPO/HMO/WC	$77.70

PLATE T OBLIQUE 3HEAD 4SHAFT

Facility

$548.00

Hospital Charge Code	1603893
Hospital Revenue Code	274
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$274.00
Rate for Payer: Aetna Commercial	$208.24
Rate for Payer: Aetna Medicare Advantage	$164.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.74
Rate for Payer: Cigna Commercial	$274.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$120.56
Rate for Payer: Qualcare PPO/HMO/WC	$82.20
Rate for Payer: UnitedHealthcare Community & State	$13.21
Rate for Payer: Wellpoint Medicaid Managed Care	$14.52

PLATE T OBLIQUE 3HEAD 4SHAFT

Facility

$548.00

Hospital Charge Code	1603893
Hospital Revenue Code	274
Min. Negotiated Rate	$82.20
Max. Negotiated Rate	$132.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$109.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$120.56
Rate for Payer: Qualcare PPO/HMO/WC	$82.20

Know your out-of-pocket cost for care.

All Charges