Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE T OBLIQUE 3HEAD 5SHAFT

Facility

$568.00

Hospital Charge Code	1603901
Hospital Revenue Code	274
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$284.00
Rate for Payer: Aetna Commercial	$215.84
Rate for Payer: Aetna Medicare Advantage	$170.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.84
Rate for Payer: Cigna Commercial	$284.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$124.96
Rate for Payer: Qualcare PPO/HMO/WC	$85.20
Rate for Payer: UnitedHealthcare Community & State	$13.69
Rate for Payer: Wellpoint Medicaid Managed Care	$15.05

PLATE T OBLIQUE 3HEAD 5SHAFT

Facility

$568.00

Hospital Charge Code	1603901
Hospital Revenue Code	274
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$137.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$124.96
Rate for Payer: Qualcare PPO/HMO/WC	$85.20

PLATE TRACK LAPIPLASTY 2.2MM

Facility

$2,725.00

Service Code	HCPCS C1713
Hospital Charge Code	270698029
Hospital Revenue Code	278
Min. Negotiated Rate	$65.67
Max. Negotiated Rate	$1,362.50
Rate for Payer: Aetna Commercial	$1,035.50
Rate for Payer: Aetna Medicare Advantage	$817.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$694.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$694.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$694.88
Rate for Payer: Cigna Commercial	$1,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$659.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$599.50
Rate for Payer: Qualcare PPO/HMO/WC	$408.75
Rate for Payer: UnitedHealthcare Community & State	$65.67
Rate for Payer: Wellpoint Medicaid Managed Care	$72.21

PLATE TRACK LAPIPLASTY 2.2MM

Facility

$2,725.00

Service Code	HCPCS C1713
Hospital Charge Code	270698029
Hospital Revenue Code	278
Min. Negotiated Rate	$408.75
Max. Negotiated Rate	$659.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$545.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$659.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$599.50
Rate for Payer: Qualcare PPO/HMO/WC	$408.75

PLATE T RT ANGLE 3HEAD 3SHAFT

Facility

$314.00

Hospital Charge Code	1603869
Hospital Revenue Code	274
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$75.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$69.08
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

PLATE T RT ANGLE 3HEAD 3SHAFT

Facility

$314.00

Hospital Charge Code	1603869
Hospital Revenue Code	274
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$157.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$69.08
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Community & State	$7.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

PLATE T RT ANGLE 3HEAD 5SHAFT

Facility

$339.00

Hospital Charge Code	1603877
Hospital Revenue Code	274
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$169.50
Rate for Payer: Aetna Commercial	$128.82
Rate for Payer: Aetna Medicare Advantage	$101.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.44
Rate for Payer: Cigna Commercial	$169.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$74.58
Rate for Payer: Qualcare PPO/HMO/WC	$50.85
Rate for Payer: UnitedHealthcare Community & State	$8.17
Rate for Payer: Wellpoint Medicaid Managed Care	$8.98

PLATE T RT ANGLE 3HEAD 5SHAFT

Facility

$339.00

Hospital Charge Code	1603877
Hospital Revenue Code	274
Min. Negotiated Rate	$50.85
Max. Negotiated Rate	$82.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$74.58
Rate for Payer: Qualcare PPO/HMO/WC	$50.85

PLATE, TTC

Facility

$6,375.00

Hospital Charge Code	270656746
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

PLATE, TTC

Facility

$6,375.00

Hospital Charge Code	270656746
Hospital Revenue Code	278
Min. Negotiated Rate	$153.64
Max. Negotiated Rate	$3,187.50
Rate for Payer: Aetna Commercial	$2,422.50
Rate for Payer: Aetna Medicare Advantage	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,625.62
Rate for Payer: Cigna Commercial	$3,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25
Rate for Payer: UnitedHealthcare Community & State	$153.64
Rate for Payer: Wellpoint Medicaid Managed Care	$168.94

PLATE TUB 3DI 10H 124MM

Facility

$7,534.45

Service Code	HCPCS C1713
Hospital Charge Code	270700624
Hospital Revenue Code	278
Min. Negotiated Rate	$1,130.17
Max. Negotiated Rate	$1,823.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,506.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,823.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,657.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,130.17

PLATE TUB 3DI 10H 124MM

Facility

$7,534.45

Service Code	HCPCS C1713
Hospital Charge Code	270700624
Hospital Revenue Code	278
Min. Negotiated Rate	$181.58
Max. Negotiated Rate	$3,767.22
Rate for Payer: Aetna Commercial	$2,863.09
Rate for Payer: Aetna Medicare Advantage	$2,260.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,921.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,921.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,506.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,921.28
Rate for Payer: Cigna Commercial	$3,767.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,823.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,657.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,130.17
Rate for Payer: UnitedHealthcare Community & State	$181.58
Rate for Payer: Wellpoint Medicaid Managed Care	$199.66

PLATE TUB 5 HOLE DELTA ORTLOC

Facility

$1,809.00

Service Code	HCPCS C1713
Hospital Charge Code	270704108
Hospital Revenue Code	278
Min. Negotiated Rate	$271.35
Max. Negotiated Rate	$437.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$361.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$437.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$397.98
Rate for Payer: Qualcare PPO/HMO/WC	$271.35

PLATE TUB 5 HOLE DELTA ORTLOC

Facility

$1,809.00

Service Code	HCPCS C1713
Hospital Charge Code	270704108
Hospital Revenue Code	278
Min. Negotiated Rate	$43.60
Max. Negotiated Rate	$904.50
Rate for Payer: Aetna Commercial	$687.42
Rate for Payer: Aetna Medicare Advantage	$542.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$361.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.30
Rate for Payer: Cigna Commercial	$904.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$437.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$397.98
Rate for Payer: Qualcare PPO/HMO/WC	$271.35
Rate for Payer: UnitedHealthcare Community & State	$43.60
Rate for Payer: Wellpoint Medicaid Managed Care	$47.94

PLATE TUB 8HOLE 95MM

Facility

$2,166.40

Service Code	HCPCS C1713
Hospital Charge Code	270696914
Hospital Revenue Code	278
Min. Negotiated Rate	$52.21
Max. Negotiated Rate	$1,083.20
Rate for Payer: Aetna Commercial	$823.23
Rate for Payer: Aetna Medicare Advantage	$649.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$552.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$552.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$433.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$552.43
Rate for Payer: Cigna Commercial	$1,083.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$524.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$476.61
Rate for Payer: Qualcare PPO/HMO/WC	$324.96
Rate for Payer: UnitedHealthcare Community & State	$52.21
Rate for Payer: Wellpoint Medicaid Managed Care	$57.41

PLATE TUB 8HOLE 95MM

Facility

$2,166.40

Service Code	HCPCS C1713
Hospital Charge Code	270696914
Hospital Revenue Code	278
Min. Negotiated Rate	$324.96
Max. Negotiated Rate	$524.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$433.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$524.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$476.61
Rate for Payer: Qualcare PPO/HMO/WC	$324.96

PLATE TUBULAR 100DEG 5H 61MM

Facility

$575.00

Hospital Charge Code	270676098
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

PLATE TUBULAR 100DEG 5H 61MM

Facility

$575.00

Hospital Charge Code	270676098
Hospital Revenue Code	278
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$13.86
Rate for Payer: Wellpoint Medicaid Managed Care	$15.24

PLATE TUBULAR 3.5mm 100 DEGREE

Facility

$605.00

Service Code	HCPCS C1713
Hospital Charge Code	270672328
Hospital Revenue Code	278
Min. Negotiated Rate	$90.75
Max. Negotiated Rate	$146.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$133.10
Rate for Payer: Qualcare PPO/HMO/WC	$90.75

PLATE TUBULAR 3.5mm 100 DEGREE

Facility

$605.00

Service Code	HCPCS C1713
Hospital Charge Code	270672328
Hospital Revenue Code	278
Min. Negotiated Rate	$14.58
Max. Negotiated Rate	$302.50
Rate for Payer: Aetna Commercial	$229.90
Rate for Payer: Aetna Medicare Advantage	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.28
Rate for Payer: Cigna Commercial	$302.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$133.10
Rate for Payer: Qualcare PPO/HMO/WC	$90.75
Rate for Payer: UnitedHealthcare Community & State	$14.58
Rate for Payer: Wellpoint Medicaid Managed Care	$16.03

PLATE TUBULAR 3 HOLE 1/3

Facility

$375.00

Hospital Charge Code	270667331
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

PLATE TUBULAR 3 HOLE 1/3

Facility

$375.00

Hospital Charge Code	270667331
Hospital Revenue Code	278
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

PLATE TWO HOLE SS

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686189
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

PLATE TWO HOLE SS

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686189
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

PLATE ULN 6 RT PROX 23480906

Facility

$3,364.40

Hospital Charge Code	270638866
Hospital Revenue Code	278
Min. Negotiated Rate	$81.08
Max. Negotiated Rate	$1,682.20
Rate for Payer: Aetna Commercial	$1,278.47
Rate for Payer: Aetna Medicare Advantage	$1,009.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$857.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$857.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$672.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$857.92
Rate for Payer: Cigna Commercial	$1,682.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$814.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$740.17
Rate for Payer: Qualcare PPO/HMO/WC	$504.66
Rate for Payer: UnitedHealthcare Community & State	$81.08
Rate for Payer: Wellpoint Medicaid Managed Care	$89.16

Know your out-of-pocket cost for care.

All Charges