Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE ULN 6 RT PROX 23480906

Facility

$3,364.40

Hospital Charge Code	270638866
Hospital Revenue Code	278
Min. Negotiated Rate	$504.66
Max. Negotiated Rate	$814.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$672.88
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

PLATE ULN 8H DORS LT 234801008

Facility

$3,619.90

Hospital Charge Code	270638714
Hospital Revenue Code	278
Min. Negotiated Rate	$87.24
Max. Negotiated Rate	$1,809.95
Rate for Payer: Aetna Commercial	$1,375.56
Rate for Payer: Aetna Medicare Advantage	$1,085.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$923.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$923.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$723.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$923.07
Rate for Payer: Cigna Commercial	$1,809.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$876.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$796.38
Rate for Payer: Qualcare PPO/HMO/WC	$542.99
Rate for Payer: UnitedHealthcare Community & State	$87.24
Rate for Payer: Wellpoint Medicaid Managed Care	$95.93

PLATE ULN 8H DORS LT 234801008

Facility

$3,619.90

Hospital Charge Code	270638714
Hospital Revenue Code	278
Min. Negotiated Rate	$542.99
Max. Negotiated Rate	$876.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$723.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$876.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$796.38
Rate for Payer: Qualcare PPO/HMO/WC	$542.99

PLATE ULN 8H DORS RT 234800908

Facility

$3,447.95

Hospital Charge Code	270638385
Hospital Revenue Code	278
Min. Negotiated Rate	$517.19
Max. Negotiated Rate	$834.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$689.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$758.55
Rate for Payer: Qualcare PPO/HMO/WC	$517.19

PLATE ULN 8H DORS RT 234800908

Facility

$3,447.95

Hospital Charge Code	270638385
Hospital Revenue Code	278
Min. Negotiated Rate	$83.10
Max. Negotiated Rate	$1,723.97
Rate for Payer: Aetna Commercial	$1,310.22
Rate for Payer: Aetna Medicare Advantage	$1,034.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$689.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.23
Rate for Payer: Cigna Commercial	$1,723.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$758.55
Rate for Payer: Qualcare PPO/HMO/WC	$517.19
Rate for Payer: UnitedHealthcare Community & State	$83.10
Rate for Payer: Wellpoint Medicaid Managed Care	$91.37

PLATE ULNA SHORTEN 2.5 TRILOCK

Facility

$12,606.30

Service Code	HCPCS C1713
Hospital Charge Code	270699549
Hospital Revenue Code	278
Min. Negotiated Rate	$303.81
Max. Negotiated Rate	$6,303.15
Rate for Payer: Aetna Commercial	$4,790.39
Rate for Payer: Aetna Medicare Advantage	$3,781.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,214.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,214.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,521.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,214.61
Rate for Payer: Cigna Commercial	$6,303.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,050.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,773.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,890.94
Rate for Payer: UnitedHealthcare Community & State	$303.81
Rate for Payer: Wellpoint Medicaid Managed Care	$334.07

PLATE ULNA SHORTEN 2.5 TRILOCK

Facility

$12,606.30

Service Code	HCPCS C1713
Hospital Charge Code	270699549
Hospital Revenue Code	278
Min. Negotiated Rate	$1,890.94
Max. Negotiated Rate	$3,050.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,521.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,050.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,773.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,890.94

PLATE UNIPLATE 1 LEVEL 14mm

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270684303
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

PLATE UNIPLATE 1 LEVEL 14mm

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270684303
Hospital Revenue Code	278
Min. Negotiated Rate	$135.56
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$2,137.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Community & State	$135.56
Rate for Payer: Wellpoint Medicaid Managed Care	$149.06

PLATE UNIPLATE 1 LEVEL 14MM

Facility

$5,625.00

Hospital Charge Code	270675230
Hospital Revenue Code	278
Min. Negotiated Rate	$135.56
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$2,137.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Community & State	$135.56
Rate for Payer: Wellpoint Medicaid Managed Care	$149.06

PLATE UNIPLATE 1 LEVEL 14MM

Facility

$5,625.00

Hospital Charge Code	270675230
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

PLATE UNIPLATE 1 LEVEL 16MM

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270667380
Hospital Revenue Code	278
Min. Negotiated Rate	$135.56
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$2,137.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Community & State	$135.56
Rate for Payer: Wellpoint Medicaid Managed Care	$149.06

PLATE UNIPLATE 1 LEVEL 16MM

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270667380
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

PLATE UNIPLATE 1 LEVEL 18MM

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270671111
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

PLATE UNIPLATE 1 LEVEL 18MM

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270671111
Hospital Revenue Code	278
Min. Negotiated Rate	$135.56
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$2,137.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Community & State	$135.56
Rate for Payer: Wellpoint Medicaid Managed Care	$149.06

PLATE UNIPLATE 1 LEVEL 20mm

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270688180
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

PLATE UNIPLATE 1 LEVEL 20mm

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270688180
Hospital Revenue Code	278
Min. Negotiated Rate	$135.56
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$2,137.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,237.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Community & State	$135.56
Rate for Payer: Wellpoint Medicaid Managed Care	$149.06

PLATE UNIPLATE 28mm

Facility

$5,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270678718
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$1,421.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,292.50
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

PLATE UNIPLATE 28mm

Facility

$5,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270678718
Hospital Revenue Code	278
Min. Negotiated Rate	$141.59
Max. Negotiated Rate	$2,937.50
Rate for Payer: Aetna Commercial	$2,232.50
Rate for Payer: Aetna Medicare Advantage	$1,762.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,498.12
Rate for Payer: Cigna Commercial	$2,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,292.50
Rate for Payer: Qualcare PPO/HMO/WC	$881.25
Rate for Payer: UnitedHealthcare Community & State	$141.59
Rate for Payer: Wellpoint Medicaid Managed Care	$155.69

PLATE UNIPLATE 2 LEVEL 30MM

Facility

$5,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270676523
Hospital Revenue Code	278
Min. Negotiated Rate	$141.59
Max. Negotiated Rate	$2,937.50
Rate for Payer: Aetna Commercial	$2,232.50
Rate for Payer: Aetna Medicare Advantage	$1,762.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,498.12
Rate for Payer: Cigna Commercial	$2,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,292.50
Rate for Payer: Qualcare PPO/HMO/WC	$881.25
Rate for Payer: UnitedHealthcare Community & State	$141.59
Rate for Payer: Wellpoint Medicaid Managed Care	$155.69

PLATE UNIPLATE 2 LEVEL 30MM

Facility

$5,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270676523
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$1,421.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,292.50
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

PLATE UNIPLATE 2 LEVEL 32MM

Facility

$5,875.00

Hospital Charge Code	270676850
Hospital Revenue Code	278
Min. Negotiated Rate	$141.59
Max. Negotiated Rate	$2,937.50
Rate for Payer: Aetna Commercial	$2,232.50
Rate for Payer: Aetna Medicare Advantage	$1,762.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,498.12
Rate for Payer: Cigna Commercial	$2,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,292.50
Rate for Payer: Qualcare PPO/HMO/WC	$881.25
Rate for Payer: UnitedHealthcare Community & State	$141.59
Rate for Payer: Wellpoint Medicaid Managed Care	$155.69

PLATE UNIPLATE 2 LEVEL 32MM

Facility

$5,875.00

Hospital Charge Code	270676850
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$1,421.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,292.50
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

PLATE UNIPLATE 2 LEVEL 34MM

Facility

$5,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270665073
Hospital Revenue Code	278
Min. Negotiated Rate	$141.59
Max. Negotiated Rate	$2,937.50
Rate for Payer: Aetna Commercial	$2,232.50
Rate for Payer: Aetna Medicare Advantage	$1,762.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,498.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,498.12
Rate for Payer: Cigna Commercial	$2,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,292.50
Rate for Payer: Qualcare PPO/HMO/WC	$881.25
Rate for Payer: UnitedHealthcare Community & State	$141.59
Rate for Payer: Wellpoint Medicaid Managed Care	$155.69

PLATE UNIPLATE 2 LEVEL 34MM

Facility

$5,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270665073
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$1,421.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,292.50
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

Know your out-of-pocket cost for care.

All Charges