Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE UNIPLATE 2 LEVEL 36MM

Facility

$5,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270663103
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 36MM

Facility

$5,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270663103
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 LEVEL 2 13MM

Facility

$5,625.00

Hospital Charge Code	270678225
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 LEVEL 2 13MM

Facility

$5,625.00

Hospital Charge Code	270678225
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 UNIVERAL 8 HOLE

Facility

$8,085.00

Service Code	HCPCS C1713
Hospital Charge Code	270690139
Hospital Revenue Code	278
Min. Negotiated Rate	$1,212.75
Max. Negotiated Rate	$1,956.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,617.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,956.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,778.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,212.75

PLATE UNIVERAL 8 HOLE

Facility

$8,085.00

Service Code	HCPCS C1713
Hospital Charge Code	270690139
Hospital Revenue Code	278
Min. Negotiated Rate	$194.85
Max. Negotiated Rate	$4,042.50
Rate for Payer: Aetna Commercial	$3,072.30
Rate for Payer: Aetna Medicare Advantage	$2,425.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,061.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,061.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,617.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,061.68
Rate for Payer: Cigna Commercial	$4,042.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,956.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,778.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,212.75
Rate for Payer: UnitedHealthcare Community & State	$194.85
Rate for Payer: Wellpoint Medicaid Managed Care	$214.25

PLATE UNIVERSAL

Facility

$5,305.00

Hospital Charge Code	270660697
Hospital Revenue Code	278
Min. Negotiated Rate	$127.85
Max. Negotiated Rate	$2,652.50
Rate for Payer: Aetna Commercial	$2,015.90
Rate for Payer: Aetna Medicare Advantage	$1,591.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,352.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,352.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,061.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,352.78
Rate for Payer: Cigna Commercial	$2,652.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,283.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,167.10
Rate for Payer: Qualcare PPO/HMO/WC	$795.75
Rate for Payer: UnitedHealthcare Community & State	$127.85
Rate for Payer: Wellpoint Medicaid Managed Care	$140.58

PLATE UNIVERSAL

Facility

$5,305.00

Hospital Charge Code	270660697
Hospital Revenue Code	278
Min. Negotiated Rate	$795.75
Max. Negotiated Rate	$1,283.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,061.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,283.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,167.10
Rate for Payer: Qualcare PPO/HMO/WC	$795.75

PLATE UNIVERSAL 2.4 MM 8 HOLE

Facility

$3,185.00

Hospital Charge Code	270663596
Hospital Revenue Code	278
Min. Negotiated Rate	$76.76
Max. Negotiated Rate	$1,592.50
Rate for Payer: Aetna Commercial	$1,210.30
Rate for Payer: Aetna Medicare Advantage	$955.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$812.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$812.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$637.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$812.17
Rate for Payer: Cigna Commercial	$1,592.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$770.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$700.70
Rate for Payer: Qualcare PPO/HMO/WC	$477.75
Rate for Payer: UnitedHealthcare Community & State	$76.76
Rate for Payer: Wellpoint Medicaid Managed Care	$84.40

PLATE UNIVERSAL 2.4 MM 8 HOLE

Facility

$3,185.00

Hospital Charge Code	270663596
Hospital Revenue Code	278
Min. Negotiated Rate	$477.75
Max. Negotiated Rate	$770.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$637.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$770.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$700.70
Rate for Payer: Qualcare PPO/HMO/WC	$477.75

PLATE UNIVERSAL ANTERIOR TT

Facility

$19,055.00

Service Code	HCPCS C1713
Hospital Charge Code	270683634
Hospital Revenue Code	278
Min. Negotiated Rate	$459.23
Max. Negotiated Rate	$9,527.50
Rate for Payer: Aetna Commercial	$7,240.90
Rate for Payer: Aetna Medicare Advantage	$5,716.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,859.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,859.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,811.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,859.02
Rate for Payer: Cigna Commercial	$9,527.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,611.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,192.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,858.25
Rate for Payer: UnitedHealthcare Community & State	$459.23
Rate for Payer: Wellpoint Medicaid Managed Care	$504.96

PLATE UNIVERSAL ANTERIOR TT

Facility

$19,055.00

Service Code	HCPCS C1713
Hospital Charge Code	270683634
Hospital Revenue Code	278
Min. Negotiated Rate	$2,858.25
Max. Negotiated Rate	$4,611.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,811.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,611.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,192.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,858.25

PLATE VA ANTLAT DSTL TIB 10H

Facility

$9,172.15

Service Code	HCPCS C1713
Hospital Charge Code	270693046
Hospital Revenue Code	278
Min. Negotiated Rate	$221.05
Max. Negotiated Rate	$4,586.07
Rate for Payer: Aetna Commercial	$3,485.42
Rate for Payer: Aetna Medicare Advantage	$2,751.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.90
Rate for Payer: Cigna Commercial	$4,586.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,017.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.82
Rate for Payer: UnitedHealthcare Community & State	$221.05
Rate for Payer: Wellpoint Medicaid Managed Care	$243.06

PLATE VA ANTLAT DSTL TIB 10H

Facility

$9,172.15

Service Code	HCPCS C1713
Hospital Charge Code	270693046
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.82
Max. Negotiated Rate	$2,219.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,017.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.82

PLATE VA LCKG CALC 2.7x40MM RT

Facility

$4,842.00

Service Code	HCPCS C1713
Hospital Charge Code	270681871
Hospital Revenue Code	278
Min. Negotiated Rate	$726.30
Max. Negotiated Rate	$1,171.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$968.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,065.24
Rate for Payer: Qualcare PPO/HMO/WC	$726.30

PLATE VA LCKG CALC 2.7x40MM RT

Facility

$4,842.00

Service Code	HCPCS C1713
Hospital Charge Code	270681871
Hospital Revenue Code	278
Min. Negotiated Rate	$116.69
Max. Negotiated Rate	$2,421.00
Rate for Payer: Aetna Commercial	$1,839.96
Rate for Payer: Aetna Medicare Advantage	$1,452.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,234.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,234.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$968.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,234.71
Rate for Payer: Cigna Commercial	$2,421.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,171.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,065.24
Rate for Payer: Qualcare PPO/HMO/WC	$726.30
Rate for Payer: UnitedHealthcare Community & State	$116.69
Rate for Payer: Wellpoint Medicaid Managed Care	$128.31

PLATE VA LCKG CALC 2.7x56MM RT

Facility

$4,492.00

Service Code	HCPCS C1713
Hospital Charge Code	270680136
Hospital Revenue Code	278
Min. Negotiated Rate	$673.80
Max. Negotiated Rate	$1,087.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$898.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,087.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$988.24
Rate for Payer: Qualcare PPO/HMO/WC	$673.80

PLATE VA LCKG CALC 2.7x56MM RT

Facility

$4,492.00

Service Code	HCPCS C1713
Hospital Charge Code	270680136
Hospital Revenue Code	278
Min. Negotiated Rate	$108.26
Max. Negotiated Rate	$2,246.00
Rate for Payer: Aetna Commercial	$1,706.96
Rate for Payer: Aetna Medicare Advantage	$1,347.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,145.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,145.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$898.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,145.46
Rate for Payer: Cigna Commercial	$2,246.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,087.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$988.24
Rate for Payer: Qualcare PPO/HMO/WC	$673.80
Rate for Payer: UnitedHealthcare Community & State	$108.26
Rate for Payer: Wellpoint Medicaid Managed Care	$119.04

PLATE VA LCKG CALC 2.7x70MM RT

Facility

$4,520.65

Hospital Charge Code	270677508
Hospital Revenue Code	278
Min. Negotiated Rate	$678.10
Max. Negotiated Rate	$1,094.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$904.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,094.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$994.54
Rate for Payer: Qualcare PPO/HMO/WC	$678.10

PLATE VA LCKG CALC 2.7x70MM RT

Facility

$4,520.65

Hospital Charge Code	270677508
Hospital Revenue Code	278
Min. Negotiated Rate	$108.95
Max. Negotiated Rate	$2,260.32
Rate for Payer: Aetna Commercial	$1,717.85
Rate for Payer: Aetna Medicare Advantage	$1,356.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,152.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,152.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$904.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,152.77
Rate for Payer: Cigna Commercial	$2,260.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,094.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$994.54
Rate for Payer: Qualcare PPO/HMO/WC	$678.10
Rate for Payer: UnitedHealthcare Community & State	$108.95
Rate for Payer: Wellpoint Medicaid Managed Care	$119.80

PLATE-VA LCKGMESH 2.4/2.7mm 12

Facility

$7,145.15

Service Code	HCPCS C1713
Hospital Charge Code	270683898
Hospital Revenue Code	278
Min. Negotiated Rate	$1,071.77
Max. Negotiated Rate	$1,729.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,429.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,729.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,571.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,071.77

PLATE-VA LCKGMESH 2.4/2.7mm 12

Facility

$7,145.15

Service Code	HCPCS C1713
Hospital Charge Code	270683898
Hospital Revenue Code	278
Min. Negotiated Rate	$172.20
Max. Negotiated Rate	$3,572.57
Rate for Payer: Aetna Commercial	$2,715.16
Rate for Payer: Aetna Medicare Advantage	$2,143.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,822.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,822.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,429.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,822.01
Rate for Payer: Cigna Commercial	$3,572.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,729.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,571.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,071.77
Rate for Payer: UnitedHealthcare Community & State	$172.20
Rate for Payer: Wellpoint Medicaid Managed Care	$189.35

PLATE VA LCP 2.3 3.5MM 8H RT

Facility

$6,813.45

Service Code	HCPCS C1713
Hospital Charge Code	270660906
Hospital Revenue Code	278
Min. Negotiated Rate	$164.20
Max. Negotiated Rate	$3,406.72
Rate for Payer: Aetna Commercial	$2,589.11
Rate for Payer: Aetna Medicare Advantage	$2,044.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,737.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,737.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,362.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,737.43
Rate for Payer: Cigna Commercial	$3,406.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,648.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,498.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,022.02
Rate for Payer: UnitedHealthcare Community & State	$164.20
Rate for Payer: Wellpoint Medicaid Managed Care	$180.56

PLATE VA LCP 2.3 3.5MM 8H RT

Facility

$6,813.45

Service Code	HCPCS C1713
Hospital Charge Code	270660906
Hospital Revenue Code	278
Min. Negotiated Rate	$1,022.02
Max. Negotiated Rate	$1,648.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,362.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,648.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,498.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,022.02

PLATE VA-LCP 2.4/2.7MM 2 HOLE

Facility

$4,822.60

Service Code	HCPCS C1713
Hospital Charge Code	270695925
Hospital Revenue Code	278
Min. Negotiated Rate	$723.39
Max. Negotiated Rate	$1,167.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$964.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,167.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,060.97
Rate for Payer: Qualcare PPO/HMO/WC	$723.39

Know your out-of-pocket cost for care.

All Charges