Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE VA LCP CALCANEAL LEFT 2.

Facility

$4,656.25

Service Code	HCPCS C1713
Hospital Charge Code	270680485
Hospital Revenue Code	278
Min. Negotiated Rate	$112.22
Max. Negotiated Rate	$2,328.12
Rate for Payer: Aetna Commercial	$1,769.38
Rate for Payer: Aetna Medicare Advantage	$1,396.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,187.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,187.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$931.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,187.34
Rate for Payer: Cigna Commercial	$2,328.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,126.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,024.38
Rate for Payer: Qualcare PPO/HMO/WC	$698.44
Rate for Payer: UnitedHealthcare Community & State	$112.22
Rate for Payer: Wellpoint Medicaid Managed Care	$123.39

PLATE VA LCP CONDYL 4.5 10H LT

Facility

$7,564.30

Service Code	HCPCS C1713
Hospital Charge Code	270676131
Hospital Revenue Code	278
Min. Negotiated Rate	$182.30
Max. Negotiated Rate	$3,782.15
Rate for Payer: Aetna Commercial	$2,874.43
Rate for Payer: Aetna Medicare Advantage	$2,269.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,928.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,928.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,512.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,928.90
Rate for Payer: Cigna Commercial	$3,782.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,830.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,664.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,134.64
Rate for Payer: UnitedHealthcare Community & State	$182.30
Rate for Payer: Wellpoint Medicaid Managed Care	$200.45

PLATE VA LCP CONDYL 4.5 10H LT

Facility

$7,564.30

Service Code	HCPCS C1713
Hospital Charge Code	270676131
Hospital Revenue Code	278
Min. Negotiated Rate	$1,134.64
Max. Negotiated Rate	$1,830.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,512.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,830.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,664.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,134.64

PLATE VA-LCP DISTAL 4H/2.7mm S

Facility

$3,943.35

Service Code	HCPCS C1713
Hospital Charge Code	270681946
Hospital Revenue Code	278
Min. Negotiated Rate	$591.50
Max. Negotiated Rate	$954.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$788.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$954.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$867.54
Rate for Payer: Qualcare PPO/HMO/WC	$591.50

PLATE VA-LCP DISTAL 4H/2.7mm S

Facility

$3,943.35

Service Code	HCPCS C1713
Hospital Charge Code	270681946
Hospital Revenue Code	278
Min. Negotiated Rate	$95.03
Max. Negotiated Rate	$1,971.67
Rate for Payer: Aetna Commercial	$1,498.47
Rate for Payer: Aetna Medicare Advantage	$1,183.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,005.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,005.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$788.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,005.55
Rate for Payer: Cigna Commercial	$1,971.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$954.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$867.54
Rate for Payer: Qualcare PPO/HMO/WC	$591.50
Rate for Payer: UnitedHealthcare Community & State	$95.03
Rate for Payer: Wellpoint Medicaid Managed Care	$104.50

PLATE VA-LCP DRP 7H HD 2H SH

Facility

$10,640.00

Service Code	HCPCS C1713
Hospital Charge Code	270699102
Hospital Revenue Code	278
Min. Negotiated Rate	$1,596.00
Max. Negotiated Rate	$2,574.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,128.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,340.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,596.00

PLATE VA-LCP DRP 7H HD 2H SH

Facility

$10,640.00

Service Code	HCPCS C1713
Hospital Charge Code	270699102
Hospital Revenue Code	278
Min. Negotiated Rate	$256.42
Max. Negotiated Rate	$5,320.00
Rate for Payer: Aetna Commercial	$4,043.20
Rate for Payer: Aetna Medicare Advantage	$3,192.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,713.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,713.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,128.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,713.20
Rate for Payer: Cigna Commercial	$5,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,340.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,596.00
Rate for Payer: UnitedHealthcare Community & State	$256.42
Rate for Payer: Wellpoint Medicaid Managed Care	$281.96

PLATE VA-LCP DRSL 2.4 2H/3H+90

Facility

$2,506.00

Service Code	HCPCS C1713
Hospital Charge Code	270661606
Hospital Revenue Code	278
Min. Negotiated Rate	$375.90
Max. Negotiated Rate	$606.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$501.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$606.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$551.32
Rate for Payer: Qualcare PPO/HMO/WC	$375.90

PLATE VA-LCP DRSL 2.4 2H/3H+90

Facility

$2,506.00

Service Code	HCPCS C1713
Hospital Charge Code	270661606
Hospital Revenue Code	278
Min. Negotiated Rate	$60.39
Max. Negotiated Rate	$1,253.00
Rate for Payer: Aetna Commercial	$952.28
Rate for Payer: Aetna Medicare Advantage	$751.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$639.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$639.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$501.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$639.03
Rate for Payer: Cigna Commercial	$1,253.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$606.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$551.32
Rate for Payer: Qualcare PPO/HMO/WC	$375.90
Rate for Payer: UnitedHealthcare Community & State	$60.39
Rate for Payer: Wellpoint Medicaid Managed Care	$66.41

PLATE VA-LCP DRSL 2.4 2H/4H+90

Facility

$2,598.70

Service Code	HCPCS C1713
Hospital Charge Code	270661614
Hospital Revenue Code	278
Min. Negotiated Rate	$389.81
Max. Negotiated Rate	$628.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$519.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$628.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$571.71
Rate for Payer: Qualcare PPO/HMO/WC	$389.81

PLATE VA-LCP DRSL 2.4 2H/4H+90

Facility

$2,598.70

Service Code	HCPCS C1713
Hospital Charge Code	270661614
Hospital Revenue Code	278
Min. Negotiated Rate	$62.63
Max. Negotiated Rate	$1,299.35
Rate for Payer: Aetna Commercial	$987.51
Rate for Payer: Aetna Medicare Advantage	$779.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$662.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$662.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$519.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$662.67
Rate for Payer: Cigna Commercial	$1,299.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$628.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$571.71
Rate for Payer: Qualcare PPO/HMO/WC	$389.81
Rate for Payer: UnitedHealthcare Community & State	$62.63
Rate for Payer: Wellpoint Medicaid Managed Care	$68.87

PLATE VA-LCP DRSL 2.4 2H/4H-90

Facility

$2,598.70

Service Code	HCPCS C1713
Hospital Charge Code	270661608
Hospital Revenue Code	278
Min. Negotiated Rate	$389.81
Max. Negotiated Rate	$628.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$519.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$628.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$571.71
Rate for Payer: Qualcare PPO/HMO/WC	$389.81

PLATE VA-LCP DRSL 2.4 2H/4H-90

Facility

$2,598.70

Service Code	HCPCS C1713
Hospital Charge Code	270661608
Hospital Revenue Code	278
Min. Negotiated Rate	$62.63
Max. Negotiated Rate	$1,299.35
Rate for Payer: Aetna Commercial	$987.51
Rate for Payer: Aetna Medicare Advantage	$779.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$662.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$662.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$519.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$662.67
Rate for Payer: Cigna Commercial	$1,299.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$628.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$571.71
Rate for Payer: Qualcare PPO/HMO/WC	$389.81
Rate for Payer: UnitedHealthcare Community & State	$62.63
Rate for Payer: Wellpoint Medicaid Managed Care	$68.87

PLATE VA-LCP LAT 2.7MM 3H LEFT

Facility

$3,423.70

Service Code	HCPCS C1713
Hospital Charge Code	270676461
Hospital Revenue Code	278
Min. Negotiated Rate	$513.55
Max. Negotiated Rate	$828.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$684.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$828.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$753.21
Rate for Payer: Qualcare PPO/HMO/WC	$513.55

PLATE VA-LCP LAT 2.7MM 3H LEFT

Facility

$3,423.70

Service Code	HCPCS C1713
Hospital Charge Code	270676461
Hospital Revenue Code	278
Min. Negotiated Rate	$82.51
Max. Negotiated Rate	$1,711.85
Rate for Payer: Aetna Commercial	$1,301.01
Rate for Payer: Aetna Medicare Advantage	$1,027.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$873.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$873.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$684.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$873.04
Rate for Payer: Cigna Commercial	$1,711.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$828.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$753.21
Rate for Payer: Qualcare PPO/HMO/WC	$513.55
Rate for Payer: UnitedHealthcare Community & State	$82.51
Rate for Payer: Wellpoint Medicaid Managed Care	$90.73

PLATE VA-LCP LAT 2.7MM 3H RT

Facility

$3,630.75

Service Code	HCPCS C1713
Hospital Charge Code	270669789
Hospital Revenue Code	278
Min. Negotiated Rate	$544.61
Max. Negotiated Rate	$878.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$726.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$878.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$798.76
Rate for Payer: Qualcare PPO/HMO/WC	$544.61

PLATE VA-LCP LAT 2.7MM 3H RT

Facility

$3,630.75

Service Code	HCPCS C1713
Hospital Charge Code	270669789
Hospital Revenue Code	278
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$1,815.38
Rate for Payer: Aetna Commercial	$1,379.68
Rate for Payer: Aetna Medicare Advantage	$1,089.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$925.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$925.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$726.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$925.84
Rate for Payer: Cigna Commercial	$1,815.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$878.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$798.76
Rate for Payer: Qualcare PPO/HMO/WC	$544.61
Rate for Payer: UnitedHealthcare Community & State	$87.50
Rate for Payer: Wellpoint Medicaid Managed Care	$96.21

PLATE VA-LCP LAT 2.7MM 4H RT

Facility

$3,685.55

Service Code	HCPCS C1713
Hospital Charge Code	270676462
Hospital Revenue Code	278
Min. Negotiated Rate	$552.83
Max. Negotiated Rate	$891.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$737.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$891.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$810.82
Rate for Payer: Qualcare PPO/HMO/WC	$552.83

PLATE VA-LCP LAT 2.7MM 4H RT

Facility

$3,898.80

Service Code	HCPCS C1713
Hospital Charge Code	270664889
Hospital Revenue Code	278
Min. Negotiated Rate	$584.82
Max. Negotiated Rate	$943.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$779.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$943.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$857.74
Rate for Payer: Qualcare PPO/HMO/WC	$584.82

PLATE VA-LCP LAT 2.7MM 4H RT

Facility

$3,898.80

Service Code	HCPCS C1713
Hospital Charge Code	270664889
Hospital Revenue Code	278
Min. Negotiated Rate	$93.96
Max. Negotiated Rate	$1,949.40
Rate for Payer: Aetna Commercial	$1,481.54
Rate for Payer: Aetna Medicare Advantage	$1,169.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$994.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$994.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$779.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$994.19
Rate for Payer: Cigna Commercial	$1,949.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$943.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$857.74
Rate for Payer: Qualcare PPO/HMO/WC	$584.82
Rate for Payer: UnitedHealthcare Community & State	$93.96
Rate for Payer: Wellpoint Medicaid Managed Care	$103.32

PLATE VA-LCP LAT 2.7MM 4H RT

Facility

$3,685.55

Service Code	HCPCS C1713
Hospital Charge Code	270676462
Hospital Revenue Code	278
Min. Negotiated Rate	$88.82
Max. Negotiated Rate	$1,842.78
Rate for Payer: Aetna Commercial	$1,400.51
Rate for Payer: Aetna Medicare Advantage	$1,105.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$939.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$939.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$737.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$939.82
Rate for Payer: Cigna Commercial	$1,842.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$891.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$810.82
Rate for Payer: Qualcare PPO/HMO/WC	$552.83
Rate for Payer: UnitedHealthcare Community & State	$88.82
Rate for Payer: Wellpoint Medicaid Managed Care	$97.67

PLATE VA-LCP LAT 2.7MM 5H RTST

Facility

$4,083.40

Service Code	HCPCS C1713
Hospital Charge Code	270664070
Hospital Revenue Code	278
Min. Negotiated Rate	$612.51
Max. Negotiated Rate	$988.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$988.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$898.35
Rate for Payer: Qualcare PPO/HMO/WC	$612.51

PLATE VA-LCP LAT 2.7MM 5H RTST

Facility

$4,083.40

Service Code	HCPCS C1713
Hospital Charge Code	270664070
Hospital Revenue Code	278
Min. Negotiated Rate	$98.41
Max. Negotiated Rate	$2,041.70
Rate for Payer: Aetna Commercial	$1,551.69
Rate for Payer: Aetna Medicare Advantage	$1,225.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,041.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,041.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,041.27
Rate for Payer: Cigna Commercial	$2,041.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$988.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$898.35
Rate for Payer: Qualcare PPO/HMO/WC	$612.51
Rate for Payer: UnitedHealthcare Community & State	$98.41
Rate for Payer: Wellpoint Medicaid Managed Care	$108.21

PLATE VA-LCP LAT 2.7MM 7H LTST

Facility

$4,341.45

Service Code	HCPCS C1713
Hospital Charge Code	270664092
Hospital Revenue Code	278
Min. Negotiated Rate	$651.22
Max. Negotiated Rate	$1,050.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$955.12
Rate for Payer: Qualcare PPO/HMO/WC	$651.22

PLATE VA-LCP LAT 2.7MM 7H LTST

Facility

$4,341.45

Service Code	HCPCS C1713
Hospital Charge Code	270664092
Hospital Revenue Code	278
Min. Negotiated Rate	$104.63
Max. Negotiated Rate	$2,170.72
Rate for Payer: Aetna Commercial	$1,649.75
Rate for Payer: Aetna Medicare Advantage	$1,302.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,107.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,107.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$868.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,107.07
Rate for Payer: Cigna Commercial	$2,170.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,050.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$955.12
Rate for Payer: Qualcare PPO/HMO/WC	$651.22
Rate for Payer: UnitedHealthcare Community & State	$104.63
Rate for Payer: Wellpoint Medicaid Managed Care	$115.05

Know your out-of-pocket cost for care.

All Charges