Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE X MED TI 3.0MM

Facility

$4,285.50

Service Code	HCPCS C1713
Hospital Charge Code	270698367
Hospital Revenue Code	278
Min. Negotiated Rate	$103.28
Max. Negotiated Rate	$2,142.75
Rate for Payer: Aetna Commercial	$1,628.49
Rate for Payer: Aetna Medicare Advantage	$1,285.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.80
Rate for Payer: Cigna Commercial	$2,142.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,037.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.81
Rate for Payer: Qualcare PPO/HMO/WC	$642.83
Rate for Payer: UnitedHealthcare Community & State	$103.28
Rate for Payer: Wellpoint Medicaid Managed Care	$113.57

PLATE X MED TI 3.0MM

Facility

$4,285.50

Service Code	HCPCS C1713
Hospital Charge Code	270698367
Hospital Revenue Code	278
Min. Negotiated Rate	$642.83
Max. Negotiated Rate	$1,037.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$857.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,037.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$942.81
Rate for Payer: Qualcare PPO/HMO/WC	$642.83

PLATE Y 7mm MTRX 04.503.377

Facility

$1,239.00

Hospital Charge Code	270640449
Hospital Revenue Code	278
Min. Negotiated Rate	$185.85
Max. Negotiated Rate	$299.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$247.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$272.58
Rate for Payer: Qualcare PPO/HMO/WC	$185.85

PLATE Y 7mm MTRX 04.503.377

Facility

$1,239.00

Hospital Charge Code	270640449
Hospital Revenue Code	278
Min. Negotiated Rate	$29.86
Max. Negotiated Rate	$619.50
Rate for Payer: Aetna Commercial	$470.82
Rate for Payer: Aetna Medicare Advantage	$371.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$315.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$315.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$247.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$315.94
Rate for Payer: Cigna Commercial	$619.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$272.58
Rate for Payer: Qualcare PPO/HMO/WC	$185.85
Rate for Payer: UnitedHealthcare Community & State	$29.86
Rate for Payer: Wellpoint Medicaid Managed Care	$32.83

PLATE Y LONG 5HOLE

Facility

$1,680.00

Hospital Charge Code	270677109
Hospital Revenue Code	278
Min. Negotiated Rate	$40.49
Max. Negotiated Rate	$840.00
Rate for Payer: Aetna Commercial	$638.40
Rate for Payer: Aetna Medicare Advantage	$504.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$428.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$428.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$428.40
Rate for Payer: Cigna Commercial	$840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$369.60
Rate for Payer: Qualcare PPO/HMO/WC	$252.00
Rate for Payer: UnitedHealthcare Community & State	$40.49
Rate for Payer: Wellpoint Medicaid Managed Care	$44.52

PLATE Y LONG 5HOLE

Facility

$1,680.00

Hospital Charge Code	270677109
Hospital Revenue Code	278
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$406.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$336.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$369.60
Rate for Payer: Qualcare PPO/HMO/WC	$252.00

PLATE Y LONG DBL 6HOLE

Facility

$1,700.00

Hospital Charge Code	270677108
Hospital Revenue Code	278
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$411.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$374.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

PLATE Y LONG DBL 6HOLE

Facility

$1,700.00

Hospital Charge Code	270677108
Hospital Revenue Code	278
Min. Negotiated Rate	$40.97
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$646.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$374.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Community & State	$40.97
Rate for Payer: Wellpoint Medicaid Managed Care	$45.05

PLATE ZAVATION 2MM

Facility

$13,000.00

Hospital Charge Code	270675884
Hospital Revenue Code	278
Min. Negotiated Rate	$313.30
Max. Negotiated Rate	$6,500.00
Rate for Payer: Aetna Commercial	$4,940.00
Rate for Payer: Aetna Medicare Advantage	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,315.00
Rate for Payer: Cigna Commercial	$6,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,860.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00
Rate for Payer: UnitedHealthcare Community & State	$313.30
Rate for Payer: Wellpoint Medicaid Managed Care	$344.50

PLATE ZAVATION 2MM

Facility

$13,000.00

Hospital Charge Code	270675884
Hospital Revenue Code	278
Min. Negotiated Rate	$1,950.00
Max. Negotiated Rate	$3,146.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,146.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,860.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,950.00

PLATE ZAVATION CERV 2LEVEL26MM

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698829
Hospital Revenue Code	278
Min. Negotiated Rate	$421.75
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$421.75
Rate for Payer: Wellpoint Medicaid Managed Care	$463.75

PLATE ZAVATION CERV 2LEVEL26MM

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698829
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,850.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

PLATE ZEVO 35MM 2 LVL

Facility

$12,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698646
Hospital Revenue Code	278
Min. Negotiated Rate	$301.25
Max. Negotiated Rate	$6,250.00
Rate for Payer: Aetna Commercial	$4,750.00
Rate for Payer: Aetna Medicare Advantage	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,187.50
Rate for Payer: Cigna Commercial	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00
Rate for Payer: UnitedHealthcare Community & State	$301.25
Rate for Payer: Wellpoint Medicaid Managed Care	$331.25

PLATE ZEVO 35MM 2 LVL

Facility

$12,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698646
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

PLATE ZEVO 39MM 2 LVL

Facility

$11,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270698146
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

PLATE ZEVO 39MM 2 LVL

Facility

$11,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270698146
Hospital Revenue Code	278
Min. Negotiated Rate	$271.12
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50
Rate for Payer: UnitedHealthcare Community & State	$271.12
Rate for Payer: Wellpoint Medicaid Managed Care	$298.12

PLATE ZEVO 3 LEVEL 57MM

Facility

$11,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270697834
Hospital Revenue Code	278
Min. Negotiated Rate	$271.12
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50
Rate for Payer: UnitedHealthcare Community & State	$271.12
Rate for Payer: Wellpoint Medicaid Managed Care	$298.12

PLATE ZEVO 3 LEVEL 57MM

Facility

$11,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270697834
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

PLATE ZEVO 78MM 4 LEVEL

Facility

$12,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697821
Hospital Revenue Code	278
Min. Negotiated Rate	$307.27
Max. Negotiated Rate	$6,375.00
Rate for Payer: Aetna Commercial	$4,845.00
Rate for Payer: Aetna Medicare Advantage	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,251.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,251.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,251.25
Rate for Payer: Cigna Commercial	$6,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,085.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,805.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.50
Rate for Payer: UnitedHealthcare Community & State	$307.27
Rate for Payer: Wellpoint Medicaid Managed Care	$337.88

PLATE ZEVO 78MM 4 LEVEL

Facility

$12,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270697821
Hospital Revenue Code	278
Min. Negotiated Rate	$1,912.50
Max. Negotiated Rate	$3,085.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,085.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,805.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,912.50

PLATE ZEVO ANT CERV LEV3 53MM

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695967
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

PLATE ZEVO ANT CERV LEV3 53MM

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695967
Hospital Revenue Code	278
Min. Negotiated Rate	$331.38
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$5,225.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50
Rate for Payer: UnitedHealthcare Community & State	$331.38
Rate for Payer: Wellpoint Medicaid Managed Care	$364.38

PLATE ZIM 1/3 TUB 6H 236106

Facility

$320.85

Hospital Charge Code	270610254
Hospital Revenue Code	278
Min. Negotiated Rate	$48.13
Max. Negotiated Rate	$77.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$70.59
Rate for Payer: Qualcare PPO/HMO/WC	$48.13

PLATE ZIM 1/3 TUB 6H 236106

Facility

$320.85

Hospital Charge Code	270610254
Hospital Revenue Code	278
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$160.43
Rate for Payer: Aetna Commercial	$121.92
Rate for Payer: Aetna Medicare Advantage	$96.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.82
Rate for Payer: Cigna Commercial	$160.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$70.59
Rate for Payer: Qualcare PPO/HMO/WC	$48.13
Rate for Payer: UnitedHealthcare Community & State	$7.73
Rate for Payer: Wellpoint Medicaid Managed Care	$8.50

PLATE ZIM 1/3 TUB 7H 236107

Facility

$150.45

Hospital Charge Code	270607163
Hospital Revenue Code	278
Min. Negotiated Rate	$22.57
Max. Negotiated Rate	$36.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$33.10
Rate for Payer: Qualcare PPO/HMO/WC	$22.57

Know your out-of-pocket cost for care.

All Charges