Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PROSTEP MICA SCREW 3.0 X 34MM

Facility

$5,762.85

Service Code	HCPCS C1713
Hospital Charge Code	270704139
Hospital Revenue Code	278
Min. Negotiated Rate	$864.43
Max. Negotiated Rate	$1,394.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,152.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,394.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,267.83
Rate for Payer: Qualcare PPO/HMO/WC	$864.43

PROSTEP MICA SCREW 3X20MM

Facility

$2,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270703851
Hospital Revenue Code	278
Min. Negotiated Rate	$429.00
Max. Negotiated Rate	$692.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$572.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$692.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$629.20
Rate for Payer: Qualcare PPO/HMO/WC	$429.00

PROSTEP MICA SCREW 3X20MM

Facility

$2,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270703851
Hospital Revenue Code	278
Min. Negotiated Rate	$68.93
Max. Negotiated Rate	$1,430.00
Rate for Payer: Aetna Commercial	$1,086.80
Rate for Payer: Aetna Medicare Advantage	$858.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$729.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$729.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$572.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$729.30
Rate for Payer: Cigna Commercial	$1,430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$692.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$629.20
Rate for Payer: Qualcare PPO/HMO/WC	$429.00
Rate for Payer: UnitedHealthcare Community & State	$68.93
Rate for Payer: Wellpoint Medicaid Managed Care	$75.79

PROSTEP MICA SCREW 3X32MM

Facility

$2,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270703852
Hospital Revenue Code	278
Min. Negotiated Rate	$429.00
Max. Negotiated Rate	$692.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$572.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$692.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$629.20
Rate for Payer: Qualcare PPO/HMO/WC	$429.00

PROSTEP MICA SCREW 3X32MM

Facility

$2,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270703852
Hospital Revenue Code	278
Min. Negotiated Rate	$68.93
Max. Negotiated Rate	$1,430.00
Rate for Payer: Aetna Commercial	$1,086.80
Rate for Payer: Aetna Medicare Advantage	$858.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$729.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$729.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$572.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$729.30
Rate for Payer: Cigna Commercial	$1,430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$692.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$629.20
Rate for Payer: Qualcare PPO/HMO/WC	$429.00
Rate for Payer: UnitedHealthcare Community & State	$68.93
Rate for Payer: Wellpoint Medicaid Managed Care	$75.79

PROSTEP MICA SCREW 3X36MM ST

Facility

$2,845.25

Service Code	HCPCS C1713
Hospital Charge Code	270702608
Hospital Revenue Code	278
Min. Negotiated Rate	$68.57
Max. Negotiated Rate	$1,422.62
Rate for Payer: Aetna Commercial	$1,081.19
Rate for Payer: Aetna Medicare Advantage	$853.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.54
Rate for Payer: Cigna Commercial	$1,422.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.96
Rate for Payer: Qualcare PPO/HMO/WC	$426.79
Rate for Payer: UnitedHealthcare Community & State	$68.57
Rate for Payer: Wellpoint Medicaid Managed Care	$75.40

PROSTEP MICA SCREW 3X36MM ST

Facility

$2,845.25

Service Code	HCPCS C1713
Hospital Charge Code	270702608
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$688.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.96
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

PROSTEP MICA SCREW 4X44 STER

Facility

$5,762.85

Service Code	HCPCS C1713
Hospital Charge Code	270702609
Hospital Revenue Code	278
Min. Negotiated Rate	$138.88
Max. Negotiated Rate	$2,881.43
Rate for Payer: Aetna Commercial	$2,189.88
Rate for Payer: Aetna Medicare Advantage	$1,728.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,469.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,469.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,152.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,469.53
Rate for Payer: Cigna Commercial	$2,881.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,394.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,267.83
Rate for Payer: Qualcare PPO/HMO/WC	$864.43
Rate for Payer: UnitedHealthcare Community & State	$138.88
Rate for Payer: Wellpoint Medicaid Managed Care	$152.72

PROSTEP MICA SCREW 4X44 STER

Facility

$5,762.85

Service Code	HCPCS C1713
Hospital Charge Code	270702609
Hospital Revenue Code	278
Min. Negotiated Rate	$864.43
Max. Negotiated Rate	$1,394.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,152.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,394.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,267.83
Rate for Payer: Qualcare PPO/HMO/WC	$864.43

PROSTEP MICA SCREW 4X46MM

Facility

$2,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270703853
Hospital Revenue Code	278
Min. Negotiated Rate	$429.00
Max. Negotiated Rate	$692.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$572.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$692.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$629.20
Rate for Payer: Qualcare PPO/HMO/WC	$429.00

PROSTEP MICA SCREW 4X46MM

Facility

$2,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270703853
Hospital Revenue Code	278
Min. Negotiated Rate	$68.93
Max. Negotiated Rate	$1,430.00
Rate for Payer: Aetna Commercial	$1,086.80
Rate for Payer: Aetna Medicare Advantage	$858.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$729.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$729.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$572.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$729.30
Rate for Payer: Cigna Commercial	$1,430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$692.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$629.20
Rate for Payer: Qualcare PPO/HMO/WC	$429.00
Rate for Payer: UnitedHealthcare Community & State	$68.93
Rate for Payer: Wellpoint Medicaid Managed Care	$75.79

PROSTEP MICA SCRW 4X38 STER

Facility

$2,845.25

Service Code	HCPCS C1713
Hospital Charge Code	270702619
Hospital Revenue Code	278
Min. Negotiated Rate	$68.57
Max. Negotiated Rate	$1,422.62
Rate for Payer: Aetna Commercial	$1,081.19
Rate for Payer: Aetna Medicare Advantage	$853.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.54
Rate for Payer: Cigna Commercial	$1,422.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.96
Rate for Payer: Qualcare PPO/HMO/WC	$426.79
Rate for Payer: UnitedHealthcare Community & State	$68.57
Rate for Payer: Wellpoint Medicaid Managed Care	$75.40

PROSTEP MICA SCRW 4X38 STER

Facility

$2,845.25

Service Code	HCPCS C1713
Hospital Charge Code	270702619
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$688.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.96
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

PROSTEP MICA SCRW 4X48 ST

Facility

$2,845.25

Service Code	HCPCS C1713
Hospital Charge Code	270702614
Hospital Revenue Code	278
Min. Negotiated Rate	$68.57
Max. Negotiated Rate	$1,422.62
Rate for Payer: Aetna Commercial	$1,081.19
Rate for Payer: Aetna Medicare Advantage	$853.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.54
Rate for Payer: Cigna Commercial	$1,422.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.96
Rate for Payer: Qualcare PPO/HMO/WC	$426.79
Rate for Payer: UnitedHealthcare Community & State	$68.57
Rate for Payer: Wellpoint Medicaid Managed Care	$75.40

PROSTEP MICA SCRW 4X48 ST

Facility

$2,845.25

Service Code	HCPCS C1713
Hospital Charge Code	270702614
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$688.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$625.96
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

PROSTHCERVINTERB 9X28X11MM 5D

Facility

$34,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270694928
Hospital Revenue Code	278
Min. Negotiated Rate	$5,137.50
Max. Negotiated Rate	$8,288.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,288.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,535.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,137.50

PROSTHCERVINTERB 9X28X11MM 5D

Facility

$34,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270694928
Hospital Revenue Code	278
Min. Negotiated Rate	$825.42
Max. Negotiated Rate	$17,125.00
Rate for Payer: Aetna Commercial	$13,015.00
Rate for Payer: Aetna Medicare Advantage	$10,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,733.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,733.75
Rate for Payer: Cigna Commercial	$17,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,288.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,535.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,137.50
Rate for Payer: UnitedHealthcare Community & State	$825.42
Rate for Payer: Wellpoint Medicaid Managed Care	$907.62

PROSTHESIS 0.6mm X 4.25mmL

Facility

$1,171.65

Hospital Charge Code	270639951
Hospital Revenue Code	272
Min. Negotiated Rate	$175.75
Max. Negotiated Rate	$175.75
Rate for Payer: Qualcare PPO/HMO/WC	$175.75

PROSTHESIS 0.6mm X 4.25mmL

Facility

$1,171.65

Hospital Charge Code	270639951
Hospital Revenue Code	272
Min. Negotiated Rate	$28.24
Max. Negotiated Rate	$585.83
Rate for Payer: Aetna Commercial	$445.23
Rate for Payer: Aetna Medicare Advantage	$351.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$298.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$298.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$298.77
Rate for Payer: Cigna Commercial	$585.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.50
Rate for Payer: Oxford Commercial	$234.33
Rate for Payer: Qualcare PPO/HMO/WC	$175.75
Rate for Payer: UnitedHealthcare Commercial	$234.33
Rate for Payer: UnitedHealthcare Community & State	$28.24
Rate for Payer: Wellpoint Medicaid Managed Care	$31.05

PROSTHESIS BMT HUMERAL 113705

Facility

$6,766.45

Hospital Charge Code	270609676
Hospital Revenue Code	278
Min. Negotiated Rate	$1,014.97
Max. Negotiated Rate	$1,637.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,353.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,637.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,488.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,014.97

PROSTHESIS BMT HUMERAL 113705

Facility

$6,766.45

Hospital Charge Code	270609676
Hospital Revenue Code	278
Min. Negotiated Rate	$163.07
Max. Negotiated Rate	$3,383.22
Rate for Payer: Aetna Commercial	$2,571.25
Rate for Payer: Aetna Medicare Advantage	$2,029.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,725.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,725.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,353.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,725.44
Rate for Payer: Cigna Commercial	$3,383.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,637.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,488.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,014.97
Rate for Payer: UnitedHealthcare Community & State	$163.07
Rate for Payer: Wellpoint Medicaid Managed Care	$179.31

PROSTHESIS BRST CONTR 354-2711

Facility

$3,024.00

Hospital Charge Code	270613850
Hospital Revenue Code	278
Min. Negotiated Rate	$72.88
Max. Negotiated Rate	$1,512.00
Rate for Payer: Aetna Commercial	$1,149.12
Rate for Payer: Aetna Medicare Advantage	$907.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$771.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$771.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$604.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$771.12
Rate for Payer: Cigna Commercial	$1,512.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$731.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$665.28
Rate for Payer: Qualcare PPO/HMO/WC	$453.60
Rate for Payer: UnitedHealthcare Community & State	$72.88
Rate for Payer: Wellpoint Medicaid Managed Care	$80.14

PROSTHESIS BRST CONTR 354-2711

Facility

$3,024.00

Hospital Charge Code	270613850
Hospital Revenue Code	278
Min. Negotiated Rate	$453.60
Max. Negotiated Rate	$731.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$604.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$731.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$665.28
Rate for Payer: Qualcare PPO/HMO/WC	$453.60

PROSTHESIS BRST CONTR 354-2912

Facility

$3,427.25

Hospital Charge Code	270613849
Hospital Revenue Code	278
Min. Negotiated Rate	$82.60
Max. Negotiated Rate	$1,713.62
Rate for Payer: Aetna Commercial	$1,302.36
Rate for Payer: Aetna Medicare Advantage	$1,028.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$873.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$873.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$685.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$873.95
Rate for Payer: Cigna Commercial	$1,713.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$829.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$754.00
Rate for Payer: Qualcare PPO/HMO/WC	$514.09
Rate for Payer: UnitedHealthcare Community & State	$82.60
Rate for Payer: Wellpoint Medicaid Managed Care	$90.82

PROSTHESIS BRST CONTR 354-2912

Facility

$3,427.25

Hospital Charge Code	270613849
Hospital Revenue Code	278
Min. Negotiated Rate	$514.09
Max. Negotiated Rate	$829.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$685.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$829.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$754.00
Rate for Payer: Qualcare PPO/HMO/WC	$514.09

Know your out-of-pocket cost for care.

All Charges