Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ROD CARBON FIBER 11x450MM

Facility

$1,253.95

Service Code	HCPCS C1713
Hospital Charge Code	270639006
Hospital Revenue Code	278
Min. Negotiated Rate	$30.22
Max. Negotiated Rate	$626.98
Rate for Payer: Aetna Commercial	$476.50
Rate for Payer: Aetna Medicare Advantage	$376.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$319.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$319.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$319.76
Rate for Payer: Cigna Commercial	$626.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.87
Rate for Payer: Qualcare PPO/HMO/WC	$188.09
Rate for Payer: UnitedHealthcare Community & State	$30.22
Rate for Payer: Wellpoint Medicaid Managed Care	$33.23

ROD CARBON FIBER 11x450MM

Facility

$1,253.95

Service Code	HCPCS C1713
Hospital Charge Code	270639006
Hospital Revenue Code	278
Min. Negotiated Rate	$188.09
Max. Negotiated Rate	$303.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.87
Rate for Payer: Qualcare PPO/HMO/WC	$188.09

ROD CARBON FIBER 11X500 39489

Facility

$1,270.00

Hospital Charge Code	270639007
Hospital Revenue Code	278
Min. Negotiated Rate	$30.61
Max. Negotiated Rate	$635.00
Rate for Payer: Aetna Commercial	$482.60
Rate for Payer: Aetna Medicare Advantage	$381.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$323.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$323.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$254.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$323.85
Rate for Payer: Cigna Commercial	$635.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$279.40
Rate for Payer: Qualcare PPO/HMO/WC	$190.50
Rate for Payer: UnitedHealthcare Community & State	$30.61
Rate for Payer: Wellpoint Medicaid Managed Care	$33.66

ROD CARBON FIBER 11X500 39489

Facility

$1,270.00

Hospital Charge Code	270639007
Hospital Revenue Code	278
Min. Negotiated Rate	$190.50
Max. Negotiated Rate	$307.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$254.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$279.40
Rate for Payer: Qualcare PPO/HMO/WC	$190.50

ROD CARBON FIBER 8.0mm X 160mm

Facility

$704.50

Service Code	HCPCS C1713
Hospital Charge Code	270644917
Hospital Revenue Code	278
Min. Negotiated Rate	$16.98
Max. Negotiated Rate	$352.25
Rate for Payer: Aetna Commercial	$267.71
Rate for Payer: Aetna Medicare Advantage	$211.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$179.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$179.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$179.65
Rate for Payer: Cigna Commercial	$352.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.99
Rate for Payer: Qualcare PPO/HMO/WC	$105.67
Rate for Payer: UnitedHealthcare Community & State	$16.98
Rate for Payer: Wellpoint Medicaid Managed Care	$18.67

ROD CARBON FIBER 8.0mm X 160mm

Facility

$704.50

Service Code	HCPCS C1713
Hospital Charge Code	270644917
Hospital Revenue Code	278
Min. Negotiated Rate	$105.67
Max. Negotiated Rate	$170.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.99
Rate for Payer: Qualcare PPO/HMO/WC	$105.67

ROD CARBON FIBER 8.0mm X 220mm

Facility

$698.35

Service Code	HCPCS C1713
Hospital Charge Code	270619758
Hospital Revenue Code	278
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$349.18
Rate for Payer: Aetna Commercial	$265.37
Rate for Payer: Aetna Medicare Advantage	$209.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.08
Rate for Payer: Cigna Commercial	$349.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$153.64
Rate for Payer: Qualcare PPO/HMO/WC	$104.75
Rate for Payer: UnitedHealthcare Community & State	$16.83
Rate for Payer: Wellpoint Medicaid Managed Care	$18.51

ROD CARBON FIBER 8.0mm X 220mm

Facility

$698.35

Service Code	HCPCS C1713
Hospital Charge Code	270619758
Hospital Revenue Code	278
Min. Negotiated Rate	$104.75
Max. Negotiated Rate	$169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$153.64
Rate for Payer: Qualcare PPO/HMO/WC	$104.75

ROD CARBON FIBER 8.0mm X 280mm

Facility

$704.50

Service Code	HCPCS C1713
Hospital Charge Code	270644918
Hospital Revenue Code	278
Min. Negotiated Rate	$16.98
Max. Negotiated Rate	$352.25
Rate for Payer: Aetna Commercial	$267.71
Rate for Payer: Aetna Medicare Advantage	$211.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$179.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$179.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$179.65
Rate for Payer: Cigna Commercial	$352.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.99
Rate for Payer: Qualcare PPO/HMO/WC	$105.67
Rate for Payer: UnitedHealthcare Community & State	$16.98
Rate for Payer: Wellpoint Medicaid Managed Care	$18.67

ROD CARBON FIBER 8.0mm X 280mm

Facility

$704.50

Service Code	HCPCS C1713
Hospital Charge Code	270644918
Hospital Revenue Code	278
Min. Negotiated Rate	$105.67
Max. Negotiated Rate	$170.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.99
Rate for Payer: Qualcare PPO/HMO/WC	$105.67

ROD CARBON FIBER 9.5x350mm

Facility

$990.00

Hospital Charge Code	270672337
Hospital Revenue Code	278
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$239.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$198.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$239.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$148.50

ROD CARBON FIBER 9.5x350mm

Facility

$990.00

Hospital Charge Code	270672337
Hospital Revenue Code	278
Min. Negotiated Rate	$23.86
Max. Negotiated Rate	$495.00
Rate for Payer: Aetna Commercial	$376.20
Rate for Payer: Aetna Medicare Advantage	$297.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.45
Rate for Payer: Cigna Commercial	$495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$239.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$217.80
Rate for Payer: Qualcare PPO/HMO/WC	$148.50
Rate for Payer: UnitedHealthcare Community & State	$23.86
Rate for Payer: Wellpoint Medicaid Managed Care	$26.23

ROD CD SOLERA TI PERC 5.5X90MM

Facility

$3,205.00

Service Code	HCPCS C1713
Hospital Charge Code	270699431
Hospital Revenue Code	278
Min. Negotiated Rate	$480.75
Max. Negotiated Rate	$775.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$641.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$775.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$705.10
Rate for Payer: Qualcare PPO/HMO/WC	$480.75

ROD CD SOLERA TI PERC 5.5X90MM

Facility

$3,205.00

Service Code	HCPCS C1713
Hospital Charge Code	270699431
Hospital Revenue Code	278
Min. Negotiated Rate	$77.24
Max. Negotiated Rate	$1,602.50
Rate for Payer: Aetna Commercial	$1,217.90
Rate for Payer: Aetna Medicare Advantage	$961.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$817.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$817.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$641.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$817.27
Rate for Payer: Cigna Commercial	$1,602.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$775.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$705.10
Rate for Payer: Qualcare PPO/HMO/WC	$480.75
Rate for Payer: UnitedHealthcare Community & State	$77.24
Rate for Payer: Wellpoint Medicaid Managed Care	$84.93

ROD & CLAMP 8/8mm MRI 49211010

Facility

$3,665.00

Hospital Charge Code	270643402
Hospital Revenue Code	272
Min. Negotiated Rate	$549.75
Max. Negotiated Rate	$549.75
Rate for Payer: Qualcare PPO/HMO/WC	$549.75

ROD & CLAMP 8/8mm MRI 49211010

Facility

$3,665.00

Hospital Charge Code	270643402
Hospital Revenue Code	272
Min. Negotiated Rate	$88.33
Max. Negotiated Rate	$1,832.50
Rate for Payer: Aetna Commercial	$1,392.70
Rate for Payer: Aetna Medicare Advantage	$1,099.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$934.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$934.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$934.58
Rate for Payer: Cigna Commercial	$1,832.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,099.50
Rate for Payer: Oxford Commercial	$733.00
Rate for Payer: Qualcare PPO/HMO/WC	$549.75
Rate for Payer: UnitedHealthcare Commercial	$733.00
Rate for Payer: UnitedHealthcare Community & State	$88.33
Rate for Payer: Wellpoint Medicaid Managed Care	$97.12

ROD CLAMP RING 393436

Facility

$4,128.25

Service Code	HCPCS C1713
Hospital Charge Code	270632994
Hospital Revenue Code	278
Min. Negotiated Rate	$99.49
Max. Negotiated Rate	$2,064.12
Rate for Payer: Aetna Commercial	$1,568.73
Rate for Payer: Aetna Medicare Advantage	$1,238.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,052.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,052.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,052.70
Rate for Payer: Cigna Commercial	$2,064.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$999.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$908.22
Rate for Payer: Qualcare PPO/HMO/WC	$619.24
Rate for Payer: UnitedHealthcare Community & State	$99.49
Rate for Payer: Wellpoint Medicaid Managed Care	$109.40

ROD CLAMP RING 393436

Facility

$4,128.25

Service Code	HCPCS C1713
Hospital Charge Code	270632994
Hospital Revenue Code	278
Min. Negotiated Rate	$619.24
Max. Negotiated Rate	$999.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$999.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$908.22
Rate for Payer: Qualcare PPO/HMO/WC	$619.24

ROD CL PERC TI 5.5X45MMROD CL

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695964
Hospital Revenue Code	278
Min. Negotiated Rate	$66.28
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$1,045.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.50
Rate for Payer: UnitedHealthcare Community & State	$66.28
Rate for Payer: Wellpoint Medicaid Managed Care	$72.88

ROD CL PERC TI 5.5X45MMROD CL

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695964
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$665.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

ROD CONN ADJUSTING LG****

Facility

$485.00

Hospital Charge Code	1601905
Hospital Revenue Code	274
Min. Negotiated Rate	$11.69
Max. Negotiated Rate	$242.50
Rate for Payer: Aetna Commercial	$184.30
Rate for Payer: Aetna Medicare Advantage	$145.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.67
Rate for Payer: Cigna Commercial	$242.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$106.70
Rate for Payer: Qualcare PPO/HMO/WC	$72.75
Rate for Payer: UnitedHealthcare Community & State	$11.69
Rate for Payer: Wellpoint Medicaid Managed Care	$12.85

ROD CONN ADJUSTING LG****

Facility

$485.00

Hospital Charge Code	1601905
Hospital Revenue Code	274
Min. Negotiated Rate	$72.75
Max. Negotiated Rate	$117.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$106.70
Rate for Payer: Qualcare PPO/HMO/WC	$72.75

ROD CONNECT CAR 8x250 50288250

Facility

$1,955.00

Hospital Charge Code	270643442
Hospital Revenue Code	278
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$977.50
Rate for Payer: Aetna Commercial	$742.90
Rate for Payer: Aetna Medicare Advantage	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$498.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$498.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$391.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$498.52
Rate for Payer: Cigna Commercial	$977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$473.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$430.10
Rate for Payer: Qualcare PPO/HMO/WC	$293.25
Rate for Payer: UnitedHealthcare Community & State	$47.12
Rate for Payer: Wellpoint Medicaid Managed Care	$51.81

ROD CONNECT CAR 8x250 50288250

Facility

$1,955.00

Hospital Charge Code	270643442
Hospital Revenue Code	278
Min. Negotiated Rate	$293.25
Max. Negotiated Rate	$473.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$391.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$473.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$430.10
Rate for Payer: Qualcare PPO/HMO/WC	$293.25

ROD CONNECTING 11X200MM

Facility

$2,530.00

Service Code	HCPCS C1713
Hospital Charge Code	270669477
Hospital Revenue Code	278
Min. Negotiated Rate	$60.97
Max. Negotiated Rate	$1,265.00
Rate for Payer: Aetna Commercial	$961.40
Rate for Payer: Aetna Medicare Advantage	$759.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$645.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$645.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$506.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$645.15
Rate for Payer: Cigna Commercial	$1,265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$612.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$556.60
Rate for Payer: Qualcare PPO/HMO/WC	$379.50
Rate for Payer: UnitedHealthcare Community & State	$60.97
Rate for Payer: Wellpoint Medicaid Managed Care	$67.05

Know your out-of-pocket cost for care.

All Charges