Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ROD LORDOTIC TI 5.5X70MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695319
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

ROD LORDOTIC TI 5.5X70MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695319
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

ROD LORDOTIC TI 5.5X75MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692449
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 LORDOTIC TI 5.5X75MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692449
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 LORDOTIC TI CL 5.5X80MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695891
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 LORDOTIC TI CL 5.5X80MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695891
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 LORDOTIC TI STR 3.5X240MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694824
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

ROD LORDOTIC TI STR 3.5X240MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694824
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

ROD LORDOTR PREBENT 55MM

Facility

$4,580.00

Hospital Charge Code	270657316
Hospital Revenue Code	278
Min. Negotiated Rate	$110.38
Max. Negotiated Rate	$2,290.00
Rate for Payer: Aetna Commercial	$1,740.40
Rate for Payer: Aetna Medicare Advantage	$1,374.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,167.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,167.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$916.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,167.90
Rate for Payer: Cigna Commercial	$2,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,108.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,007.60
Rate for Payer: Qualcare PPO/HMO/WC	$687.00
Rate for Payer: UnitedHealthcare Community & State	$110.38
Rate for Payer: Wellpoint Medicaid Managed Care	$121.37

ROD LORDOTR PREBENT 55MM

Facility

$4,580.00

Hospital Charge Code	270657316
Hospital Revenue Code	278
Min. Negotiated Rate	$687.00
Max. Negotiated Rate	$1,108.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$916.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,108.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,007.60
Rate for Payer: Qualcare PPO/HMO/WC	$687.00

ROD LOTUS AXIAL CONN 3.5X3.5MM

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698265
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

ROD LOTUS AXIAL CONN 3.5X3.5MM

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698265
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

ROD LOTUS AXIAL CONN 3.5X5.5MM

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698264
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

ROD LOTUS AXIAL CONN 3.5X5.5MM

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698264
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

ROD LOTUS LORDOSED 3.5X240MM

Facility

$720.00

Service Code	HCPCS C1713
Hospital Charge Code	270698263
Hospital Revenue Code	278
Min. Negotiated Rate	$17.35
Max. Negotiated Rate	$360.00
Rate for Payer: Aetna Commercial	$273.60
Rate for Payer: Aetna Medicare Advantage	$216.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.60
Rate for Payer: Cigna Commercial	$360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$158.40
Rate for Payer: Qualcare PPO/HMO/WC	$108.00
Rate for Payer: UnitedHealthcare Community & State	$17.35
Rate for Payer: Wellpoint Medicaid Managed Care	$19.08

ROD LOTUS LORDOSED 3.5X240MM

Facility

$720.00

Service Code	HCPCS C1713
Hospital Charge Code	270698263
Hospital Revenue Code	278
Min. Negotiated Rate	$108.00
Max. Negotiated Rate	$174.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$158.40
Rate for Payer: Qualcare PPO/HMO/WC	$108.00

ROD LOTUS LORDOSED 3.5X40MM

Facility

$720.00

Service Code	HCPCS C1713
Hospital Charge Code	270696779
Hospital Revenue Code	278
Min. Negotiated Rate	$17.35
Max. Negotiated Rate	$360.00
Rate for Payer: Aetna Commercial	$273.60
Rate for Payer: Aetna Medicare Advantage	$216.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.60
Rate for Payer: Cigna Commercial	$360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$158.40
Rate for Payer: Qualcare PPO/HMO/WC	$108.00
Rate for Payer: UnitedHealthcare Community & State	$17.35
Rate for Payer: Wellpoint Medicaid Managed Care	$19.08

ROD LOTUS LORDOSED 3.5X40MM

Facility

$720.00

Service Code	HCPCS C1713
Hospital Charge Code	270696779
Hospital Revenue Code	278
Min. Negotiated Rate	$108.00
Max. Negotiated Rate	$174.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$158.40
Rate for Payer: Qualcare PPO/HMO/WC	$108.00

ROD MAS PLIF FIXATION 35MM PRE

Facility

$2,980.00

Hospital Charge Code	270663772
Hospital Revenue Code	278
Min. Negotiated Rate	$71.82
Max. Negotiated Rate	$1,490.00
Rate for Payer: Aetna Commercial	$1,132.40
Rate for Payer: Aetna Medicare Advantage	$894.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$759.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$759.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$596.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$759.90
Rate for Payer: Cigna Commercial	$1,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$721.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$655.60
Rate for Payer: Qualcare PPO/HMO/WC	$447.00
Rate for Payer: UnitedHealthcare Community & State	$71.82
Rate for Payer: Wellpoint Medicaid Managed Care	$78.97

ROD MAS PLIF FIXATION 35MM PRE

Facility

$2,980.00

Hospital Charge Code	270663772
Hospital Revenue Code	278
Min. Negotiated Rate	$447.00
Max. Negotiated Rate	$721.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$596.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$721.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$655.60
Rate for Payer: Qualcare PPO/HMO/WC	$447.00

ROD MEDIUM FA10000.2

Facility

$4,290.45

Hospital Charge Code	270632397
Hospital Revenue Code	278
Min. Negotiated Rate	$643.57
Max. Negotiated Rate	$1,038.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$858.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,038.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$943.90
Rate for Payer: Qualcare PPO/HMO/WC	$643.57

ROD MEDIUM FA10000.2

Facility

$4,290.45

Hospital Charge Code	270632397
Hospital Revenue Code	278
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$2,145.22
Rate for Payer: Aetna Commercial	$1,630.37
Rate for Payer: Aetna Medicare Advantage	$1,287.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,094.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,094.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$858.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,094.06
Rate for Payer: Cigna Commercial	$2,145.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,038.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$943.90
Rate for Payer: Qualcare PPO/HMO/WC	$643.57
Rate for Payer: UnitedHealthcare Community & State	$103.40
Rate for Payer: Wellpoint Medicaid Managed Care	$113.70

ROD MEDT TUNNELING 859041

Facility

$690.45

Hospital Charge Code	270612540
Hospital Revenue Code	278
Min. Negotiated Rate	$103.57
Max. Negotiated Rate	$167.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.90
Rate for Payer: Qualcare PPO/HMO/WC	$103.57

ROD MEDT TUNNELING 859041

Facility

$690.45

Hospital Charge Code	270612540
Hospital Revenue Code	278
Min. Negotiated Rate	$16.64
Max. Negotiated Rate	$345.23
Rate for Payer: Aetna Commercial	$262.37
Rate for Payer: Aetna Medicare Advantage	$207.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$176.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$138.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$176.06
Rate for Payer: Cigna Commercial	$345.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$151.90
Rate for Payer: Qualcare PPO/HMO/WC	$103.57
Rate for Payer: UnitedHealthcare Community & State	$16.64
Rate for Payer: Wellpoint Medicaid Managed Care	$18.30

ROD MERCURY BULLET LORDO 45MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693008
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

Know your out-of-pocket cost for care.

All Charges