Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ROD PRE-LORDOSED W/LINE 75MM

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270661532
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 PRE-LORDOSED W/LINE 85MM

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270667976
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 PRE-LORDOSED W/LINE 85MM

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270667976
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 PRE-LORDOSED W/LINE 95MM

Facility

$2,000.00

Hospital Charge Code	270670735
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 PRE-LORDOSED W/LINE 95MM

Facility

$2,000.00

Hospital Charge Code	270670735
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 PRELORDOSOCCIPTISH3.5X90D

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270696792
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 PRELORDOSOCCIPTISH3.5X90D

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270696792
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 PRE LORDOT BULLET 5.5X45MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698072
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

ROD PRE LORDOT BULLET 5.5X45MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698072
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

ROD PRE LORDOT BULLET 5.5X55MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698073
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

ROD PRE LORDOT BULLET 5.5X55MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698073
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

ROD PRE-LORDOT BULLET 5.5X60MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698584
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

ROD PRE-LORDOT BULLET 5.5X60MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698584
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

ROD PRE-LORGOSED W/LINE 45mm

Facility

$3,075.00

Hospital Charge Code	270665207
Hospital Revenue Code	278
Min. Negotiated Rate	$74.11
Max. Negotiated Rate	$1,537.50
Rate for Payer: Aetna Commercial	$1,168.50
Rate for Payer: Aetna Medicare Advantage	$922.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$784.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$784.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$784.12
Rate for Payer: Cigna Commercial	$1,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$744.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$676.50
Rate for Payer: Qualcare PPO/HMO/WC	$461.25
Rate for Payer: UnitedHealthcare Community & State	$74.11
Rate for Payer: Wellpoint Medicaid Managed Care	$81.49

ROD PRE-LORGOSED W/LINE 45mm

Facility

$3,075.00

Hospital Charge Code	270665207
Hospital Revenue Code	278
Min. Negotiated Rate	$461.25
Max. Negotiated Rate	$744.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$744.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$676.50
Rate for Payer: Qualcare PPO/HMO/WC	$461.25

ROD RAD DIA 6 MM 40 MM

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270691421
Hospital Revenue Code	278
Min. Negotiated Rate	$59.65
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Community & State	$59.65
Rate for Payer: Wellpoint Medicaid Managed Care	$65.59

ROD RAD DIA 6 MM 40 MM

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270691421
Hospital Revenue Code	278
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$598.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

ROD RAD DIAM 6 MM X 45 MM

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270691012
Hospital Revenue Code	278
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$598.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

ROD RAD DIAM 6 MM X 45 MM

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270691012
Hospital Revenue Code	278
Min. Negotiated Rate	$59.65
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Community & State	$59.65
Rate for Payer: Wellpoint Medicaid Managed Care	$65.59

ROD REAMING 2.5 X 950MM

Facility

$677.95

Hospital Charge Code	270656627
Hospital Revenue Code	272
Min. Negotiated Rate	$16.34
Max. Negotiated Rate	$338.98
Rate for Payer: Aetna Commercial	$257.62
Rate for Payer: Aetna Medicare Advantage	$203.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.88
Rate for Payer: Cigna Commercial	$338.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.38
Rate for Payer: Oxford Commercial	$135.59
Rate for Payer: Qualcare PPO/HMO/WC	$101.69
Rate for Payer: UnitedHealthcare Commercial	$135.59
Rate for Payer: UnitedHealthcare Community & State	$16.34
Rate for Payer: Wellpoint Medicaid Managed Care	$17.97

ROD REAMING 2.5 X 950MM

Facility

$677.95

Hospital Charge Code	270656627
Hospital Revenue Code	272
Min. Negotiated Rate	$101.69
Max. Negotiated Rate	$101.69
Rate for Payer: Qualcare PPO/HMO/WC	$101.69

ROD REAMING 3MM OFFSET BALL ST

Facility

$714.00

Hospital Charge Code	270652133
Hospital Revenue Code	272
Min. Negotiated Rate	$17.21
Max. Negotiated Rate	$357.00
Rate for Payer: Aetna Commercial	$271.32
Rate for Payer: Aetna Medicare Advantage	$214.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$182.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$182.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$182.07
Rate for Payer: Cigna Commercial	$357.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.20
Rate for Payer: Oxford Commercial	$142.80
Rate for Payer: Qualcare PPO/HMO/WC	$107.10
Rate for Payer: UnitedHealthcare Commercial	$142.80
Rate for Payer: UnitedHealthcare Community & State	$17.21
Rate for Payer: Wellpoint Medicaid Managed Care	$18.92

ROD REAMING 3MM OFFSET BALL ST

Facility

$714.00

Hospital Charge Code	270652133
Hospital Revenue Code	272
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$107.10
Rate for Payer: Qualcare PPO/HMO/WC	$107.10

ROD REAMING BALL TIP 2.5x1150M

Facility

$607.90

Service Code	HCPCS C1713
Hospital Charge Code	270680628
Hospital Revenue Code	278
Min. Negotiated Rate	$14.65
Max. Negotiated Rate	$303.95
Rate for Payer: Aetna Commercial	$231.00
Rate for Payer: Aetna Medicare Advantage	$182.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.01
Rate for Payer: Cigna Commercial	$303.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$133.74
Rate for Payer: Qualcare PPO/HMO/WC	$91.19
Rate for Payer: UnitedHealthcare Community & State	$14.65
Rate for Payer: Wellpoint Medicaid Managed Care	$16.11

ROD REAMING BALL TIP 2.5x1150M

Facility

$607.90

Service Code	HCPCS C1713
Hospital Charge Code	270680628
Hospital Revenue Code	278
Min. Negotiated Rate	$91.19
Max. Negotiated Rate	$147.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$133.74
Rate for Payer: Qualcare PPO/HMO/WC	$91.19

Know your out-of-pocket cost for care.

All Charges