Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

3.5X40 PT SCREW

Facility

$885.00

Service Code	HCPCS C1713
Hospital Charge Code	270703144
Hospital Revenue Code	278
Min. Negotiated Rate	$132.75
Max. Negotiated Rate	$214.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$194.70
Rate for Payer: Qualcare PPO/HMO/WC	$132.75

3.5X40 PT SCREW

Facility

$885.00

Service Code	HCPCS C1713
Hospital Charge Code	270703144
Hospital Revenue Code	278
Min. Negotiated Rate	$21.33
Max. Negotiated Rate	$442.50
Rate for Payer: Aetna Commercial	$336.30
Rate for Payer: Aetna Medicare Advantage	$265.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.68
Rate for Payer: Cigna Commercial	$442.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$194.70
Rate for Payer: Qualcare PPO/HMO/WC	$132.75
Rate for Payer: UnitedHealthcare Community & State	$21.33
Rate for Payer: Wellpoint Medicaid Managed Care	$23.45

3.5X4.2MM CORTICAL SCREW

Facility

$145.00

Hospital Charge Code	270656407
Hospital Revenue Code	278
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$72.50
Rate for Payer: Aetna Commercial	$55.10
Rate for Payer: Aetna Medicare Advantage	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.98
Rate for Payer: Cigna Commercial	$72.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$31.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.75
Rate for Payer: UnitedHealthcare Community & State	$3.49
Rate for Payer: Wellpoint Medicaid Managed Care	$3.84

3.5X4.2MM CORTICAL SCREW

Facility

$145.00

Hospital Charge Code	270656407
Hospital Revenue Code	278
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$31.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

3.5 X 50MM NONLOCK SCREW

Facility

$602.50

Service Code	HCPCS C1713
Hospital Charge Code	270704491
Hospital Revenue Code	279
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$90.38
Rate for Payer: Qualcare PPO/HMO/WC	$90.38

3.5 X 50MM NONLOCK SCREW

Facility

$602.50

Service Code	HCPCS C1713
Hospital Charge Code	270704491
Hospital Revenue Code	279
Min. Negotiated Rate	$14.52
Max. Negotiated Rate	$301.25
Rate for Payer: Aetna Commercial	$228.95
Rate for Payer: Aetna Medicare Advantage	$180.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.64
Rate for Payer: Cigna Commercial	$301.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.75
Rate for Payer: Oxford Commercial	$120.50
Rate for Payer: Qualcare PPO/HMO/WC	$90.38
Rate for Payer: UnitedHealthcare Commercial	$120.50
Rate for Payer: UnitedHealthcare Community & State	$14.52
Rate for Payer: Wellpoint Medicaid Managed Care	$15.97

3.5X55 CORT.SCREW

Facility

$200.00

Hospital Charge Code	270656403
Hospital Revenue Code	278
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$44.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

3.5X55 CORT.SCREW

Facility

$200.00

Hospital Charge Code	270656403
Hospital Revenue Code	278
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$44.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Community & State	$4.82
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

3.5X56 SCREW

Facility

$662.00

Service Code	HCPCS C1713
Hospital Charge Code	270675181
Hospital Revenue Code	278
Min. Negotiated Rate	$99.30
Max. Negotiated Rate	$160.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.64
Rate for Payer: Qualcare PPO/HMO/WC	$99.30

3.5X56 SCREW

Facility

$662.00

Service Code	HCPCS C1713
Hospital Charge Code	270675181
Hospital Revenue Code	278
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$331.00
Rate for Payer: Aetna Commercial	$251.56
Rate for Payer: Aetna Medicare Advantage	$198.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.81
Rate for Payer: Cigna Commercial	$331.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.64
Rate for Payer: Qualcare PPO/HMO/WC	$99.30
Rate for Payer: UnitedHealthcare Community & State	$15.95
Rate for Payer: Wellpoint Medicaid Managed Care	$17.54

3.5X60 CORT.SCREW

Facility

$200.00

Hospital Charge Code	270656404
Hospital Revenue Code	278
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$44.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Community & State	$4.82
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

3.5X60 CORT.SCREW

Facility

$200.00

Hospital Charge Code	270656404
Hospital Revenue Code	278
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$48.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$44.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

3.5X8MM CORTICAL LOCK SCREW

Facility

$590.00

Hospital Charge Code	270656018
Hospital Revenue Code	278
Min. Negotiated Rate	$88.50
Max. Negotiated Rate	$142.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$118.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$129.80
Rate for Payer: Qualcare PPO/HMO/WC	$88.50

3.5X8MM CORTICAL LOCK SCREW

Facility

$590.00

Hospital Charge Code	270656018
Hospital Revenue Code	278
Min. Negotiated Rate	$14.22
Max. Negotiated Rate	$295.00
Rate for Payer: Aetna Commercial	$224.20
Rate for Payer: Aetna Medicare Advantage	$177.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$118.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.45
Rate for Payer: Cigna Commercial	$295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$129.80
Rate for Payer: Qualcare PPO/HMO/WC	$88.50
Rate for Payer: UnitedHealthcare Community & State	$14.22
Rate for Payer: Wellpoint Medicaid Managed Care	$15.63

36MM 10DEG FOR 62MM O.D. SHELL

Facility

$6,221.55

Hospital Charge Code	270656891
Hospital Revenue Code	278
Min. Negotiated Rate	$933.23
Max. Negotiated Rate	$1,505.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,368.74
Rate for Payer: Qualcare PPO/HMO/WC	$933.23

36MM 10DEG FOR 62MM O.D. SHELL

Facility

$6,221.55

Hospital Charge Code	270656891
Hospital Revenue Code	278
Min. Negotiated Rate	$149.94
Max. Negotiated Rate	$3,110.78
Rate for Payer: Aetna Commercial	$2,364.19
Rate for Payer: Aetna Medicare Advantage	$1,866.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,586.50
Rate for Payer: Cigna Commercial	$3,110.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,368.74
Rate for Payer: Qualcare PPO/HMO/WC	$933.23
Rate for Payer: UnitedHealthcare Community & State	$149.94
Rate for Payer: Wellpoint Medicaid Managed Care	$164.87

36MM-3.5 HEAD

Facility

$3,311.05

Service Code	HCPCS C1713
Hospital Charge Code	270656893
Hospital Revenue Code	278
Min. Negotiated Rate	$496.66
Max. Negotiated Rate	$801.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$662.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$801.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$728.43
Rate for Payer: Qualcare PPO/HMO/WC	$496.66

36MM-3.5 HEAD

Facility

$3,311.05

Service Code	HCPCS C1713
Hospital Charge Code	270656893
Hospital Revenue Code	278
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$1,655.53
Rate for Payer: Aetna Commercial	$1,258.20
Rate for Payer: Aetna Medicare Advantage	$993.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$844.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$844.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$662.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$844.32
Rate for Payer: Cigna Commercial	$1,655.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$801.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$728.43
Rate for Payer: Qualcare PPO/HMO/WC	$496.66
Rate for Payer: UnitedHealthcare Community & State	$79.80
Rate for Payer: Wellpoint Medicaid Managed Care	$87.74

36MM 50/52/54 LINER

Facility

$6,221.55

Service Code	HCPCS C1776
Hospital Charge Code	270656895
Hospital Revenue Code	278
Min. Negotiated Rate	$149.94
Max. Negotiated Rate	$3,110.78
Rate for Payer: Aetna Commercial	$2,364.19
Rate for Payer: Aetna Medicare Advantage	$1,866.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,586.50
Rate for Payer: Cigna Commercial	$3,110.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,368.74
Rate for Payer: Qualcare PPO/HMO/WC	$933.23
Rate for Payer: UnitedHealthcare Community & State	$149.94
Rate for Payer: Wellpoint Medicaid Managed Care	$164.87

36MM 50/52/54 LINER

Facility

$6,221.55

Service Code	HCPCS C1776
Hospital Charge Code	270656895
Hospital Revenue Code	278
Min. Negotiated Rate	$933.23
Max. Negotiated Rate	$1,505.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,368.74
Rate for Payer: Qualcare PPO/HMO/WC	$933.23

36MM ATS SPHERE FLAT

Facility

$99,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270704204
Hospital Revenue Code	278
Min. Negotiated Rate	$2,406.99
Max. Negotiated Rate	$49,937.50
Rate for Payer: Aetna Commercial	$37,952.50
Rate for Payer: Aetna Medicare Advantage	$29,962.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,468.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,468.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25,468.12
Rate for Payer: Cigna Commercial	$49,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,169.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$21,972.50
Rate for Payer: Qualcare PPO/HMO/WC	$14,981.25
Rate for Payer: UnitedHealthcare Community & State	$2,406.99
Rate for Payer: Wellpoint Medicaid Managed Care	$2,646.69

36MM ATS SPHERE FLAT

Facility

$99,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270704204
Hospital Revenue Code	278
Min. Negotiated Rate	$14,981.25
Max. Negotiated Rate	$24,169.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,169.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$21,972.50
Rate for Payer: Qualcare PPO/HMO/WC	$14,981.25

36MM COCR MOD HD + 9MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672278
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

36MM COCR MOD HD + 9MM

Facility

$2,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672278
Hospital Revenue Code	278
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

36MM LINER 10 58 CUP

Facility

$6,221.55

Hospital Charge Code	270656897
Hospital Revenue Code	278
Min. Negotiated Rate	$933.23
Max. Negotiated Rate	$1,505.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,244.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,505.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,368.74
Rate for Payer: Qualcare PPO/HMO/WC	$933.23

Know your out-of-pocket cost for care.

All Charges