Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SCREW GLENOID POLY LKG L14

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270696735
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$27.50
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

SCREW GLENOSPHERE

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270693054
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

SCREW GLENOSPHERE

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270693054
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

SCREW GRUVE ACP 12MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270699353
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

SCREW GRUVE ACP 12MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270699353
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

SCREW GRUVE ACP 14MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270699095
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

SCREW GRUVE ACP 14MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270699095
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

SCREW GRUVE ANT CERV 14MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270699045
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

SCREW GRUVE ANT CERV 14MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270699045
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

SCREW GRUVE ST FIX ANG 4X16MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270699027
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

SCREW GRUVE ST FIX ANG 4X16MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270699027
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

SCREW GRUVE VARIABLE 4X18MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270699339
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

SCREW GRUVE VARIABLE 4X18MM

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270699339
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

SCREW HARRIER-SA 5.5X35MM

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270696343
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

SCREW HARRIER-SA 5.5X35MM

Facility

$4,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270696343
Hospital Revenue Code	278
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,700.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25
Rate for Payer: UnitedHealthcare Community & State	$107.85
Rate for Payer: Wellpoint Medicaid Managed Care	$118.59

SCREWHDLESSCANN4.0LT40-STICOMP

Facility

$2,132.00

Service Code	HCPCS C1713
Hospital Charge Code	270693252
Hospital Revenue Code	278
Min. Negotiated Rate	$319.80
Max. Negotiated Rate	$515.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$426.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$515.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$469.04
Rate for Payer: Qualcare PPO/HMO/WC	$319.80

SCREWHDLESSCANN4.0LT40-STICOMP

Facility

$2,132.00

Service Code	HCPCS C1713
Hospital Charge Code	270693252
Hospital Revenue Code	278
Min. Negotiated Rate	$51.38
Max. Negotiated Rate	$1,066.00
Rate for Payer: Aetna Commercial	$810.16
Rate for Payer: Aetna Medicare Advantage	$639.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$543.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$543.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$426.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$543.66
Rate for Payer: Cigna Commercial	$1,066.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$515.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$469.04
Rate for Payer: Qualcare PPO/HMO/WC	$319.80
Rate for Payer: UnitedHealthcare Community & State	$51.38
Rate for Payer: Wellpoint Medicaid Managed Care	$56.50

SCREWHDLESSCANN4.0TICOMPLT44-S

Facility

$2,132.00

Service Code	HCPCS C1713
Hospital Charge Code	270693253
Hospital Revenue Code	278
Min. Negotiated Rate	$319.80
Max. Negotiated Rate	$515.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$426.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$515.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$469.04
Rate for Payer: Qualcare PPO/HMO/WC	$319.80

SCREWHDLESSCANN4.0TICOMPLT44-S

Facility

$2,132.00

Service Code	HCPCS C1713
Hospital Charge Code	270693253
Hospital Revenue Code	278
Min. Negotiated Rate	$51.38
Max. Negotiated Rate	$1,066.00
Rate for Payer: Aetna Commercial	$810.16
Rate for Payer: Aetna Medicare Advantage	$639.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$543.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$543.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$426.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$543.66
Rate for Payer: Cigna Commercial	$1,066.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$515.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$469.04
Rate for Payer: Qualcare PPO/HMO/WC	$319.80
Rate for Payer: UnitedHealthcare Community & State	$51.38
Rate for Payer: Wellpoint Medicaid Managed Care	$56.50

SCREWHDLESSCANN4.0TICOMPLT52-S

Facility

$2,132.00

Service Code	HCPCS C1713
Hospital Charge Code	270693254
Hospital Revenue Code	278
Min. Negotiated Rate	$51.38
Max. Negotiated Rate	$1,066.00
Rate for Payer: Aetna Commercial	$810.16
Rate for Payer: Aetna Medicare Advantage	$639.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$543.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$543.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$426.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$543.66
Rate for Payer: Cigna Commercial	$1,066.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$515.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$469.04
Rate for Payer: Qualcare PPO/HMO/WC	$319.80
Rate for Payer: UnitedHealthcare Community & State	$51.38
Rate for Payer: Wellpoint Medicaid Managed Care	$56.50

SCREWHDLESSCANN4.0TICOMPLT52-S

Facility

$2,132.00

Service Code	HCPCS C1713
Hospital Charge Code	270693254
Hospital Revenue Code	278
Min. Negotiated Rate	$319.80
Max. Negotiated Rate	$515.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$426.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$515.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$469.04
Rate for Payer: Qualcare PPO/HMO/WC	$319.80

SCREW HDLS 3.0X26MM

Facility

$2,210.00

Service Code	HCPCS C1713
Hospital Charge Code	270698689
Hospital Revenue Code	278
Min. Negotiated Rate	$331.50
Max. Negotiated Rate	$534.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$442.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$486.20
Rate for Payer: Qualcare PPO/HMO/WC	$331.50

SCREW HDLS 3.0X26MM

Facility

$2,210.00

Service Code	HCPCS C1713
Hospital Charge Code	270698689
Hospital Revenue Code	278
Min. Negotiated Rate	$53.26
Max. Negotiated Rate	$1,105.00
Rate for Payer: Aetna Commercial	$839.80
Rate for Payer: Aetna Medicare Advantage	$663.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$563.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$563.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$442.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$563.55
Rate for Payer: Cigna Commercial	$1,105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$486.20
Rate for Payer: Qualcare PPO/HMO/WC	$331.50
Rate for Payer: UnitedHealthcare Community & State	$53.26
Rate for Payer: Wellpoint Medicaid Managed Care	$58.56

SCREW HDLS CMPN 2.5X16MM

Facility

$1,560.00

Service Code	HCPCS C1713
Hospital Charge Code	270692688
Hospital Revenue Code	278
Min. Negotiated Rate	$234.00
Max. Negotiated Rate	$377.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$312.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$343.20
Rate for Payer: Qualcare PPO/HMO/WC	$234.00

SCREW HDLS CMPN 2.5X16MM

Facility

$1,560.00

Service Code	HCPCS C1713
Hospital Charge Code	270692688
Hospital Revenue Code	278
Min. Negotiated Rate	$37.60
Max. Negotiated Rate	$780.00
Rate for Payer: Aetna Commercial	$592.80
Rate for Payer: Aetna Medicare Advantage	$468.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$397.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$397.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$312.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$397.80
Rate for Payer: Cigna Commercial	$780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$377.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$343.20
Rate for Payer: Qualcare PPO/HMO/WC	$234.00
Rate for Payer: UnitedHealthcare Community & State	$37.60
Rate for Payer: Wellpoint Medicaid Managed Care	$41.34

Know your out-of-pocket cost for care.

All Charges