Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

3-D VOLUMN RECONSTRUCTIO

Facility

$928.00

Service Code	HCPCS 76377
Hospital Charge Code	94061155
Hospital Revenue Code	402
Min. Negotiated Rate	$139.20
Max. Negotiated Rate	$139.20
Rate for Payer: Qualcare PPO/HMO/WC	$139.20

3-D VOLUMN RECONSTRUCTIO

Facility

$928.00

Service Code	HCPCS 76377
Hospital Charge Code	94061155
Hospital Revenue Code	402
Min. Negotiated Rate	$22.36
Max. Negotiated Rate	$2,517.00
Rate for Payer: Aetna Commercial	$352.64
Rate for Payer: Aetna Medicare Advantage	$278.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$236.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$236.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$236.64
Rate for Payer: Cigna Commercial	$464.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.40
Rate for Payer: Oxford Commercial	$1,746.00
Rate for Payer: Qualcare PPO/HMO/WC	$139.20
Rate for Payer: UnitedHealthcare Commercial	$2,517.00
Rate for Payer: UnitedHealthcare Community & State	$22.36
Rate for Payer: Wellpoint Medicaid Managed Care	$24.59

3 HOLE VDR PLATE

Facility

$9,075.00

Service Code	HCPCS C1713
Hospital Charge Code	270706028
Hospital Revenue Code	278
Min. Negotiated Rate	$218.71
Max. Negotiated Rate	$4,537.50
Rate for Payer: Aetna Commercial	$3,448.50
Rate for Payer: Aetna Medicare Advantage	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,314.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,314.12
Rate for Payer: Cigna Commercial	$4,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25
Rate for Payer: UnitedHealthcare Community & State	$218.71
Rate for Payer: Wellpoint Medicaid Managed Care	$240.49

3 HOLE VDR PLATE

Facility

$9,075.00

Service Code	HCPCS C1713
Hospital Charge Code	270706028
Hospital Revenue Code	278
Min. Negotiated Rate	$1,361.25
Max. Negotiated Rate	$2,196.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,815.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,196.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,361.25

3 LONG 180 RINGS

Facility

$5,775.00

Hospital Charge Code	270656620
Hospital Revenue Code	272
Min. Negotiated Rate	$139.18
Max. Negotiated Rate	$2,887.50
Rate for Payer: Aetna Commercial	$2,194.50
Rate for Payer: Aetna Medicare Advantage	$1,732.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,472.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,472.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,472.62
Rate for Payer: Cigna Commercial	$2,887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,732.50
Rate for Payer: Oxford Commercial	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$866.25
Rate for Payer: UnitedHealthcare Commercial	$1,155.00
Rate for Payer: UnitedHealthcare Community & State	$139.18
Rate for Payer: Wellpoint Medicaid Managed Care	$153.04

3 LONG 180 RINGS

Facility

$5,775.00

Hospital Charge Code	270656620
Hospital Revenue Code	272
Min. Negotiated Rate	$866.25
Max. Negotiated Rate	$866.25
Rate for Payer: Qualcare PPO/HMO/WC	$866.25

3 LVL PLATE 45MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704424
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

3 LVL PLATE 45MM

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704424
Hospital Revenue Code	278
Min. Negotiated Rate	$120.50
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

3MM DRILLBIT FOR 4.5MM SCREW

Facility

$785.00

Hospital Charge Code	270703979
Hospital Revenue Code	279
Min. Negotiated Rate	$18.92
Max. Negotiated Rate	$392.50
Rate for Payer: Aetna Commercial	$298.30
Rate for Payer: Aetna Medicare Advantage	$235.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.18
Rate for Payer: Cigna Commercial	$392.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.50
Rate for Payer: Oxford Commercial	$157.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.75
Rate for Payer: UnitedHealthcare Commercial	$157.00
Rate for Payer: UnitedHealthcare Community & State	$18.92
Rate for Payer: Wellpoint Medicaid Managed Care	$20.80

3MM DRILLBIT FOR 4.5MM SCREW

Facility

$785.00

Hospital Charge Code	270703979
Hospital Revenue Code	279
Min. Negotiated Rate	$117.75
Max. Negotiated Rate	$117.75
Rate for Payer: Qualcare PPO/HMO/WC	$117.75

3 PEG PATELLA/7.2MM THICKNESS

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668734
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

3 PEG PATELLA/7.2MM THICKNESS

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270668734
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

3 SHELF METRO DEEP LEDGE UTILI

Facility

$1,325.25

Hospital Charge Code	270662655
Hospital Revenue Code	270
Min. Negotiated Rate	$198.79
Max. Negotiated Rate	$198.79
Rate for Payer: Qualcare PPO/HMO/WC	$198.79

3 SHELF METRO DEEP LEDGE UTILI

Facility

$1,325.25

Hospital Charge Code	270662655
Hospital Revenue Code	270
Min. Negotiated Rate	$31.94
Max. Negotiated Rate	$662.62
Rate for Payer: Aetna Commercial	$503.60
Rate for Payer: Aetna Medicare Advantage	$397.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.94
Rate for Payer: Cigna Commercial	$662.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$397.57
Rate for Payer: Oxford Commercial	$265.05
Rate for Payer: Qualcare PPO/HMO/WC	$198.79
Rate for Payer: UnitedHealthcare Commercial	$265.05
Rate for Payer: UnitedHealthcare Community & State	$31.94
Rate for Payer: Wellpoint Medicaid Managed Care	$35.12

3X12MM HYBRID SCREW

Facility

$643.75

Service Code	HCPCS C1713
Hospital Charge Code	270705522
Hospital Revenue Code	278
Min. Negotiated Rate	$15.51
Max. Negotiated Rate	$321.88
Rate for Payer: Aetna Commercial	$244.62
Rate for Payer: Aetna Medicare Advantage	$193.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.16
Rate for Payer: Cigna Commercial	$321.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$141.62
Rate for Payer: Qualcare PPO/HMO/WC	$96.56
Rate for Payer: UnitedHealthcare Community & State	$15.51
Rate for Payer: Wellpoint Medicaid Managed Care	$17.06

3X12MM HYBRID SCREW

Facility

$643.75

Service Code	HCPCS C1713
Hospital Charge Code	270705522
Hospital Revenue Code	278
Min. Negotiated Rate	$96.56
Max. Negotiated Rate	$155.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$141.62
Rate for Payer: Qualcare PPO/HMO/WC	$96.56

4.0/2.5MM SELF-DR SCHANZ SCRW

Facility

$735.20

Service Code	HCPCS C1713
Hospital Charge Code	270680657
Hospital Revenue Code	278
Min. Negotiated Rate	$110.28
Max. Negotiated Rate	$177.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$161.74
Rate for Payer: Qualcare PPO/HMO/WC	$110.28

4.0/2.5MM SELF-DR SCHANZ SCRW

Facility

$735.20

Service Code	HCPCS C1713
Hospital Charge Code	270680657
Hospital Revenue Code	278
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$367.60
Rate for Payer: Aetna Commercial	$279.38
Rate for Payer: Aetna Medicare Advantage	$220.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$187.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$187.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$187.48
Rate for Payer: Cigna Commercial	$367.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$161.74
Rate for Payer: Qualcare PPO/HMO/WC	$110.28
Rate for Payer: UnitedHealthcare Community & State	$17.72
Rate for Payer: Wellpoint Medicaid Managed Care	$19.48

4.0/3.0MM SCHANZ SCREW

Facility

$735.20

Service Code	HCPCS C1713
Hospital Charge Code	270619756
Hospital Revenue Code	278
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$367.60
Rate for Payer: Aetna Commercial	$279.38
Rate for Payer: Aetna Medicare Advantage	$220.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$187.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$187.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$187.48
Rate for Payer: Cigna Commercial	$367.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$161.74
Rate for Payer: Qualcare PPO/HMO/WC	$110.28
Rate for Payer: UnitedHealthcare Community & State	$17.72
Rate for Payer: Wellpoint Medicaid Managed Care	$19.48

4.0/3.0MM SCHANZ SCREW

Facility

$735.20

Service Code	HCPCS C1713
Hospital Charge Code	270619756
Hospital Revenue Code	278
Min. Negotiated Rate	$110.28
Max. Negotiated Rate	$177.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$161.74
Rate for Payer: Qualcare PPO/HMO/WC	$110.28

4.0 CAN BEV HL COM SCR 38MM L

Facility

$4,075.00

Hospital Charge Code	270703231
Hospital Revenue Code	278
Min. Negotiated Rate	$611.25
Max. Negotiated Rate	$986.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$815.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$986.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$896.50
Rate for Payer: Qualcare PPO/HMO/WC	$611.25

4.0 CAN BEV HL COM SCR 38MM L

Facility

$4,075.00

Hospital Charge Code	270703231
Hospital Revenue Code	278
Min. Negotiated Rate	$98.21
Max. Negotiated Rate	$2,037.50
Rate for Payer: Aetna Commercial	$1,548.50
Rate for Payer: Aetna Medicare Advantage	$1,222.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,039.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,039.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,039.12
Rate for Payer: Cigna Commercial	$2,037.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$986.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$896.50
Rate for Payer: Qualcare PPO/HMO/WC	$611.25
Rate for Payer: UnitedHealthcare Community & State	$98.21
Rate for Payer: Wellpoint Medicaid Managed Care	$107.99

4.0 CANN CANC LAG SCR 44MM

Facility

$797.50

Service Code	HCPCS C1713
Hospital Charge Code	270682616
Hospital Revenue Code	278
Min. Negotiated Rate	$19.22
Max. Negotiated Rate	$398.75
Rate for Payer: Aetna Commercial	$303.05
Rate for Payer: Aetna Medicare Advantage	$239.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$203.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$203.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$203.36
Rate for Payer: Cigna Commercial	$398.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$175.45
Rate for Payer: Qualcare PPO/HMO/WC	$119.62
Rate for Payer: UnitedHealthcare Community & State	$19.22
Rate for Payer: Wellpoint Medicaid Managed Care	$21.13

4.0 CANN CANC LAG SCR 44MM

Facility

$797.50

Service Code	HCPCS C1713
Hospital Charge Code	270682616
Hospital Revenue Code	278
Min. Negotiated Rate	$119.62
Max. Negotiated Rate	$193.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$175.45
Rate for Payer: Qualcare PPO/HMO/WC	$119.62

4.0MM/4.0MM CLAMP

Facility

$1,435.40

Hospital Charge Code	270601807
Hospital Revenue Code	272
Min. Negotiated Rate	$215.31
Max. Negotiated Rate	$215.31
Rate for Payer: Qualcare PPO/HMO/WC	$215.31

Know your out-of-pocket cost for care.

All Charges