Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SCREW LOCKING GLENOSPHERE

Facility

$675.00

Service Code	HCPCS C1713
Hospital Charge Code	270668555
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$163.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$148.50
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

SCREW LOCKING HEX 3.5x20MM

Facility

$1,120.00

Hospital Charge Code	270656792
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$271.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$246.40
Rate for Payer: Qualcare PPO/HMO/WC	$168.00

SCREW LOCKING HEX 3.5x20MM

Facility

$1,120.00

Hospital Charge Code	270656792
Hospital Revenue Code	278
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$560.00
Rate for Payer: Aetna Commercial	$425.60
Rate for Payer: Aetna Medicare Advantage	$336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.60
Rate for Payer: Cigna Commercial	$560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$246.40
Rate for Payer: Qualcare PPO/HMO/WC	$168.00
Rate for Payer: UnitedHealthcare Community & State	$26.99
Rate for Payer: Wellpoint Medicaid Managed Care	$29.68

SCREW LOCKING HEX 3.5x24MM

Facility

$1,120.00

Hospital Charge Code	270656793
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$271.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$246.40
Rate for Payer: Qualcare PPO/HMO/WC	$168.00

SCREW LOCKING HEX 3.5x24MM

Facility

$1,120.00

Hospital Charge Code	270656793
Hospital Revenue Code	278
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$560.00
Rate for Payer: Aetna Commercial	$425.60
Rate for Payer: Aetna Medicare Advantage	$336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.60
Rate for Payer: Cigna Commercial	$560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$246.40
Rate for Payer: Qualcare PPO/HMO/WC	$168.00
Rate for Payer: UnitedHealthcare Community & State	$26.99
Rate for Payer: Wellpoint Medicaid Managed Care	$29.68

SCREW LOCKING LG HD 2.7x16MM

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270680849
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$271.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$246.40
Rate for Payer: Qualcare PPO/HMO/WC	$168.00

SCREW LOCKING LG HD 2.7x16MM

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270680849
Hospital Revenue Code	278
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$560.00
Rate for Payer: Aetna Commercial	$425.60
Rate for Payer: Aetna Medicare Advantage	$336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.60
Rate for Payer: Cigna Commercial	$560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$246.40
Rate for Payer: Qualcare PPO/HMO/WC	$168.00
Rate for Payer: UnitedHealthcare Community & State	$26.99
Rate for Payer: Wellpoint Medicaid Managed Care	$29.68

SCREW LOCKING LG HD 2.7x18MM

Facility

$1,210.00

Service Code	HCPCS C1713
Hospital Charge Code	270662456
Hospital Revenue Code	278
Min. Negotiated Rate	$181.50
Max. Negotiated Rate	$292.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$266.20
Rate for Payer: Qualcare PPO/HMO/WC	$181.50

SCREW LOCKING LG HD 2.7x18MM

Facility

$1,210.00

Service Code	HCPCS C1713
Hospital Charge Code	270662456
Hospital Revenue Code	278
Min. Negotiated Rate	$29.16
Max. Negotiated Rate	$605.00
Rate for Payer: Aetna Commercial	$459.80
Rate for Payer: Aetna Medicare Advantage	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.55
Rate for Payer: Cigna Commercial	$605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$266.20
Rate for Payer: Qualcare PPO/HMO/WC	$181.50
Rate for Payer: UnitedHealthcare Community & State	$29.16
Rate for Payer: Wellpoint Medicaid Managed Care	$32.06

SCREW LOCKING LG HD 2.7x20MM

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270662457
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$271.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$246.40
Rate for Payer: Qualcare PPO/HMO/WC	$168.00

SCREW LOCKING LG HD 2.7x20MM

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270662457
Hospital Revenue Code	278
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$560.00
Rate for Payer: Aetna Commercial	$425.60
Rate for Payer: Aetna Medicare Advantage	$336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.60
Rate for Payer: Cigna Commercial	$560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$246.40
Rate for Payer: Qualcare PPO/HMO/WC	$168.00
Rate for Payer: UnitedHealthcare Community & State	$26.99
Rate for Payer: Wellpoint Medicaid Managed Care	$29.68

SCREW LOCKING LG HD 2.7x22MM

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270683759
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$271.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$246.40
Rate for Payer: Qualcare PPO/HMO/WC	$168.00

SCREW LOCKING LG HD 2.7x22MM

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270683759
Hospital Revenue Code	278
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$560.00
Rate for Payer: Aetna Commercial	$425.60
Rate for Payer: Aetna Medicare Advantage	$336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.60
Rate for Payer: Cigna Commercial	$560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$246.40
Rate for Payer: Qualcare PPO/HMO/WC	$168.00
Rate for Payer: UnitedHealthcare Community & State	$26.99
Rate for Payer: Wellpoint Medicaid Managed Care	$29.68

SCREW LOCKING LG HD 2.7x24MM

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270680850
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$271.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$246.40
Rate for Payer: Qualcare PPO/HMO/WC	$168.00

SCREW LOCKING LG HD 2.7x24MM

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270680850
Hospital Revenue Code	278
Min. Negotiated Rate	$26.99
Max. Negotiated Rate	$560.00
Rate for Payer: Aetna Commercial	$425.60
Rate for Payer: Aetna Medicare Advantage	$336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.60
Rate for Payer: Cigna Commercial	$560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$246.40
Rate for Payer: Qualcare PPO/HMO/WC	$168.00
Rate for Payer: UnitedHealthcare Community & State	$26.99
Rate for Payer: Wellpoint Medicaid Managed Care	$29.68

SCREW LOCKING LO PRO 3.5X16MM

Facility

$353.20

Service Code	HCPCS C1713
Hospital Charge Code	270668410
Hospital Revenue Code	278
Min. Negotiated Rate	$52.98
Max. Negotiated Rate	$85.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$77.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.98

SCREW LOCKING LO PRO 3.5X16MM

Facility

$353.20

Service Code	HCPCS C1713
Hospital Charge Code	270668410
Hospital Revenue Code	278
Min. Negotiated Rate	$8.51
Max. Negotiated Rate	$176.60
Rate for Payer: Aetna Commercial	$134.22
Rate for Payer: Aetna Medicare Advantage	$105.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.07
Rate for Payer: Cigna Commercial	$176.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$77.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.98
Rate for Payer: UnitedHealthcare Community & State	$8.51
Rate for Payer: Wellpoint Medicaid Managed Care	$9.36

SCREW LOCKING LO PRO 3.5x18MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270668412
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

SCREW LOCKING LO PRO 3.5x18MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270668412
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
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
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

SCREW LOCKING LO PRO 3.5X20MM

Facility

$425.00

Service Code	HCPCS C1713
Hospital Charge Code	270669481
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

SCREW LOCKING LO PRO 3.5X20MM

Facility

$425.00

Service Code	HCPCS C1713
Hospital Charge Code	270669481
Hospital Revenue Code	278
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

SCREW LOCKING LO PRO 3.5X22MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270676695
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
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
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

SCREW LOCKING LO PRO 3.5X22MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270676695
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

SCREW LOCKING LO PRO 3.5x30MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270681399
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

SCREW LOCKING LO PRO 3.5x30MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270681399
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
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
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

Know your out-of-pocket cost for care.

All Charges