Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SCREW MIS CAN PEDICLE 5.5X45MM

Facility

$23,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270698197
Hospital Revenue Code	278
Min. Negotiated Rate	$3,487.50
Max. Negotiated Rate	$5,626.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,626.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,115.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,487.50

SCREW MIS EXT TAB 8.5X50MM

Facility

$4,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270696482
Hospital Revenue Code	278
Min. Negotiated Rate	$630.00
Max. Negotiated Rate	$1,016.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,016.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$924.00
Rate for Payer: Qualcare PPO/HMO/WC	$630.00

SCREW MIS EXT TAB 8.5X50MM

Facility

$4,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270696482
Hospital Revenue Code	278
Min. Negotiated Rate	$101.22
Max. Negotiated Rate	$2,100.00
Rate for Payer: Aetna Commercial	$1,596.00
Rate for Payer: Aetna Medicare Advantage	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,071.00
Rate for Payer: Cigna Commercial	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,016.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$924.00
Rate for Payer: Qualcare PPO/HMO/WC	$630.00
Rate for Payer: UnitedHealthcare Community & State	$101.22
Rate for Payer: Wellpoint Medicaid Managed Care	$111.30

SCREW MIS EXT TAB TULIP TI

Facility

$6,140.80

Service Code	HCPCS C1713
Hospital Charge Code	270695963
Hospital Revenue Code	278
Min. Negotiated Rate	$921.12
Max. Negotiated Rate	$1,486.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,486.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,350.98
Rate for Payer: Qualcare PPO/HMO/WC	$921.12

SCREW MIS EXT TAB TULIP TI

Facility

$6,140.80

Service Code	HCPCS C1713
Hospital Charge Code	270695963
Hospital Revenue Code	278
Min. Negotiated Rate	$147.99
Max. Negotiated Rate	$3,070.40
Rate for Payer: Aetna Commercial	$2,333.50
Rate for Payer: Aetna Medicare Advantage	$1,842.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,565.90
Rate for Payer: Cigna Commercial	$3,070.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,486.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,350.98
Rate for Payer: Qualcare PPO/HMO/WC	$921.12
Rate for Payer: UnitedHealthcare Community & State	$147.99
Rate for Payer: Wellpoint Medicaid Managed Care	$162.73

SCREW MIS EXT TAB TULIP TOWER

Facility

$6,140.80

Service Code	HCPCS C1713
Hospital Charge Code	270695296
Hospital Revenue Code	278
Min. Negotiated Rate	$921.12
Max. Negotiated Rate	$1,486.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,486.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,350.98
Rate for Payer: Qualcare PPO/HMO/WC	$921.12

SCREW MIS EXT TAB TULIP TOWER

Facility

$6,140.80

Service Code	HCPCS C1713
Hospital Charge Code	270695296
Hospital Revenue Code	278
Min. Negotiated Rate	$147.99
Max. Negotiated Rate	$3,070.40
Rate for Payer: Aetna Commercial	$2,333.50
Rate for Payer: Aetna Medicare Advantage	$1,842.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,565.90
Rate for Payer: Cigna Commercial	$3,070.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,486.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,350.98
Rate for Payer: Qualcare PPO/HMO/WC	$921.12
Rate for Payer: UnitedHealthcare Community & State	$147.99
Rate for Payer: Wellpoint Medicaid Managed Care	$162.73

SCREW MIS NON-MOD CANN 6.5X40

Facility

$10,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270694160
Hospital Revenue Code	278
Min. Negotiated Rate	$259.07
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$259.07
Rate for Payer: Wellpoint Medicaid Managed Care	$284.88

SCREW MIS NON-MOD CANN 6.5X40

Facility

$10,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270694160
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,365.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

SCREW MIS PEDICLE 6.5X45MM

Facility

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693202
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

SCREW MIS PEDICLE 6.5X45MM

Facility

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693202
Hospital Revenue Code	278
Min. Negotiated Rate	$186.78
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$186.78
Rate for Payer: Wellpoint Medicaid Managed Care	$205.38

SCREW MIS PEDICLE 6.5X50MM

Facility

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693205
Hospital Revenue Code	278
Min. Negotiated Rate	$186.78
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$186.78
Rate for Payer: Wellpoint Medicaid Managed Care	$205.38

SCREW MIS PEDICLE 6.5X50MM

Facility

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693205
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

SCREW MIS POL EXT TAB 7.5X35MM

Facility

$4,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270697645
Hospital Revenue Code	278
Min. Negotiated Rate	$630.00
Max. Negotiated Rate	$1,016.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,016.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$924.00
Rate for Payer: Qualcare PPO/HMO/WC	$630.00

SCREW MIS POL EXT TAB 7.5X35MM

Facility

$4,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270697645
Hospital Revenue Code	278
Min. Negotiated Rate	$101.22
Max. Negotiated Rate	$2,100.00
Rate for Payer: Aetna Commercial	$1,596.00
Rate for Payer: Aetna Medicare Advantage	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,071.00
Rate for Payer: Cigna Commercial	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,016.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$924.00
Rate for Payer: Qualcare PPO/HMO/WC	$630.00
Rate for Payer: UnitedHealthcare Community & State	$101.22
Rate for Payer: Wellpoint Medicaid Managed Care	$111.30

SCREW MIS POLY EX TAB 5.5X45MM

Facility

$5,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693175
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

SCREW MIS POLY EX TAB 5.5X45MM

Facility

$5,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693175
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

SCREW MIS REDUCTION

Facility

$5,000.00

Hospital Charge Code	270703023
Hospital Revenue Code	270
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) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.00
Rate for Payer: Oxford Commercial	$1,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$1,000.00
Rate for Payer: UnitedHealthcare Community & State	$120.50
Rate for Payer: Wellpoint Medicaid Managed Care	$132.50

SCREW MIS REDUCTION

Facility

$5,000.00

Hospital Charge Code	270703023
Hospital Revenue Code	270
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SCREW MNTR F/A 3.5x10MM

Facility

$6,600.00

Hospital Charge Code	270663774
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

SCREW MNTR F/A 3.5x10MM

Facility

$6,600.00

Hospital Charge Code	270663774
Hospital Revenue Code	278
Min. Negotiated Rate	$159.06
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$2,508.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.00
Rate for Payer: UnitedHealthcare Community & State	$159.06
Rate for Payer: Wellpoint Medicaid Managed Care	$174.90

SCREW MNTR F/A 3.5x12MM

Facility

$6,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270663775
Hospital Revenue Code	278
Min. Negotiated Rate	$159.06
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$2,508.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.00
Rate for Payer: UnitedHealthcare Community & State	$159.06
Rate for Payer: Wellpoint Medicaid Managed Care	$174.90

SCREW MNTR F/A 3.5x12MM

Facility

$6,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270663775
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

SCREW MNTR F/A 3.5x14MM

Facility

$6,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270669974
Hospital Revenue Code	278
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

SCREW MNTR F/A 3.5x14MM

Facility

$6,600.00

Service Code	HCPCS C1713
Hospital Charge Code	270669974
Hospital Revenue Code	278
Min. Negotiated Rate	$159.06
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$2,508.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.00
Rate for Payer: UnitedHealthcare Community & State	$159.06
Rate for Payer: Wellpoint Medicaid Managed Care	$174.90

Know your out-of-pocket cost for care.

All Charges