Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SCREW RELINE MAS, 5.5X50MM LRD

Facility

$5,245.00

Service Code	HCPCS C1713
Hospital Charge Code	270686451
Hospital Revenue Code	278
Min. Negotiated Rate	$786.75
Max. Negotiated Rate	$1,269.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,153.90
Rate for Payer: Qualcare PPO/HMO/WC	$786.75

SCREW RELINE MAS, 5.5X50MM LRD

Facility

$5,245.00

Service Code	HCPCS C1713
Hospital Charge Code	270686451
Hospital Revenue Code	278
Min. Negotiated Rate	$126.40
Max. Negotiated Rate	$2,622.50
Rate for Payer: Aetna Commercial	$1,993.10
Rate for Payer: Aetna Medicare Advantage	$1,573.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,337.47
Rate for Payer: Cigna Commercial	$2,622.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,153.90
Rate for Payer: Qualcare PPO/HMO/WC	$786.75
Rate for Payer: UnitedHealthcare Community & State	$126.40
Rate for Payer: Wellpoint Medicaid Managed Care	$138.99

SCREW RELINE MAS 5.5X55MM LRD

Facility

$5,245.00

Service Code	HCPCS C1713
Hospital Charge Code	270686452
Hospital Revenue Code	278
Min. Negotiated Rate	$786.75
Max. Negotiated Rate	$1,269.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,153.90
Rate for Payer: Qualcare PPO/HMO/WC	$786.75

SCREW RELINE MAS 5.5X55MM LRD

Facility

$5,245.00

Service Code	HCPCS C1713
Hospital Charge Code	270686452
Hospital Revenue Code	278
Min. Negotiated Rate	$126.40
Max. Negotiated Rate	$2,622.50
Rate for Payer: Aetna Commercial	$1,993.10
Rate for Payer: Aetna Medicare Advantage	$1,573.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,337.47
Rate for Payer: Cigna Commercial	$2,622.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,153.90
Rate for Payer: Qualcare PPO/HMO/WC	$786.75
Rate for Payer: UnitedHealthcare Community & State	$126.40
Rate for Payer: Wellpoint Medicaid Managed Care	$138.99

SCREW RELINE MAS 6.5X40MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693950
Hospital Revenue Code	278
Min. Negotiated Rate	$66.28
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$1,045.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.50
Rate for Payer: UnitedHealthcare Community & State	$66.28
Rate for Payer: Wellpoint Medicaid Managed Care	$72.88

SCREW RELINE MAS 6.5X40MM

Facility

$2,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693950
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$665.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

SCREW RELINE MAS, 7.5 X 45 MM

Facility

$9,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686449
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,980.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

SCREW RELINE MAS, 7.5 X 45 MM

Facility

$9,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686449
Hospital Revenue Code	278
Min. Negotiated Rate	$216.90
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,980.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$216.90
Rate for Payer: Wellpoint Medicaid Managed Care	$238.50

SCREW RELINE MAS7.5X45MMPOLY2C

Facility

$17,310.00

Service Code	HCPCS C1713
Hospital Charge Code	270692907
Hospital Revenue Code	278
Min. Negotiated Rate	$2,596.50
Max. Negotiated Rate	$4,189.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,462.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,189.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,808.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,596.50

SCREW RELINE MAS7.5X45MMPOLY2C

Facility

$17,310.00

Service Code	HCPCS C1713
Hospital Charge Code	270692907
Hospital Revenue Code	278
Min. Negotiated Rate	$417.17
Max. Negotiated Rate	$8,655.00
Rate for Payer: Aetna Commercial	$6,577.80
Rate for Payer: Aetna Medicare Advantage	$5,193.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,414.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,414.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,462.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,414.05
Rate for Payer: Cigna Commercial	$8,655.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,189.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,808.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,596.50
Rate for Payer: UnitedHealthcare Community & State	$417.17
Rate for Payer: Wellpoint Medicaid Managed Care	$458.71

SCREW RELINE MAS, 8.5X50 MM

Facility

$9,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686450
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,980.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

SCREW RELINE MAS, 8.5X50 MM

Facility

$9,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686450
Hospital Revenue Code	278
Min. Negotiated Rate	$216.90
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,980.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$216.90
Rate for Payer: Wellpoint Medicaid Managed Care	$238.50

SCREW RELINE O MOD 6.5 X 40

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270691444
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

SCREW RELINE O MOD 6.5 X 40

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270691444
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

SCREW RELINE-O MOD 6.5X45MM 2S

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695243
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

SCREW RELINE-O MOD 6.5X45MM 2S

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270695243
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

SCREW RELINE POLY 5.5X45MM 2C

Facility

$6,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270691364
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,663.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

SCREW RELINE POLY 5.5X45MM 2C

Facility

$6,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270691364
Hospital Revenue Code	278
Min. Negotiated Rate	$165.69
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,612.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25
Rate for Payer: UnitedHealthcare Community & State	$165.69
Rate for Payer: Wellpoint Medicaid Managed Care	$182.19

SCREW REM INST TORQ DEFINING

Facility

$1,160.00

Hospital Charge Code	270669494
Hospital Revenue Code	278
Min. Negotiated Rate	$27.96
Max. Negotiated Rate	$580.00
Rate for Payer: Aetna Commercial	$440.80
Rate for Payer: Aetna Medicare Advantage	$348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$295.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$295.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$295.80
Rate for Payer: Cigna Commercial	$580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$280.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$255.20
Rate for Payer: Qualcare PPO/HMO/WC	$174.00
Rate for Payer: UnitedHealthcare Community & State	$27.96
Rate for Payer: Wellpoint Medicaid Managed Care	$30.74

SCREW REM INST TORQ DEFINING

Facility

$1,160.00

Hospital Charge Code	270669494
Hospital Revenue Code	278
Min. Negotiated Rate	$174.00
Max. Negotiated Rate	$280.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$280.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$255.20
Rate for Payer: Qualcare PPO/HMO/WC	$174.00

SCREW RESCUE 3.7X12

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693875
Hospital Revenue Code	278
Min. Negotiated Rate	$162.68
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$162.68
Rate for Payer: Wellpoint Medicaid Managed Care	$178.88

SCREW RESCUE 3.7X12

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270693875
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

SCREW RESCUE 5.2X16MM

Facility

$1,365.90

Service Code	HCPCS C1713
Hospital Charge Code	270694154
Hospital Revenue Code	278
Min. Negotiated Rate	$204.88
Max. Negotiated Rate	$330.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$273.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$330.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$300.50
Rate for Payer: Qualcare PPO/HMO/WC	$204.88

SCREW RESCUE 5.2X16MM

Facility

$1,365.90

Service Code	HCPCS C1713
Hospital Charge Code	270694154
Hospital Revenue Code	278
Min. Negotiated Rate	$32.92
Max. Negotiated Rate	$682.95
Rate for Payer: Aetna Commercial	$519.04
Rate for Payer: Aetna Medicare Advantage	$409.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$348.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$348.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$273.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$348.30
Rate for Payer: Cigna Commercial	$682.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$330.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$300.50
Rate for Payer: Qualcare PPO/HMO/WC	$204.88
Rate for Payer: UnitedHealthcare Community & State	$32.92
Rate for Payer: Wellpoint Medicaid Managed Care	$36.20

SCREW RESCUE VARIABLE 4.5X12MM

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270699100
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

Know your out-of-pocket cost for care.

All Charges