Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SCREW SHANK PRECEPT MOD 6.5X45

Facility

$500.00

Hospital Charge Code	270659977
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

SCREW SHANK PRECEPT MOD 6.5X45

Facility

$500.00

Hospital Charge Code	270659977
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

SCREW SHANK RELINE 5.5X45MM 2C

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270691362
Hospital Revenue Code	278
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$1,512.50
Rate for Payer: Aetna Commercial	$1,149.50
Rate for Payer: Aetna Medicare Advantage	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$771.38
Rate for Payer: Cigna Commercial	$1,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$453.75
Rate for Payer: UnitedHealthcare Community & State	$72.90
Rate for Payer: Wellpoint Medicaid Managed Care	$80.16

SCREW SHANK RELINE 5.5X45MM 2C

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270691362
Hospital Revenue Code	278
Min. Negotiated Rate	$453.75
Max. Negotiated Rate	$732.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$453.75

SCREW SHANK RELINE 6.5X50MM 2C

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270692444
Hospital Revenue Code	278
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$1,512.50
Rate for Payer: Aetna Commercial	$1,149.50
Rate for Payer: Aetna Medicare Advantage	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$771.38
Rate for Payer: Cigna Commercial	$1,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$453.75
Rate for Payer: UnitedHealthcare Community & State	$72.90
Rate for Payer: Wellpoint Medicaid Managed Care	$80.16

SCREW SHANK RELINE 6.5X50MM 2C

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270692444
Hospital Revenue Code	278
Min. Negotiated Rate	$453.75
Max. Negotiated Rate	$732.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$453.75

SCREW SHANK RELINE 6.5X50 POLY

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270692448
Hospital Revenue Code	278
Min. Negotiated Rate	$453.75
Max. Negotiated Rate	$732.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$453.75

SCREW SHANK RELINE 6.5X50 POLY

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270692448
Hospital Revenue Code	278
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$1,512.50
Rate for Payer: Aetna Commercial	$1,149.50
Rate for Payer: Aetna Medicare Advantage	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$771.38
Rate for Payer: Cigna Commercial	$1,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$453.75
Rate for Payer: UnitedHealthcare Community & State	$72.90
Rate for Payer: Wellpoint Medicaid Managed Care	$80.16

SCREW SHANK RELINE 7.5X45MM 2C

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270692445
Hospital Revenue Code	278
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$1,512.50
Rate for Payer: Aetna Commercial	$1,149.50
Rate for Payer: Aetna Medicare Advantage	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$771.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$771.38
Rate for Payer: Cigna Commercial	$1,512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$453.75
Rate for Payer: UnitedHealthcare Community & State	$72.90
Rate for Payer: Wellpoint Medicaid Managed Care	$80.16

SCREW SHANK RELINE 7.5X45MM 2C

Facility

$3,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270692445
Hospital Revenue Code	278
Min. Negotiated Rate	$453.75
Max. Negotiated Rate	$732.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$605.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$732.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$453.75

SCREW SHEATH 4.0 75MM

Facility

$2,695.00

Service Code	HCPCS C1713
Hospital Charge Code	270687082
Hospital Revenue Code	278
Min. Negotiated Rate	$404.25
Max. Negotiated Rate	$652.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$539.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$652.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$404.25

SCREW SHEATH 4.0 75MM

Facility

$2,695.00

Service Code	HCPCS C1713
Hospital Charge Code	270687082
Hospital Revenue Code	278
Min. Negotiated Rate	$64.95
Max. Negotiated Rate	$1,347.50
Rate for Payer: Aetna Commercial	$1,024.10
Rate for Payer: Aetna Medicare Advantage	$808.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$687.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$687.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$687.23
Rate for Payer: Cigna Commercial	$1,347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$652.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$404.25
Rate for Payer: UnitedHealthcare Community & State	$64.95
Rate for Payer: Wellpoint Medicaid Managed Care	$71.42

SCREW SHEATH 4.0 X 50MM

Facility

$2,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270687086
Hospital Revenue Code	278
Min. Negotiated Rate	$402.00
Max. Negotiated Rate	$648.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$536.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$648.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$589.60
Rate for Payer: Qualcare PPO/HMO/WC	$402.00

SCREW SHEATH 4.0 X 50MM

Facility

$2,680.00

Service Code	HCPCS C1713
Hospital Charge Code	270687086
Hospital Revenue Code	278
Min. Negotiated Rate	$64.59
Max. Negotiated Rate	$1,340.00
Rate for Payer: Aetna Commercial	$1,018.40
Rate for Payer: Aetna Medicare Advantage	$804.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$683.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$683.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$683.40
Rate for Payer: Cigna Commercial	$1,340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$648.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$589.60
Rate for Payer: Qualcare PPO/HMO/WC	$402.00
Rate for Payer: UnitedHealthcare Community & State	$64.59
Rate for Payer: Wellpoint Medicaid Managed Care	$71.02

SCREW SHEATH 7.3 X 55MM

Facility

$2,695.00

Service Code	HCPCS C1713
Hospital Charge Code	270687083
Hospital Revenue Code	278
Min. Negotiated Rate	$404.25
Max. Negotiated Rate	$652.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$539.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$652.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$404.25

SCREW SHEATH 7.3 X 55MM

Facility

$2,695.00

Service Code	HCPCS C1713
Hospital Charge Code	270687083
Hospital Revenue Code	278
Min. Negotiated Rate	$64.95
Max. Negotiated Rate	$1,347.50
Rate for Payer: Aetna Commercial	$1,024.10
Rate for Payer: Aetna Medicare Advantage	$808.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$687.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$687.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$687.23
Rate for Payer: Cigna Commercial	$1,347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$652.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$404.25
Rate for Payer: UnitedHealthcare Community & State	$64.95
Rate for Payer: Wellpoint Medicaid Managed Care	$71.42

SCREW SHORT 2.5 X 17MM

Facility

$962.50

Service Code	HCPCS C1713
Hospital Charge Code	270701200
Hospital Revenue Code	278
Min. Negotiated Rate	$144.38
Max. Negotiated Rate	$232.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$144.38

SCREW SHORT 2.5 X 17MM

Facility

$962.50

Service Code	HCPCS C1713
Hospital Charge Code	270701200
Hospital Revenue Code	278
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$481.25
Rate for Payer: Aetna Commercial	$365.75
Rate for Payer: Aetna Medicare Advantage	$288.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$245.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$245.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$245.44
Rate for Payer: Cigna Commercial	$481.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$144.38
Rate for Payer: UnitedHealthcare Community & State	$23.20
Rate for Payer: Wellpoint Medicaid Managed Care	$25.51

SCREW SHORT THD 4x24MM

Facility

$1,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270674312
Hospital Revenue Code	278
Min. Negotiated Rate	$27.35
Max. Negotiated Rate	$567.50
Rate for Payer: Aetna Commercial	$431.30
Rate for Payer: Aetna Medicare Advantage	$340.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$289.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$289.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$289.43
Rate for Payer: Cigna Commercial	$567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$249.70
Rate for Payer: Qualcare PPO/HMO/WC	$170.25
Rate for Payer: UnitedHealthcare Community & State	$27.35
Rate for Payer: Wellpoint Medicaid Managed Care	$30.08

SCREW SHORT THD 4x24MM

Facility

$1,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270674312
Hospital Revenue Code	278
Min. Negotiated Rate	$170.25
Max. Negotiated Rate	$274.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$249.70
Rate for Payer: Qualcare PPO/HMO/WC	$170.25

SCREW SHORT THD 4x28MM

Facility

$1,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270674311
Hospital Revenue Code	278
Min. Negotiated Rate	$27.35
Max. Negotiated Rate	$567.50
Rate for Payer: Aetna Commercial	$431.30
Rate for Payer: Aetna Medicare Advantage	$340.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$289.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$289.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$289.43
Rate for Payer: Cigna Commercial	$567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$249.70
Rate for Payer: Qualcare PPO/HMO/WC	$170.25
Rate for Payer: UnitedHealthcare Community & State	$27.35
Rate for Payer: Wellpoint Medicaid Managed Care	$30.08

SCREW SHORT THD 4x28MM

Facility

$1,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270674311
Hospital Revenue Code	278
Min. Negotiated Rate	$170.25
Max. Negotiated Rate	$274.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$249.70
Rate for Payer: Qualcare PPO/HMO/WC	$170.25

SCREW SHORT THD 4x32MM

Facility

$1,135.00

Hospital Charge Code	270656797
Hospital Revenue Code	278
Min. Negotiated Rate	$170.25
Max. Negotiated Rate	$274.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$249.70
Rate for Payer: Qualcare PPO/HMO/WC	$170.25

SCREW SHORT THD 4x32MM

Facility

$1,135.00

Hospital Charge Code	270656797
Hospital Revenue Code	278
Min. Negotiated Rate	$27.35
Max. Negotiated Rate	$567.50
Rate for Payer: Aetna Commercial	$431.30
Rate for Payer: Aetna Medicare Advantage	$340.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$289.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$289.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$289.43
Rate for Payer: Cigna Commercial	$567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$249.70
Rate for Payer: Qualcare PPO/HMO/WC	$170.25
Rate for Payer: UnitedHealthcare Community & State	$27.35
Rate for Payer: Wellpoint Medicaid Managed Care	$30.08

SCREW SHORT THREAD 6.2 X 56 MM

Facility

$3,231.25

Service Code	HCPCS C1713
Hospital Charge Code	270701365
Hospital Revenue Code	278
Min. Negotiated Rate	$484.69
Max. Negotiated Rate	$781.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$646.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$781.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$710.88
Rate for Payer: Qualcare PPO/HMO/WC	$484.69

Know your out-of-pocket cost for care.

All Charges