Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SCREW Ti 6.5 x 20mm 103531

Facility

$600.00

Service Code	HCPCS C1713
Hospital Charge Code	270612161
Hospital Revenue Code	278
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$132.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

SCREW TI 6.5 X 40MM

Facility

$540.00

Hospital Charge Code	207612169
Hospital Revenue Code	275
Min. Negotiated Rate	$13.01
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna Commercial	$205.20
Rate for Payer: Aetna Medicare Advantage	$162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$137.70
Rate for Payer: Cigna Commercial	$270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$118.80
Rate for Payer: Qualcare PPO/HMO/WC	$81.00
Rate for Payer: UnitedHealthcare Community & State	$13.01
Rate for Payer: Wellpoint Medicaid Managed Care	$14.31

SCREW TI 6.5 X 40MM

Facility

$540.00

Hospital Charge Code	207612169
Hospital Revenue Code	275
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$130.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$118.80
Rate for Payer: Qualcare PPO/HMO/WC	$81.00

SCREW TIBIAL INSERT SZ1 30MM

Facility

$6,903.00

Service Code	HCPCS C1713
Hospital Charge Code	270680671
Hospital Revenue Code	278
Min. Negotiated Rate	$166.36
Max. Negotiated Rate	$3,451.50
Rate for Payer: Aetna Commercial	$2,623.14
Rate for Payer: Aetna Medicare Advantage	$2,070.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,760.27
Rate for Payer: Cigna Commercial	$3,451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,518.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45
Rate for Payer: UnitedHealthcare Community & State	$166.36
Rate for Payer: Wellpoint Medicaid Managed Care	$182.93

SCREW TIBIAL INSERT SZ1 30MM

Facility

$6,903.00

Service Code	HCPCS C1713
Hospital Charge Code	270680671
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$1,670.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,518.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

SCREW TIBIAL INSERT SZ2 15MM

Facility

$6,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270680185
Hospital Revenue Code	278
Min. Negotiated Rate	$166.29
Max. Negotiated Rate	$3,450.00
Rate for Payer: Aetna Commercial	$2,622.00
Rate for Payer: Aetna Medicare Advantage	$2,070.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,759.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,759.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,759.50
Rate for Payer: Cigna Commercial	$3,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,669.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,518.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.00
Rate for Payer: UnitedHealthcare Community & State	$166.29
Rate for Payer: Wellpoint Medicaid Managed Care	$182.85

SCREW TIBIAL INSERT SZ2 15MM

Facility

$6,900.00

Service Code	HCPCS C1713
Hospital Charge Code	270680185
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.00
Max. Negotiated Rate	$1,669.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,669.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,518.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.00

SCREW TIBIAL INSERT SZ2 30MM

Facility

$6,930.30

Hospital Charge Code	270677339
Hospital Revenue Code	278
Min. Negotiated Rate	$167.02
Max. Negotiated Rate	$3,465.15
Rate for Payer: Aetna Commercial	$2,633.51
Rate for Payer: Aetna Medicare Advantage	$2,079.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,767.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,767.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,767.23
Rate for Payer: Cigna Commercial	$3,465.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,524.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.55
Rate for Payer: UnitedHealthcare Community & State	$167.02
Rate for Payer: Wellpoint Medicaid Managed Care	$183.65

SCREW TIBIAL INSERT SZ2 30MM

Facility

$6,930.30

Hospital Charge Code	270677339
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.55
Max. Negotiated Rate	$1,677.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,524.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.55

SCREW TIBIAL INSERT SZ3 15MM

Facility

$6,903.00

Service Code	HCPCS C1713
Hospital Charge Code	270680593
Hospital Revenue Code	278
Min. Negotiated Rate	$166.36
Max. Negotiated Rate	$3,451.50
Rate for Payer: Aetna Commercial	$2,623.14
Rate for Payer: Aetna Medicare Advantage	$2,070.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,760.27
Rate for Payer: Cigna Commercial	$3,451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,518.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45
Rate for Payer: UnitedHealthcare Community & State	$166.36
Rate for Payer: Wellpoint Medicaid Managed Care	$182.93

SCREW TIBIAL INSERT SZ3 15MM

Facility

$6,903.00

Service Code	HCPCS C1713
Hospital Charge Code	270680593
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$1,670.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,518.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

SCREW TIBIAL INSERT SZ3 30MM

Facility

$6,950.00

Service Code	HCPCS C1713
Hospital Charge Code	270677685
Hospital Revenue Code	278
Min. Negotiated Rate	$1,042.50
Max. Negotiated Rate	$1,681.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,681.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,529.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,042.50

SCREW TIBIAL INSERT SZ3 30MM

Facility

$6,950.00

Service Code	HCPCS C1713
Hospital Charge Code	270677685
Hospital Revenue Code	278
Min. Negotiated Rate	$167.50
Max. Negotiated Rate	$3,475.00
Rate for Payer: Aetna Commercial	$2,641.00
Rate for Payer: Aetna Medicare Advantage	$2,085.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,772.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,772.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,772.25
Rate for Payer: Cigna Commercial	$3,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,681.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,529.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,042.50
Rate for Payer: UnitedHealthcare Community & State	$167.50
Rate for Payer: Wellpoint Medicaid Managed Care	$184.18

SCREW TIBIAL INSERT SZ4 15MM

Facility

$6,903.00

Service Code	HCPCS C1713
Hospital Charge Code	270679485
Hospital Revenue Code	278
Min. Negotiated Rate	$166.36
Max. Negotiated Rate	$3,451.50
Rate for Payer: Aetna Commercial	$2,623.14
Rate for Payer: Aetna Medicare Advantage	$2,070.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,760.27
Rate for Payer: Cigna Commercial	$3,451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,518.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45
Rate for Payer: UnitedHealthcare Community & State	$166.36
Rate for Payer: Wellpoint Medicaid Managed Care	$182.93

SCREW TIBIAL INSERT SZ4 15MM

Facility

$6,903.00

Service Code	HCPCS C1713
Hospital Charge Code	270679485
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$1,670.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,518.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

SCREW TIBIAL INSERT SZ4 22MM

Facility

$6,903.00

Service Code	HCPCS C1713
Hospital Charge Code	270680025
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$1,670.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,518.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

SCREW TIBIAL INSERT SZ4 22MM

Facility

$6,903.00

Service Code	HCPCS C1713
Hospital Charge Code	270680025
Hospital Revenue Code	278
Min. Negotiated Rate	$166.36
Max. Negotiated Rate	$3,451.50
Rate for Payer: Aetna Commercial	$2,623.14
Rate for Payer: Aetna Medicare Advantage	$2,070.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,760.27
Rate for Payer: Cigna Commercial	$3,451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,518.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45
Rate for Payer: UnitedHealthcare Community & State	$166.36
Rate for Payer: Wellpoint Medicaid Managed Care	$182.93

SCREW TIBIAL INSERT SZ5 22MM

Facility

$6,903.00

Service Code	HCPCS C1713
Hospital Charge Code	270676684
Hospital Revenue Code	278
Min. Negotiated Rate	$166.36
Max. Negotiated Rate	$3,451.50
Rate for Payer: Aetna Commercial	$2,623.14
Rate for Payer: Aetna Medicare Advantage	$2,070.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,760.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,760.27
Rate for Payer: Cigna Commercial	$3,451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,518.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45
Rate for Payer: UnitedHealthcare Community & State	$166.36
Rate for Payer: Wellpoint Medicaid Managed Care	$182.93

SCREW TIBIAL INSERT SZ5 22MM

Facility

$6,903.00

Service Code	HCPCS C1713
Hospital Charge Code	270676684
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.45
Max. Negotiated Rate	$1,670.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,380.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,670.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,518.66
Rate for Payer: Qualcare PPO/HMO/WC	$1,035.45

SCREW TIBIAL SCREW SZ4 26MM

Facility

$6,503.00

Service Code	HCPCS C1713
Hospital Charge Code	270676556
Hospital Revenue Code	278
Min. Negotiated Rate	$156.72
Max. Negotiated Rate	$3,251.50
Rate for Payer: Aetna Commercial	$2,471.14
Rate for Payer: Aetna Medicare Advantage	$1,950.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,658.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,658.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,658.27
Rate for Payer: Cigna Commercial	$3,251.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.66
Rate for Payer: Qualcare PPO/HMO/WC	$975.45
Rate for Payer: UnitedHealthcare Community & State	$156.72
Rate for Payer: Wellpoint Medicaid Managed Care	$172.33

SCREW TIBIAL SCREW SZ4 26MM

Facility

$6,503.00

Service Code	HCPCS C1713
Hospital Charge Code	270676556
Hospital Revenue Code	278
Min. Negotiated Rate	$975.45
Max. Negotiated Rate	$1,573.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.66
Rate for Payer: Qualcare PPO/HMO/WC	$975.45

SCREW TIBIAL STEM EXTERNSION

Facility

$506.50

Service Code	HCPCS C1713
Hospital Charge Code	270671719
Hospital Revenue Code	278
Min. Negotiated Rate	$12.21
Max. Negotiated Rate	$253.25
Rate for Payer: Aetna Commercial	$192.47
Rate for Payer: Aetna Medicare Advantage	$151.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$129.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$129.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$101.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$129.16
Rate for Payer: Cigna Commercial	$253.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$111.43
Rate for Payer: Qualcare PPO/HMO/WC	$75.97
Rate for Payer: UnitedHealthcare Community & State	$12.21
Rate for Payer: Wellpoint Medicaid Managed Care	$13.42

SCREW TIBIAL STEM EXTERNSION

Facility

$506.50

Service Code	HCPCS C1713
Hospital Charge Code	270671719
Hospital Revenue Code	278
Min. Negotiated Rate	$75.97
Max. Negotiated Rate	$122.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$101.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$111.43
Rate for Payer: Qualcare PPO/HMO/WC	$75.97

SCREW TI CAN CMP HDLS 4.5X24MM

Facility

$5,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270700711
Hospital Revenue Code	278
Min. Negotiated Rate	$129.54
Max. Negotiated Rate	$2,687.50
Rate for Payer: Aetna Commercial	$2,042.50
Rate for Payer: Aetna Medicare Advantage	$1,612.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,370.62
Rate for Payer: Cigna Commercial	$2,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,182.50
Rate for Payer: Qualcare PPO/HMO/WC	$806.25
Rate for Payer: UnitedHealthcare Community & State	$129.54
Rate for Payer: Wellpoint Medicaid Managed Care	$142.44

SCREW TI CAN CMP HDLS 4.5X24MM

Facility

$5,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270700711
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,182.50
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

Know your out-of-pocket cost for care.

All Charges