Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SCREW VENTED 8 MM X 20 MM BC

Facility

$1,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270688546
Hospital Revenue Code	278
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$324.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$39.09

SCREW VERIDTE 12MM

Facility

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270686286
Hospital Revenue Code	278
Min. Negotiated Rate	$206.25
Max. Negotiated Rate	$332.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$206.25

SCREW VERIDTE 12MM

Facility

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270686287
Hospital Revenue Code	278
Min. Negotiated Rate	$206.25
Max. Negotiated Rate	$332.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$206.25

SCREW VERIDTE 12MM

Facility

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270686286
Hospital Revenue Code	278
Min. Negotiated Rate	$33.14
Max. Negotiated Rate	$687.50
Rate for Payer: Aetna Commercial	$522.50
Rate for Payer: Aetna Medicare Advantage	$412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.62
Rate for Payer: Cigna Commercial	$687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$206.25
Rate for Payer: UnitedHealthcare Community & State	$33.14
Rate for Payer: Wellpoint Medicaid Managed Care	$36.44

SCREW VERIDTE 12MM

Facility

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270686287
Hospital Revenue Code	278
Min. Negotiated Rate	$33.14
Max. Negotiated Rate	$687.50
Rate for Payer: Aetna Commercial	$522.50
Rate for Payer: Aetna Medicare Advantage	$412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.62
Rate for Payer: Cigna Commercial	$687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$206.25
Rate for Payer: UnitedHealthcare Community & State	$33.14
Rate for Payer: Wellpoint Medicaid Managed Care	$36.44

SCREW VERSAFITCUP 30MM

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270683284
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

SCREW VERSAFITCUP 30MM

Facility

$250.00

Service Code	HCPCS C1713
Hospital Charge Code	270683284
Hospital Revenue Code	278
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

SCREW VHS 4.5 SS CORT S/T 28MM

Facility

$90.00

Hospital Charge Code	270654419
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$21.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

SCREW VHS 4.5 SS CORT S/T 28MM

Facility

$90.00

Hospital Charge Code	270654419
Hospital Revenue Code	278
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

SCREW VHS 4.5 SS CORT S/T 46MM

Facility

$90.00

Hospital Charge Code	270654423
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$21.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

SCREW VHS 4.5 SS CORT S/T 46MM

Facility

$90.00

Hospital Charge Code	270654423
Hospital Revenue Code	278
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

SCREW VHS LAG 12.7x105 200205

Facility

$1,390.00

Hospital Charge Code	270643802
Hospital Revenue Code	278
Min. Negotiated Rate	$208.50
Max. Negotiated Rate	$336.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$278.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$305.80
Rate for Payer: Qualcare PPO/HMO/WC	$208.50

SCREW VHS LAG 12.7x105 200205

Facility

$1,390.00

Hospital Charge Code	270643802
Hospital Revenue Code	278
Min. Negotiated Rate	$33.50
Max. Negotiated Rate	$695.00
Rate for Payer: Aetna Commercial	$528.20
Rate for Payer: Aetna Medicare Advantage	$417.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$354.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$354.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$278.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$354.45
Rate for Payer: Cigna Commercial	$695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$305.80
Rate for Payer: Qualcare PPO/HMO/WC	$208.50
Rate for Payer: UnitedHealthcare Community & State	$33.50
Rate for Payer: Wellpoint Medicaid Managed Care	$36.84

SCREW VIPER CORT PED TI 7X45MM

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693868
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

SCREW VIPER CORT PED TI 7X45MM

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693868
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

SCREW VIPER CORT PED TI 7X50MM

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693869
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

SCREW VIPER CORT PED TI 7X50MM

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693869
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

SCREW V-LOCK 90DEGREE 30mNL-30

Facility

$421.65

Hospital Charge Code	270636607
Hospital Revenue Code	278
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$210.82
Rate for Payer: Aetna Commercial	$160.23
Rate for Payer: Aetna Medicare Advantage	$126.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.52
Rate for Payer: Cigna Commercial	$210.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.76
Rate for Payer: Qualcare PPO/HMO/WC	$63.25
Rate for Payer: UnitedHealthcare Community & State	$10.16
Rate for Payer: Wellpoint Medicaid Managed Care	$11.17

SCREW V-LOCK 90DEGREE 30mNL-30

Facility

$421.65

Hospital Charge Code	270636607
Hospital Revenue Code	278
Min. Negotiated Rate	$63.25
Max. Negotiated Rate	$102.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.76
Rate for Payer: Qualcare PPO/HMO/WC	$63.25

SCREW VLOCK 90DEGREE 34m NL-34

Facility

$421.65

Hospital Charge Code	270636608
Hospital Revenue Code	278
Min. Negotiated Rate	$63.25
Max. Negotiated Rate	$102.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.76
Rate for Payer: Qualcare PPO/HMO/WC	$63.25

SCREW VLOCK 90DEGREE 34m NL-34

Facility

$421.65

Hospital Charge Code	270636608
Hospital Revenue Code	278
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$210.82
Rate for Payer: Aetna Commercial	$160.23
Rate for Payer: Aetna Medicare Advantage	$126.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.52
Rate for Payer: Cigna Commercial	$210.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.76
Rate for Payer: Qualcare PPO/HMO/WC	$63.25
Rate for Payer: UnitedHealthcare Community & State	$10.16
Rate for Payer: Wellpoint Medicaid Managed Care	$11.17

SCREW VLX CANN 3.0 30 P227-30

Facility

$460.85

Hospital Charge Code	270614806
Hospital Revenue Code	278
Min. Negotiated Rate	$69.13
Max. Negotiated Rate	$111.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$101.39
Rate for Payer: Qualcare PPO/HMO/WC	$69.13

SCREW VLX CANN 3.0 30 P227-30

Facility

$460.85

Hospital Charge Code	270614806
Hospital Revenue Code	278
Min. Negotiated Rate	$11.11
Max. Negotiated Rate	$230.43
Rate for Payer: Aetna Commercial	$175.12
Rate for Payer: Aetna Medicare Advantage	$138.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$117.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$117.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$117.52
Rate for Payer: Cigna Commercial	$230.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$101.39
Rate for Payer: Qualcare PPO/HMO/WC	$69.13
Rate for Payer: UnitedHealthcare Community & State	$11.11
Rate for Payer: Wellpoint Medicaid Managed Care	$12.21

SCREW VLX CANN 3.0 32 P227-32

Facility

$484.00

Hospital Charge Code	270614807
Hospital Revenue Code	278
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$242.00
Rate for Payer: Aetna Commercial	$183.92
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$106.48
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Community & State	$11.66
Rate for Payer: Wellpoint Medicaid Managed Care	$12.83

SCREW VLX CANN 3.0 32 P227-32

Facility

$484.00

Hospital Charge Code	270614807
Hospital Revenue Code	278
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$117.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$106.48
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

Know your out-of-pocket cost for care.

All Charges