Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

4.2X14MM SCREW

Facility

$4,275.00

Service Code	HCPCS 4275
Hospital Charge Code	270704993
Hospital Revenue Code	278
Min. Negotiated Rate	$103.03
Max. Negotiated Rate	$2,137.50
Rate for Payer: Aetna Commercial	$1,624.50
Rate for Payer: Aetna Medicare Advantage	$1,282.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,090.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,090.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,090.12
Rate for Payer: Cigna Commercial	$2,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$940.50
Rate for Payer: Qualcare PPO/HMO/WC	$641.25
Rate for Payer: UnitedHealthcare Community & State	$103.03
Rate for Payer: Wellpoint Medicaid Managed Care	$113.29

4.2X23MM SCREW

Facility

$4,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270704995
Hospital Revenue Code	278
Min. Negotiated Rate	$641.25
Max. Negotiated Rate	$1,034.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$940.50
Rate for Payer: Qualcare PPO/HMO/WC	$641.25

4.2X23MM SCREW

Facility

$4,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270704995
Hospital Revenue Code	278
Min. Negotiated Rate	$103.03
Max. Negotiated Rate	$2,137.50
Rate for Payer: Aetna Commercial	$1,624.50
Rate for Payer: Aetna Medicare Advantage	$1,282.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,090.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,090.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$855.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,090.12
Rate for Payer: Cigna Commercial	$2,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,034.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$940.50
Rate for Payer: Qualcare PPO/HMO/WC	$641.25
Rate for Payer: UnitedHealthcare Community & State	$103.03
Rate for Payer: Wellpoint Medicaid Managed Care	$113.29

42X4.0 LOCKING SCREW

Facility

$752.70

Service Code	HCPCS C1713
Hospital Charge Code	270656441
Hospital Revenue Code	278
Min. Negotiated Rate	$112.91
Max. Negotiated Rate	$182.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.59
Rate for Payer: Qualcare PPO/HMO/WC	$112.91

42X4.0 LOCKING SCREW

Facility

$752.70

Service Code	HCPCS C1713
Hospital Charge Code	270656441
Hospital Revenue Code	278
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.35
Rate for Payer: Aetna Commercial	$286.03
Rate for Payer: Aetna Medicare Advantage	$225.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.94
Rate for Payer: Cigna Commercial	$376.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.59
Rate for Payer: Qualcare PPO/HMO/WC	$112.91
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.95

4.3 GUIDE

Facility

$605.65

Hospital Charge Code	270679074
Hospital Revenue Code	272
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$302.82
Rate for Payer: Aetna Commercial	$230.15
Rate for Payer: Aetna Medicare Advantage	$181.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.44
Rate for Payer: Cigna Commercial	$302.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.69
Rate for Payer: Oxford Commercial	$121.13
Rate for Payer: Qualcare PPO/HMO/WC	$90.85
Rate for Payer: UnitedHealthcare Commercial	$121.13
Rate for Payer: UnitedHealthcare Community & State	$14.60
Rate for Payer: Wellpoint Medicaid Managed Care	$16.05

4.3 GUIDE

Facility

$605.65

Hospital Charge Code	270679074
Hospital Revenue Code	272
Min. Negotiated Rate	$90.85
Max. Negotiated Rate	$90.85
Rate for Payer: Qualcare PPO/HMO/WC	$90.85

4.3MM DRILL BIT LENGTH 413MM

Facility

$2,175.00

Hospital Charge Code	270686946
Hospital Revenue Code	272
Min. Negotiated Rate	$52.42
Max. Negotiated Rate	$1,087.50
Rate for Payer: Aetna Commercial	$826.50
Rate for Payer: Aetna Medicare Advantage	$652.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$554.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$554.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$554.62
Rate for Payer: Cigna Commercial	$1,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$652.50
Rate for Payer: Oxford Commercial	$435.00
Rate for Payer: Qualcare PPO/HMO/WC	$326.25
Rate for Payer: UnitedHealthcare Commercial	$435.00
Rate for Payer: UnitedHealthcare Community & State	$52.42
Rate for Payer: Wellpoint Medicaid Managed Care	$57.64

4.3MM DRILL BIT LENGTH 413MM

Facility

$2,175.00

Hospital Charge Code	270686946
Hospital Revenue Code	272
Min. Negotiated Rate	$326.25
Max. Negotiated Rate	$326.25
Rate for Payer: Qualcare PPO/HMO/WC	$326.25

4.3MM DRILL MEASURING SLEEVE

Facility

$1,368.00

Hospital Charge Code	270680796
Hospital Revenue Code	272
Min. Negotiated Rate	$205.20
Max. Negotiated Rate	$205.20
Rate for Payer: Qualcare PPO/HMO/WC	$205.20

4.3MM DRILL MEASURING SLEEVE

Facility

$1,368.00

Hospital Charge Code	270680796
Hospital Revenue Code	272
Min. Negotiated Rate	$32.97
Max. Negotiated Rate	$684.00
Rate for Payer: Aetna Commercial	$519.84
Rate for Payer: Aetna Medicare Advantage	$410.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$348.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$348.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$348.84
Rate for Payer: Cigna Commercial	$684.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$410.40
Rate for Payer: Oxford Commercial	$273.60
Rate for Payer: Qualcare PPO/HMO/WC	$205.20
Rate for Payer: UnitedHealthcare Commercial	$273.60
Rate for Payer: UnitedHealthcare Community & State	$32.97
Rate for Payer: Wellpoint Medicaid Managed Care	$36.25

4.3MM DRILL MEASURING SLEEVE

Facility

$1,475.00

Hospital Charge Code	270690293
Hospital Revenue Code	272
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$221.25
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

4.3MM DRILL MEASURING SLEEVE

Facility

$1,475.00

Hospital Charge Code	270690293
Hospital Revenue Code	272
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) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.50
Rate for Payer: Oxford Commercial	$295.00
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Commercial	$295.00
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$39.09

4.3MM FREE HAND DRILL 152.5MM

Facility

$522.00

Hospital Charge Code	270665470
Hospital Revenue Code	272
Min. Negotiated Rate	$12.58
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna Commercial	$198.36
Rate for Payer: Aetna Medicare Advantage	$156.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.11
Rate for Payer: Cigna Commercial	$261.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.60
Rate for Payer: Oxford Commercial	$104.40
Rate for Payer: Qualcare PPO/HMO/WC	$78.30
Rate for Payer: UnitedHealthcare Commercial	$104.40
Rate for Payer: UnitedHealthcare Community & State	$12.58
Rate for Payer: Wellpoint Medicaid Managed Care	$13.83

4.3MM FREE HAND DRILL 152.5MM

Facility

$522.00

Hospital Charge Code	270665470
Hospital Revenue Code	272
Min. Negotiated Rate	$78.30
Max. Negotiated Rate	$78.30
Rate for Payer: Qualcare PPO/HMO/WC	$78.30

4.3MML DISTAL GRADUATED DRILL

Facility

$1,025.00

Hospital Charge Code	270656694
Hospital Revenue Code	272
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.50
Rate for Payer: Oxford Commercial	$205.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Commercial	$205.00
Rate for Payer: UnitedHealthcare Community & State	$24.70
Rate for Payer: Wellpoint Medicaid Managed Care	$27.16

4.3MML DISTAL GRADUATED DRILL

Facility

$1,025.00

Hospital Charge Code	270656694
Hospital Revenue Code	272
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$153.75
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

4.3MMS DISTAL GRADUATED DRILL

Facility

$936.00

Hospital Charge Code	270677922
Hospital Revenue Code	272
Min. Negotiated Rate	$22.56
Max. Negotiated Rate	$468.00
Rate for Payer: Aetna Commercial	$355.68
Rate for Payer: Aetna Medicare Advantage	$280.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$238.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$238.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$238.68
Rate for Payer: Cigna Commercial	$468.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$280.80
Rate for Payer: Oxford Commercial	$187.20
Rate for Payer: Qualcare PPO/HMO/WC	$140.40
Rate for Payer: UnitedHealthcare Commercial	$187.20
Rate for Payer: UnitedHealthcare Community & State	$22.56
Rate for Payer: Wellpoint Medicaid Managed Care	$24.80

4.3MMS DISTAL GRADUATED DRILL

Facility

$936.00

Hospital Charge Code	270677922
Hospital Revenue Code	272
Min. Negotiated Rate	$140.40
Max. Negotiated Rate	$140.40
Rate for Payer: Qualcare PPO/HMO/WC	$140.40

44X4.0 LOCKING SCREW

Facility

$752.70

Service Code	HCPCS C1713
Hospital Charge Code	270656443
Hospital Revenue Code	278
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$376.35
Rate for Payer: Aetna Commercial	$286.03
Rate for Payer: Aetna Medicare Advantage	$225.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.94
Rate for Payer: Cigna Commercial	$376.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.59
Rate for Payer: Qualcare PPO/HMO/WC	$112.91
Rate for Payer: UnitedHealthcare Community & State	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$19.95

44X4.0 LOCKING SCREW

Facility

$752.70

Service Code	HCPCS C1713
Hospital Charge Code	270656443
Hospital Revenue Code	278
Min. Negotiated Rate	$112.91
Max. Negotiated Rate	$182.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.59
Rate for Payer: Qualcare PPO/HMO/WC	$112.91

4.5LCP FEMUR PLATE,6H LEFT

Facility

$6,362.30

Service Code	HCPCS C1713
Hospital Charge Code	270679064
Hospital Revenue Code	278
Min. Negotiated Rate	$153.33
Max. Negotiated Rate	$3,181.15
Rate for Payer: Aetna Commercial	$2,417.67
Rate for Payer: Aetna Medicare Advantage	$1,908.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,622.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,622.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,622.39
Rate for Payer: Cigna Commercial	$3,181.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,399.71
Rate for Payer: Qualcare PPO/HMO/WC	$954.35
Rate for Payer: UnitedHealthcare Community & State	$153.33
Rate for Payer: Wellpoint Medicaid Managed Care	$168.60

4.5LCP FEMUR PLATE,6H LEFT

Facility

$6,362.30

Service Code	HCPCS C1713
Hospital Charge Code	270679064
Hospital Revenue Code	278
Min. Negotiated Rate	$954.35
Max. Negotiated Rate	$1,539.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,399.71
Rate for Payer: Qualcare PPO/HMO/WC	$954.35

4.5LCP FEMUR PLATE 6H RIGHT

Facility

$6,362.30

Service Code	HCPCS C1713
Hospital Charge Code	270679071
Hospital Revenue Code	278
Min. Negotiated Rate	$153.33
Max. Negotiated Rate	$3,181.15
Rate for Payer: Aetna Commercial	$2,417.67
Rate for Payer: Aetna Medicare Advantage	$1,908.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,622.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,622.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,622.39
Rate for Payer: Cigna Commercial	$3,181.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,399.71
Rate for Payer: Qualcare PPO/HMO/WC	$954.35
Rate for Payer: UnitedHealthcare Community & State	$153.33
Rate for Payer: Wellpoint Medicaid Managed Care	$168.60

4.5LCP FEMUR PLATE 6H RIGHT

Facility

$6,362.30

Service Code	HCPCS C1713
Hospital Charge Code	270679071
Hospital Revenue Code	278
Min. Negotiated Rate	$954.35
Max. Negotiated Rate	$1,539.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,399.71
Rate for Payer: Qualcare PPO/HMO/WC	$954.35

Know your out-of-pocket cost for care.

All Charges