Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

4.5 TI MULTILOC SCREW

Facility

$2,569.95

Service Code	HCPCS C1713
Hospital Charge Code	270705549
Hospital Revenue Code	278
Min. Negotiated Rate	$61.94
Max. Negotiated Rate	$1,284.97
Rate for Payer: Aetna Commercial	$976.58
Rate for Payer: Aetna Medicare Advantage	$770.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$655.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$655.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$513.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$655.34
Rate for Payer: Cigna Commercial	$1,284.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$565.39
Rate for Payer: Qualcare PPO/HMO/WC	$385.49
Rate for Payer: UnitedHealthcare Community & State	$61.94
Rate for Payer: Wellpoint Medicaid Managed Care	$68.10

4.5X14MM SCREW

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704541
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

4.5X14MM SCREW

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704541
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

4.5x16MM SCREW PRECISION SPINE

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705172
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

4.5x16MM SCREW PRECISION SPINE

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705172
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

4.5 X 32MM BONE TORNIER

Facility

$525.00

Hospital Charge Code	270339517
Hospital Revenue Code	278
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$12.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.91

4.5 X 32MM BONE TORNIER

Facility

$525.00

Hospital Charge Code	270339517
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

4.5X34MM BONE SCREW

Facility

$525.00

Hospital Charge Code	270656728
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

4.5X34MM BONE SCREW

Facility

$525.00

Hospital Charge Code	270656728
Hospital Revenue Code	278
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$12.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.91

4.5X34MM BONE SCREWS

Facility

$525.00

Hospital Charge Code	270656729
Hospital Revenue Code	278
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$12.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.91

4.5X34MM BONE SCREWS

Facility

$525.00

Hospital Charge Code	270656729
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

4.5X36MM BONE SCREW

Facility

$525.00

Hospital Charge Code	270656730
Hospital Revenue Code	278
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$12.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.91

4.5X36MM BONE SCREW

Facility

$525.00

Hospital Charge Code	270656730
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

4.5 X36MM BONE SCREW TORNIER

Facility

$525.00

Hospital Charge Code	270339518
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

4.5 X36MM BONE SCREW TORNIER

Facility

$525.00

Hospital Charge Code	270339518
Hospital Revenue Code	278
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$12.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.91

45X4.0 CONCELLOUS SCREW

Facility

$136.50

Service Code	HCPCS C1713
Hospital Charge Code	270656446
Hospital Revenue Code	278
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$68.25
Rate for Payer: Aetna Commercial	$51.87
Rate for Payer: Aetna Medicare Advantage	$40.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.81
Rate for Payer: Cigna Commercial	$68.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.03
Rate for Payer: Qualcare PPO/HMO/WC	$20.48
Rate for Payer: UnitedHealthcare Community & State	$3.29
Rate for Payer: Wellpoint Medicaid Managed Care	$3.62

45X4.0 CONCELLOUS SCREW

Facility

$136.50

Service Code	HCPCS C1713
Hospital Charge Code	270656446
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$33.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.03
Rate for Payer: Qualcare PPO/HMO/WC	$20.48

4.5X40MM BONE SCREW

Facility

$525.00

Hospital Charge Code	270656731
Hospital Revenue Code	278
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$12.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.91

4.5X40MM BONE SCREW

Facility

$525.00

Hospital Charge Code	270656731
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

4.5 X 40MM BONE SCREW TORNIER

Facility

$525.00

Hospital Charge Code	270339519
Hospital Revenue Code	278
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$12.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.91

4.5 X 40MM BONE SCREW TORNIER

Facility

$525.00

Hospital Charge Code	270339519
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

4.5X45MM BONE SCREW

Facility

$525.00

Hospital Charge Code	270656732
Hospital Revenue Code	278
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$12.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.91

4.5X45MM BONE SCREW

Facility

$525.00

Hospital Charge Code	270656732
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

4.5 X 45MM BONE SCREW TORNIER

Facility

$525.00

Hospital Charge Code	270339520
Hospital Revenue Code	278
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$12.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.91

4.5 X 45MM BONE SCREW TORNIER

Facility

$525.00

Hospital Charge Code	270339520
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$115.50
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

Know your out-of-pocket cost for care.

All Charges