Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

5.0 3FLTD DRIL BT QC 356/126MM

Facility

$1,370.05

Hospital Charge Code	270687938
Hospital Revenue Code	272
Min. Negotiated Rate	$205.51
Max. Negotiated Rate	$205.51
Rate for Payer: Qualcare PPO/HMO/WC	$205.51

5.0 3FLTD DRIL BT QC 356/126MM

Facility

$1,370.05

Hospital Charge Code	270687938
Hospital Revenue Code	272
Min. Negotiated Rate	$33.02
Max. Negotiated Rate	$685.02
Rate for Payer: Aetna Commercial	$520.62
Rate for Payer: Aetna Medicare Advantage	$411.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$349.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$349.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$349.36
Rate for Payer: Cigna Commercial	$685.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.01
Rate for Payer: Oxford Commercial	$274.01
Rate for Payer: Qualcare PPO/HMO/WC	$205.51
Rate for Payer: UnitedHealthcare Commercial	$274.01
Rate for Payer: UnitedHealthcare Community & State	$33.02
Rate for Payer: Wellpoint Medicaid Managed Care	$36.31

5.0 CANNULATED DRILL BIT5.0 CA

Facility

$1,690.50

Hospital Charge Code	270656452
Hospital Revenue Code	272
Min. Negotiated Rate	$253.57
Max. Negotiated Rate	$253.57
Rate for Payer: Qualcare PPO/HMO/WC	$253.57

5.0 CANNULATED DRILL BIT5.0 CA

Facility

$1,690.50

Hospital Charge Code	270656452
Hospital Revenue Code	272
Min. Negotiated Rate	$40.74
Max. Negotiated Rate	$845.25
Rate for Payer: Aetna Commercial	$642.39
Rate for Payer: Aetna Medicare Advantage	$507.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$431.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$431.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$431.08
Rate for Payer: Cigna Commercial	$845.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$507.15
Rate for Payer: Oxford Commercial	$338.10
Rate for Payer: Qualcare PPO/HMO/WC	$253.57
Rate for Payer: UnitedHealthcare Commercial	$338.10
Rate for Payer: UnitedHealthcare Community & State	$40.74
Rate for Payer: Wellpoint Medicaid Managed Care	$44.80

5.0 CANNULATED LOCKING SCREW 2

Facility

$1,050.60

Service Code	HCPCS C1713
Hospital Charge Code	270679067
Hospital Revenue Code	278
Min. Negotiated Rate	$157.59
Max. Negotiated Rate	$254.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$231.13
Rate for Payer: Qualcare PPO/HMO/WC	$157.59

5.0 CANNULATED LOCKING SCREW 2

Facility

$1,050.60

Service Code	HCPCS C1713
Hospital Charge Code	270679067
Hospital Revenue Code	278
Min. Negotiated Rate	$25.32
Max. Negotiated Rate	$525.30
Rate for Payer: Aetna Commercial	$399.23
Rate for Payer: Aetna Medicare Advantage	$315.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.90
Rate for Payer: Cigna Commercial	$525.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$231.13
Rate for Payer: Qualcare PPO/HMO/WC	$157.59
Rate for Payer: UnitedHealthcare Community & State	$25.32
Rate for Payer: Wellpoint Medicaid Managed Care	$27.84

5.0 LOCKING SCREW 20

Facility

$753.00

Service Code	HCPCS C1713
Hospital Charge Code	270677478
Hospital Revenue Code	278
Min. Negotiated Rate	$112.95
Max. Negotiated Rate	$182.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.66
Rate for Payer: Qualcare PPO/HMO/WC	$112.95

5.0 LOCKING SCREW 20

Facility

$753.00

Service Code	HCPCS C1713
Hospital Charge Code	270677478
Hospital Revenue Code	278
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$376.50
Rate for Payer: Aetna Commercial	$286.14
Rate for Payer: Aetna Medicare Advantage	$225.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.01
Rate for Payer: Cigna Commercial	$376.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.66
Rate for Payer: Qualcare PPO/HMO/WC	$112.95
Rate for Payer: UnitedHealthcare Community & State	$18.15
Rate for Payer: Wellpoint Medicaid Managed Care	$19.95

5.0 LOCKING SCREW 8

Facility

$1,294.70

Service Code	HCPCS C1713
Hospital Charge Code	270679068
Hospital Revenue Code	278
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$647.35
Rate for Payer: Aetna Commercial	$491.99
Rate for Payer: Aetna Medicare Advantage	$388.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$258.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.15
Rate for Payer: Cigna Commercial	$647.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$284.83
Rate for Payer: Qualcare PPO/HMO/WC	$194.21
Rate for Payer: UnitedHealthcare Community & State	$31.20
Rate for Payer: Wellpoint Medicaid Managed Care	$34.31

5.0 LOCKING SCREW 8

Facility

$1,294.70

Service Code	HCPCS C1713
Hospital Charge Code	270679068
Hospital Revenue Code	278
Min. Negotiated Rate	$194.21
Max. Negotiated Rate	$313.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$258.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$284.83
Rate for Payer: Qualcare PPO/HMO/WC	$194.21

50MM 3 LEVEL CERVICAL PLATE

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704837
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

50MM 3 LEVEL CERVICAL PLATE

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704837
Hospital Revenue Code	278
Min. Negotiated Rate	$132.55
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$132.55
Rate for Payer: Wellpoint Medicaid Managed Care	$145.75

5.0MM CANN DRILL BIT LARGE QC/

Facility

$1,919.15

Hospital Charge Code	270605095
Hospital Revenue Code	272
Min. Negotiated Rate	$287.87
Max. Negotiated Rate	$287.87
Rate for Payer: Qualcare PPO/HMO/WC	$287.87

5.0MM CANN DRILL BIT LARGE QC/

Facility

$1,919.15

Hospital Charge Code	270605095
Hospital Revenue Code	272
Min. Negotiated Rate	$46.25
Max. Negotiated Rate	$959.58
Rate for Payer: Aetna Commercial	$729.28
Rate for Payer: Aetna Medicare Advantage	$575.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$489.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$489.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$489.38
Rate for Payer: Cigna Commercial	$959.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$575.75
Rate for Payer: Oxford Commercial	$383.83
Rate for Payer: Qualcare PPO/HMO/WC	$287.87
Rate for Payer: UnitedHealthcare Commercial	$383.83
Rate for Payer: UnitedHealthcare Community & State	$46.25
Rate for Payer: Wellpoint Medicaid Managed Care	$50.86

5.0MM THREADED DRILL SLEEVE

Facility

$900.00

Hospital Charge Code	270703298
Hospital Revenue Code	270
Min. Negotiated Rate	$21.69
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$270.00
Rate for Payer: Oxford Commercial	$180.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Commercial	$180.00
Rate for Payer: UnitedHealthcare Community & State	$21.69
Rate for Payer: Wellpoint Medicaid Managed Care	$23.85

5.0MM THREADED DRILL SLEEVE

Facility

$900.00

Hospital Charge Code	270703298
Hospital Revenue Code	270
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

5.0MM TI LOCKIMNG SCR SLF TPNG

Facility

$1,077.00

Service Code	HCPCS C1713
Hospital Charge Code	270686945
Hospital Revenue Code	278
Min. Negotiated Rate	$161.55
Max. Negotiated Rate	$260.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.94
Rate for Payer: Qualcare PPO/HMO/WC	$161.55

5.0MM TI LOCKIMNG SCR SLF TPNG

Facility

$1,077.00

Service Code	HCPCS C1713
Hospital Charge Code	270686945
Hospital Revenue Code	278
Min. Negotiated Rate	$25.96
Max. Negotiated Rate	$538.50
Rate for Payer: Aetna Commercial	$409.26
Rate for Payer: Aetna Medicare Advantage	$323.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.63
Rate for Payer: Cigna Commercial	$538.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.94
Rate for Payer: Qualcare PPO/HMO/WC	$161.55
Rate for Payer: UnitedHealthcare Community & State	$25.96
Rate for Payer: Wellpoint Medicaid Managed Care	$28.54

50MM TI LOCKING SCR SLF-TPNG 4

Facility

$1,077.00

Service Code	HCPCS C1713
Hospital Charge Code	270687018
Hospital Revenue Code	278
Min. Negotiated Rate	$25.96
Max. Negotiated Rate	$538.50
Rate for Payer: Aetna Commercial	$409.26
Rate for Payer: Aetna Medicare Advantage	$323.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.63
Rate for Payer: Cigna Commercial	$538.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.94
Rate for Payer: Qualcare PPO/HMO/WC	$161.55
Rate for Payer: UnitedHealthcare Community & State	$25.96
Rate for Payer: Wellpoint Medicaid Managed Care	$28.54

50MM TI LOCKING SCR SLF-TPNG 4

Facility

$1,077.00

Service Code	HCPCS C1713
Hospital Charge Code	270687018
Hospital Revenue Code	278
Min. Negotiated Rate	$161.55
Max. Negotiated Rate	$260.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.94
Rate for Payer: Qualcare PPO/HMO/WC	$161.55

5.0MMTILOCKSCRSLFTP T25SD40MM

Facility

$868.95

Service Code	HCPCS C1713
Hospital Charge Code	270690900
Hospital Revenue Code	278
Min. Negotiated Rate	$20.94
Max. Negotiated Rate	$434.48
Rate for Payer: Aetna Commercial	$330.20
Rate for Payer: Aetna Medicare Advantage	$260.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$173.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$221.58
Rate for Payer: Cigna Commercial	$434.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$210.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$191.17
Rate for Payer: Qualcare PPO/HMO/WC	$130.34
Rate for Payer: UnitedHealthcare Community & State	$20.94
Rate for Payer: Wellpoint Medicaid Managed Care	$23.03

5.0MMTILOCKSCRSLFTP T25SD40MM

Facility

$868.95

Service Code	HCPCS C1713
Hospital Charge Code	270690900
Hospital Revenue Code	278
Min. Negotiated Rate	$130.34
Max. Negotiated Rate	$210.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$173.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$210.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$191.17
Rate for Payer: Qualcare PPO/HMO/WC	$130.34

50MM TM W/ HOLE CUP

Facility

$8,660.65

Hospital Charge Code	270656911
Hospital Revenue Code	278
Min. Negotiated Rate	$208.72
Max. Negotiated Rate	$4,330.32
Rate for Payer: Aetna Commercial	$3,291.05
Rate for Payer: Aetna Medicare Advantage	$2,598.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,208.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,208.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,208.47
Rate for Payer: Cigna Commercial	$4,330.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,905.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.10
Rate for Payer: UnitedHealthcare Community & State	$208.72
Rate for Payer: Wellpoint Medicaid Managed Care	$229.51

50MM TM W/ HOLE CUP

Facility

$8,660.65

Hospital Charge Code	270656911
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.10
Max. Negotiated Rate	$2,095.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,732.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,905.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.10

5.0 SCREW 38

Facility

$1,314.45

Service Code	HCPCS C1713
Hospital Charge Code	270656660
Hospital Revenue Code	278
Min. Negotiated Rate	$197.17
Max. Negotiated Rate	$318.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$262.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$289.18
Rate for Payer: Qualcare PPO/HMO/WC	$197.17

Know your out-of-pocket cost for care.

All Charges