Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

T-PLATE LCP 4.5x147MM 8HOLE

Facility

$3,411.35

Hospital Charge Code	270666772
Hospital Revenue Code	278
Min. Negotiated Rate	$511.70
Max. Negotiated Rate	$825.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$682.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$825.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$750.50
Rate for Payer: Qualcare PPO/HMO/WC	$511.70

T-PLATE LCP 4.5x147MM 8HOLE

Facility

$3,411.35

Hospital Charge Code	270666772
Hospital Revenue Code	278
Min. Negotiated Rate	$82.21
Max. Negotiated Rate	$1,705.67
Rate for Payer: Aetna Commercial	$1,296.31
Rate for Payer: Aetna Medicare Advantage	$1,023.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$869.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$869.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$682.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$869.89
Rate for Payer: Cigna Commercial	$1,705.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$825.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$750.50
Rate for Payer: Qualcare PPO/HMO/WC	$511.70
Rate for Payer: UnitedHealthcare Community & State	$82.21
Rate for Payer: Wellpoint Medicaid Managed Care	$90.40

T-PLATE LCP 4.5x83MM 4HOLE

Facility

$2,577.05

Hospital Charge Code	270671990
Hospital Revenue Code	278
Min. Negotiated Rate	$62.11
Max. Negotiated Rate	$1,288.53
Rate for Payer: Aetna Commercial	$979.28
Rate for Payer: Aetna Medicare Advantage	$773.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$657.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$657.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$515.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$657.15
Rate for Payer: Cigna Commercial	$1,288.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$623.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$566.95
Rate for Payer: Qualcare PPO/HMO/WC	$386.56
Rate for Payer: UnitedHealthcare Community & State	$62.11
Rate for Payer: Wellpoint Medicaid Managed Care	$68.29

T-PLATE LCP 4.5x83MM 4HOLE

Facility

$2,577.05

Hospital Charge Code	270671990
Hospital Revenue Code	278
Min. Negotiated Rate	$386.56
Max. Negotiated Rate	$623.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$515.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$623.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$566.95
Rate for Payer: Qualcare PPO/HMO/WC	$386.56

T-PLATE LKG NARROW 5H 34MM

Facility

$4,565.20

Service Code	HCPCS C1713
Hospital Charge Code	270700479
Hospital Revenue Code	278
Min. Negotiated Rate	$110.02
Max. Negotiated Rate	$2,282.60
Rate for Payer: Aetna Commercial	$1,734.78
Rate for Payer: Aetna Medicare Advantage	$1,369.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,164.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,164.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,164.13
Rate for Payer: Cigna Commercial	$2,282.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,004.34
Rate for Payer: Qualcare PPO/HMO/WC	$684.78
Rate for Payer: UnitedHealthcare Community & State	$110.02
Rate for Payer: Wellpoint Medicaid Managed Care	$120.98

T-PLATE LKG NARROW 5H 34MM

Facility

$4,565.20

Service Code	HCPCS C1713
Hospital Charge Code	270700479
Hospital Revenue Code	278
Min. Negotiated Rate	$684.78
Max. Negotiated Rate	$1,104.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,004.34
Rate for Payer: Qualcare PPO/HMO/WC	$684.78

T-PLATE LOW PRO 3-HOLE TI 3MM

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270666083
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

T-PLATE LOW PRO 3-HOLE TI 3MM

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270666083
Hospital Revenue Code	278
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$96.40
Rate for Payer: Wellpoint Medicaid Managed Care	$106.00

T-PLATE LOW PROFILE 2.4MM 3H

Facility

$3,475.00

Hospital Charge Code	270674261
Hospital Revenue Code	278
Min. Negotiated Rate	$83.75
Max. Negotiated Rate	$1,737.50
Rate for Payer: Aetna Commercial	$1,320.50
Rate for Payer: Aetna Medicare Advantage	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$886.12
Rate for Payer: Cigna Commercial	$1,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$764.50
Rate for Payer: Qualcare PPO/HMO/WC	$521.25
Rate for Payer: UnitedHealthcare Community & State	$83.75
Rate for Payer: Wellpoint Medicaid Managed Care	$92.09

T-PLATE LOW PROFILE 2.4MM 3H

Facility

$3,475.00

Hospital Charge Code	270674261
Hospital Revenue Code	278
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$840.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$764.50
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

T-PLATE LOW PROFILE 2.4MM 4H

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270679307
Hospital Revenue Code	278
Min. Negotiated Rate	$83.75
Max. Negotiated Rate	$1,737.50
Rate for Payer: Aetna Commercial	$1,320.50
Rate for Payer: Aetna Medicare Advantage	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$886.12
Rate for Payer: Cigna Commercial	$1,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$764.50
Rate for Payer: Qualcare PPO/HMO/WC	$521.25
Rate for Payer: UnitedHealthcare Community & State	$83.75
Rate for Payer: Wellpoint Medicaid Managed Care	$92.09

T-PLATE LOW PROFILE 2.4MM 4H

Facility

$3,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270679307
Hospital Revenue Code	278
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$840.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$764.50
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

T-PLATE NARROW 6 HOLE

Facility

$2,725.00

Service Code	HCPCS C1713
Hospital Charge Code	270673830
Hospital Revenue Code	278
Min. Negotiated Rate	$65.67
Max. Negotiated Rate	$1,362.50
Rate for Payer: Aetna Commercial	$1,035.50
Rate for Payer: Aetna Medicare Advantage	$817.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$694.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$694.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$694.88
Rate for Payer: Cigna Commercial	$1,362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$659.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$599.50
Rate for Payer: Qualcare PPO/HMO/WC	$408.75
Rate for Payer: UnitedHealthcare Community & State	$65.67
Rate for Payer: Wellpoint Medicaid Managed Care	$72.21

T-PLATE NARROW 6 HOLE

Facility

$2,725.00

Service Code	HCPCS C1713
Hospital Charge Code	270673830
Hospital Revenue Code	278
Min. Negotiated Rate	$408.75
Max. Negotiated Rate	$659.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$545.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$659.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$599.50
Rate for Payer: Qualcare PPO/HMO/WC	$408.75

T PLATE TI 5 HOLES/100 MM

Facility

$1,308.00

Service Code	HCPCS C1713
Hospital Charge Code	270675393
Hospital Revenue Code	278
Min. Negotiated Rate	$196.20
Max. Negotiated Rate	$316.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$261.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$316.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$287.76
Rate for Payer: Qualcare PPO/HMO/WC	$196.20

T PLATE TI 5 HOLES/100 MM

Facility

$1,308.00

Service Code	HCPCS C1713
Hospital Charge Code	270675393
Hospital Revenue Code	278
Min. Negotiated Rate	$31.52
Max. Negotiated Rate	$654.00
Rate for Payer: Aetna Commercial	$497.04
Rate for Payer: Aetna Medicare Advantage	$392.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$333.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$333.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$261.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$333.54
Rate for Payer: Cigna Commercial	$654.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$316.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$287.76
Rate for Payer: Qualcare PPO/HMO/WC	$196.20
Rate for Payer: UnitedHealthcare Community & State	$31.52
Rate for Payer: Wellpoint Medicaid Managed Care	$34.66

TPMT ACTIVITY

Facility

$390.00

Service Code	HCPCS 83789
Hospital Charge Code	39900340
Hospital Revenue Code	301
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$65.58
Rate for Payer: Aetna Medicare Advantage	$78.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.03
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$24.11
Rate for Payer: Clover Medicare Advantage	$22.90
Rate for Payer: EmblemHealth Commercial	$72.33
Rate for Payer: Humana Medicare Advantage	$24.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$19.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.11
Rate for Payer: Wellcare Medicare Advantage	$24.11
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

TPMT ACTIVITY

Facility

$390.00

Service Code	HCPCS 83789
Hospital Charge Code	39900340
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TPMT GENOTYPE

Facility

$390.00

Hospital Charge Code	3035132B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TPMT GENOTYPE

Facility

$390.00

Hospital Charge Code	3035132C
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TPMT GENOTYPE

Facility

$390.00

Service Code	HCPCS 81335
Hospital Charge Code	3035132A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TPMT GENOTYPE

Facility

$390.00

Hospital Charge Code	3035132B
Hospital Revenue Code	301
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

TPMT GENOTYPE

Facility

$390.00

Hospital Charge Code	3035132E
Hospital Revenue Code	301
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

TPMT GENOTYPE

Facility

$390.00

Hospital Charge Code	3035132D
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TPMT GENOTYPE

Facility

$390.00

Hospital Charge Code	3035132E
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges