Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

5X23MM VARIABLE SCREW

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704060
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

5X26MM CORTICAL BONE SCREW

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Charge Code	270703330
Hospital Revenue Code	278
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$399.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

5X26MM CORTICAL BONE SCREW

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Charge Code	270703330
Hospital Revenue Code	278
Min. Negotiated Rate	$39.77
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$627.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50
Rate for Payer: UnitedHealthcare Community & State	$39.77
Rate for Payer: Wellpoint Medicaid Managed Care	$43.73

5X30MM BONE SCREW

Facility

$1,250.00

Hospital Charge Code	270703311
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

5X30MM BONE SCREW

Facility

$1,250.00

Hospital Charge Code	270703311
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

5X31MM SELF DRILLING SCREW

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704059
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

5X31MM SELF DRILLING SCREW

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704059
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

5X32MM CORTICAL BONE SCREW

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Charge Code	270703329
Hospital Revenue Code	278
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$399.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

5X32MM CORTICAL BONE SCREW

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Charge Code	270703329
Hospital Revenue Code	278
Min. Negotiated Rate	$39.77
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$627.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50
Rate for Payer: UnitedHealthcare Community & State	$39.77
Rate for Payer: Wellpoint Medicaid Managed Care	$43.73

5X34MM CORTICAL BONE SCREW

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Charge Code	270703328
Hospital Revenue Code	278
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$399.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

5X34MM CORTICAL BONE SCREW

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Charge Code	270703328
Hospital Revenue Code	278
Min. Negotiated Rate	$39.77
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$627.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50
Rate for Payer: UnitedHealthcare Community & State	$39.77
Rate for Payer: Wellpoint Medicaid Managed Care	$43.73

5X38X28MM SPACER 15DEGREES

Facility

$33,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705940
Hospital Revenue Code	278
Min. Negotiated Rate	$4,968.75
Max. Negotiated Rate	$8,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,016.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,287.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,968.75

5X38X28MM SPACER 15DEGREES

Facility

$33,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270705940
Hospital Revenue Code	278
Min. Negotiated Rate	$798.31
Max. Negotiated Rate	$16,562.50
Rate for Payer: Aetna Commercial	$12,587.50
Rate for Payer: Aetna Medicare Advantage	$9,937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,446.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,446.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,446.88
Rate for Payer: Cigna Commercial	$16,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,016.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,287.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,968.75
Rate for Payer: UnitedHealthcare Community & State	$798.31
Rate for Payer: Wellpoint Medicaid Managed Care	$877.81

5X40MM CORTICAL BONE SCREW

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Charge Code	270703327
Hospital Revenue Code	278
Min. Negotiated Rate	$39.77
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$627.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50
Rate for Payer: UnitedHealthcare Community & State	$39.77
Rate for Payer: Wellpoint Medicaid Managed Care	$43.73

5X40MM CORTICAL BONE SCREW

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Charge Code	270703327
Hospital Revenue Code	278
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$399.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

5X44MM CORTICAL BONE SCREW

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Charge Code	270703326
Hospital Revenue Code	278
Min. Negotiated Rate	$39.77
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$627.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50
Rate for Payer: UnitedHealthcare Community & State	$39.77
Rate for Payer: Wellpoint Medicaid Managed Care	$43.73

5X44MM CORTICAL BONE SCREW

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Charge Code	270703326
Hospital Revenue Code	278
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$399.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

5 X 68 LOCKING SCREW

Facility

$980.25

Service Code	HCPCS C1713
Hospital Charge Code	270686262
Hospital Revenue Code	278
Min. Negotiated Rate	$147.04
Max. Negotiated Rate	$237.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$215.66
Rate for Payer: Qualcare PPO/HMO/WC	$147.04

5 X 68 LOCKING SCREW

Facility

$980.25

Service Code	HCPCS C1713
Hospital Charge Code	270686262
Hospital Revenue Code	278
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$490.12
Rate for Payer: Aetna Commercial	$372.50
Rate for Payer: Aetna Medicare Advantage	$294.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$249.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$249.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$249.96
Rate for Payer: Cigna Commercial	$490.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$215.66
Rate for Payer: Qualcare PPO/HMO/WC	$147.04
Rate for Payer: UnitedHealthcare Community & State	$23.62
Rate for Payer: Wellpoint Medicaid Managed Care	$25.98

60 MM ROD

Facility

$875.00

Service Code	HCPCS C1713
Hospital Charge Code	270703627
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$211.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$192.50
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

60 MM ROD

Facility

$875.00

Service Code	HCPCS C1713
Hospital Charge Code	270703627
Hospital Revenue Code	278
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$192.50
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Community & State	$21.09
Rate for Payer: Wellpoint Medicaid Managed Care	$23.19

60MM ROD

Facility

$1,285.00

Service Code	HCPCS C1713
Hospital Charge Code	270704096
Hospital Revenue Code	278
Min. Negotiated Rate	$192.75
Max. Negotiated Rate	$310.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$257.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$310.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$282.70
Rate for Payer: Qualcare PPO/HMO/WC	$192.75

60MM ROD

Facility

$1,285.00

Service Code	HCPCS C1713
Hospital Charge Code	270704096
Hospital Revenue Code	278
Min. Negotiated Rate	$30.97
Max. Negotiated Rate	$642.50
Rate for Payer: Aetna Commercial	$488.30
Rate for Payer: Aetna Medicare Advantage	$385.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$327.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$327.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$257.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$327.68
Rate for Payer: Cigna Commercial	$642.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$310.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$282.70
Rate for Payer: Qualcare PPO/HMO/WC	$192.75
Rate for Payer: UnitedHealthcare Community & State	$30.97
Rate for Payer: Wellpoint Medicaid Managed Care	$34.05

60MM TM MULTI HOLE CUP

Facility

$8,660.65

Hospital Charge Code	270656932
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

60MM TM MULTI HOLE CUP

Facility

$8,660.65

Hospital Charge Code	270656932
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

Know your out-of-pocket cost for care.

All Charges