Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BOLT SALVATION 6.5x130MM

Facility

$8,610.00

Service Code	HCPCS C1713
Hospital Charge Code	270674306
Hospital Revenue Code	278
Min. Negotiated Rate	$1,291.50
Max. Negotiated Rate	$2,083.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,722.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,083.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,894.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,291.50

BOLT SALVATION TOE JT 5X125MM

Facility

$9,230.00

Service Code	HCPCS C1713
Hospital Charge Code	270698682
Hospital Revenue Code	278
Min. Negotiated Rate	$1,384.50
Max. Negotiated Rate	$2,233.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,846.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,233.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,030.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,384.50

BOLT SALVATION TOE JT 5X125MM

Facility

$9,230.00

Service Code	HCPCS C1713
Hospital Charge Code	270698682
Hospital Revenue Code	278
Min. Negotiated Rate	$222.44
Max. Negotiated Rate	$4,615.00
Rate for Payer: Aetna Commercial	$3,507.40
Rate for Payer: Aetna Medicare Advantage	$2,769.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,353.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,353.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,846.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,353.65
Rate for Payer: Cigna Commercial	$4,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,233.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,030.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,384.50
Rate for Payer: UnitedHealthcare Community & State	$222.44
Rate for Payer: Wellpoint Medicaid Managed Care	$244.59

BOLT SALVATION WIRE

Facility

$835.00

Hospital Charge Code	270684459
Hospital Revenue Code	272
Min. Negotiated Rate	$125.25
Max. Negotiated Rate	$125.25
Rate for Payer: Qualcare PPO/HMO/WC	$125.25

BOLT SALVATION WIRE

Facility

$835.00

Hospital Charge Code	270684459
Hospital Revenue Code	272
Min. Negotiated Rate	$20.12
Max. Negotiated Rate	$417.50
Rate for Payer: Aetna Commercial	$317.30
Rate for Payer: Aetna Medicare Advantage	$250.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.93
Rate for Payer: Cigna Commercial	$417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$250.50
Rate for Payer: Oxford Commercial	$167.00
Rate for Payer: Qualcare PPO/HMO/WC	$125.25
Rate for Payer: UnitedHealthcare Commercial	$167.00
Rate for Payer: UnitedHealthcare Community & State	$20.12
Rate for Payer: Wellpoint Medicaid Managed Care	$22.13

BOLT SCHANZ POST EXT FIX

Facility

$1,111.95

Hospital Charge Code	270693746
Hospital Revenue Code	272
Min. Negotiated Rate	$166.79
Max. Negotiated Rate	$166.79
Rate for Payer: Qualcare PPO/HMO/WC	$166.79

BOLT SCHANZ POST EXT FIX

Facility

$1,111.95

Hospital Charge Code	270693746
Hospital Revenue Code	272
Min. Negotiated Rate	$26.80
Max. Negotiated Rate	$555.98
Rate for Payer: Aetna Commercial	$422.54
Rate for Payer: Aetna Medicare Advantage	$333.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$283.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$283.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$283.55
Rate for Payer: Cigna Commercial	$555.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$333.58
Rate for Payer: Oxford Commercial	$222.39
Rate for Payer: Qualcare PPO/HMO/WC	$166.79
Rate for Payer: UnitedHealthcare Commercial	$222.39
Rate for Payer: UnitedHealthcare Community & State	$26.80
Rate for Payer: Wellpoint Medicaid Managed Care	$29.47

BOLT SCREW EXTRACTION 3.5/4MM

Facility

$414.05

Hospital Charge Code	270654493
Hospital Revenue Code	272
Min. Negotiated Rate	$62.11
Max. Negotiated Rate	$62.11
Rate for Payer: Qualcare PPO/HMO/WC	$62.11

BOLT SCREW EXTRACTION 3.5/4MM

Facility

$414.05

Hospital Charge Code	270654493
Hospital Revenue Code	272
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$207.03
Rate for Payer: Aetna Commercial	$157.34
Rate for Payer: Aetna Medicare Advantage	$124.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.58
Rate for Payer: Cigna Commercial	$207.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.22
Rate for Payer: Oxford Commercial	$82.81
Rate for Payer: Qualcare PPO/HMO/WC	$62.11
Rate for Payer: UnitedHealthcare Commercial	$82.81
Rate for Payer: UnitedHealthcare Community & State	$9.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.97

BOLT SCREW SCHANZ POST

Facility

$1,005.75

Service Code	HCPCS C1713
Hospital Charge Code	270683954
Hospital Revenue Code	278
Min. Negotiated Rate	$24.24
Max. Negotiated Rate	$502.88
Rate for Payer: Aetna Commercial	$382.19
Rate for Payer: Aetna Medicare Advantage	$301.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.47
Rate for Payer: Cigna Commercial	$502.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$221.26
Rate for Payer: Qualcare PPO/HMO/WC	$150.86
Rate for Payer: UnitedHealthcare Community & State	$24.24
Rate for Payer: Wellpoint Medicaid Managed Care	$26.65

BOLT SCREW SCHANZ POST

Facility

$1,005.75

Service Code	HCPCS C1713
Hospital Charge Code	270683954
Hospital Revenue Code	278
Min. Negotiated Rate	$150.86
Max. Negotiated Rate	$243.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$221.26
Rate for Payer: Qualcare PPO/HMO/WC	$150.86

BOLT SDK SHORT 35 6.5 8430123

Facility

$1,816.85

Hospital Charge Code	270616299
Hospital Revenue Code	278
Min. Negotiated Rate	$43.79
Max. Negotiated Rate	$908.42
Rate for Payer: Aetna Commercial	$690.40
Rate for Payer: Aetna Medicare Advantage	$545.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$463.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$463.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$463.30
Rate for Payer: Cigna Commercial	$908.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$399.71
Rate for Payer: Qualcare PPO/HMO/WC	$272.53
Rate for Payer: UnitedHealthcare Community & State	$43.79
Rate for Payer: Wellpoint Medicaid Managed Care	$48.15

BOLT SDK SHORT 35 6.5 8430123

Facility

$1,816.85

Hospital Charge Code	270616299
Hospital Revenue Code	278
Min. Negotiated Rate	$272.53
Max. Negotiated Rate	$439.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$399.71
Rate for Payer: Qualcare PPO/HMO/WC	$272.53

BOLT SDK SHORT 40 6.5 8430124

Facility

$1,816.85

Hospital Charge Code	270616284
Hospital Revenue Code	278
Min. Negotiated Rate	$43.79
Max. Negotiated Rate	$908.42
Rate for Payer: Aetna Commercial	$690.40
Rate for Payer: Aetna Medicare Advantage	$545.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$463.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$463.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$463.30
Rate for Payer: Cigna Commercial	$908.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$399.71
Rate for Payer: Qualcare PPO/HMO/WC	$272.53
Rate for Payer: UnitedHealthcare Community & State	$43.79
Rate for Payer: Wellpoint Medicaid Managed Care	$48.15

BOLT SDK SHORT 40 6.5 8430124

Facility

$1,816.85

Hospital Charge Code	270616284
Hospital Revenue Code	278
Min. Negotiated Rate	$272.53
Max. Negotiated Rate	$439.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$399.71
Rate for Payer: Qualcare PPO/HMO/WC	$272.53

BOLT SDK SHORT 45 5.5 8430105

Facility

$1,816.85

Hospital Charge Code	270616282
Hospital Revenue Code	278
Min. Negotiated Rate	$43.79
Max. Negotiated Rate	$908.42
Rate for Payer: Aetna Commercial	$690.40
Rate for Payer: Aetna Medicare Advantage	$545.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$463.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$463.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$463.30
Rate for Payer: Cigna Commercial	$908.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$399.71
Rate for Payer: Qualcare PPO/HMO/WC	$272.53
Rate for Payer: UnitedHealthcare Community & State	$43.79
Rate for Payer: Wellpoint Medicaid Managed Care	$48.15

BOLT SDK SHORT 45 5.5 8430105

Facility

$1,816.85

Hospital Charge Code	270616282
Hospital Revenue Code	278
Min. Negotiated Rate	$272.53
Max. Negotiated Rate	$439.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$399.71
Rate for Payer: Qualcare PPO/HMO/WC	$272.53

BOLT SDK SHORT 45 6.5 8430125

Facility

$1,816.85

Hospital Charge Code	270616277
Hospital Revenue Code	278
Min. Negotiated Rate	$43.79
Max. Negotiated Rate	$908.42
Rate for Payer: Aetna Commercial	$690.40
Rate for Payer: Aetna Medicare Advantage	$545.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$463.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$463.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$463.30
Rate for Payer: Cigna Commercial	$908.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$399.71
Rate for Payer: Qualcare PPO/HMO/WC	$272.53
Rate for Payer: UnitedHealthcare Community & State	$43.79
Rate for Payer: Wellpoint Medicaid Managed Care	$48.15

BOLT SDK SHORT 45 6.5 8430125

Facility

$1,816.85

Hospital Charge Code	270616277
Hospital Revenue Code	278
Min. Negotiated Rate	$272.53
Max. Negotiated Rate	$439.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$399.71
Rate for Payer: Qualcare PPO/HMO/WC	$272.53

BOLT SHOULDER MAXFRAME 8 MM

Facility

$1,136.25

Hospital Charge Code	270683953
Hospital Revenue Code	272
Min. Negotiated Rate	$170.44
Max. Negotiated Rate	$170.44
Rate for Payer: Qualcare PPO/HMO/WC	$170.44

BOLT SHOULDER MAXFRAME 8 MM

Facility

$1,136.25

Hospital Charge Code	270683953
Hospital Revenue Code	272
Min. Negotiated Rate	$27.38
Max. Negotiated Rate	$568.12
Rate for Payer: Aetna Commercial	$431.77
Rate for Payer: Aetna Medicare Advantage	$340.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$289.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$289.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$289.74
Rate for Payer: Cigna Commercial	$568.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$340.88
Rate for Payer: Oxford Commercial	$227.25
Rate for Payer: Qualcare PPO/HMO/WC	$170.44
Rate for Payer: UnitedHealthcare Commercial	$227.25
Rate for Payer: UnitedHealthcare Community & State	$27.38
Rate for Payer: Wellpoint Medicaid Managed Care	$30.11

BOLT SHOULDER MAXFRAME FOR 8MM

Facility

$450.00

Hospital Charge Code	270681234
Hospital Revenue Code	272
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

BOLT SHOULDER MAXFRAME FOR 8MM

Facility

$450.00

Hospital Charge Code	270681234
Hospital Revenue Code	272
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.00
Rate for Payer: Oxford Commercial	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$90.00
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

BOLT SYN LOCK 3.9 38MM 458.36S

Facility

$601.65

Hospital Charge Code	270612758
Hospital Revenue Code	278
Min. Negotiated Rate	$14.50
Max. Negotiated Rate	$300.82
Rate for Payer: Aetna Commercial	$228.63
Rate for Payer: Aetna Medicare Advantage	$180.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.42
Rate for Payer: Cigna Commercial	$300.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$132.36
Rate for Payer: Qualcare PPO/HMO/WC	$90.25
Rate for Payer: UnitedHealthcare Community & State	$14.50
Rate for Payer: Wellpoint Medicaid Managed Care	$15.94

BOLT SYN LOCK 3.9 38MM 458.36S

Facility

$601.65

Hospital Charge Code	270612758
Hospital Revenue Code	278
Min. Negotiated Rate	$90.25
Max. Negotiated Rate	$145.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$132.36
Rate for Payer: Qualcare PPO/HMO/WC	$90.25

Know your out-of-pocket cost for care.

All Charges