Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BONE SCREW SELF TAP 3.5x34MM

Facility

$685.00

Service Code	HCPCS C1713
Hospital Charge Code	270673669
Hospital Revenue Code	278
Min. Negotiated Rate	$102.75
Max. Negotiated Rate	$165.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$150.70
Rate for Payer: Qualcare PPO/HMO/WC	$102.75

BONE SCREW SELF TAP 3.5x34MM

Facility

$685.00

Service Code	HCPCS C1713
Hospital Charge Code	270673669
Hospital Revenue Code	278
Min. Negotiated Rate	$16.51
Max. Negotiated Rate	$342.50
Rate for Payer: Aetna Commercial	$260.30
Rate for Payer: Aetna Medicare Advantage	$205.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.68
Rate for Payer: Cigna Commercial	$342.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$150.70
Rate for Payer: Qualcare PPO/HMO/WC	$102.75
Rate for Payer: UnitedHealthcare Community & State	$16.51
Rate for Payer: Wellpoint Medicaid Managed Care	$18.15

BONE SCREW T10 3.5MMXL28

Facility

$383.15

Service Code	HCPCS C1713
Hospital Charge Code	270700424
Hospital Revenue Code	278
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$191.57
Rate for Payer: Aetna Commercial	$145.60
Rate for Payer: Aetna Medicare Advantage	$114.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.70
Rate for Payer: Cigna Commercial	$191.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$84.29
Rate for Payer: Qualcare PPO/HMO/WC	$57.47
Rate for Payer: UnitedHealthcare Community & State	$9.23
Rate for Payer: Wellpoint Medicaid Managed Care	$10.15

BONE SCREW T10 3.5MMXL28

Facility

$383.15

Service Code	HCPCS C1713
Hospital Charge Code	270700424
Hospital Revenue Code	278
Min. Negotiated Rate	$57.47
Max. Negotiated Rate	$92.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$84.29
Rate for Payer: Qualcare PPO/HMO/WC	$57.47

BONE SCREW T10 3.5MMXL30

Facility

$383.15

Service Code	HCPCS C1713
Hospital Charge Code	270700425
Hospital Revenue Code	278
Min. Negotiated Rate	$57.47
Max. Negotiated Rate	$92.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$84.29
Rate for Payer: Qualcare PPO/HMO/WC	$57.47

BONE SCREW T10 3.5MMXL30

Facility

$383.15

Service Code	HCPCS C1713
Hospital Charge Code	270700425
Hospital Revenue Code	278
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$191.57
Rate for Payer: Aetna Commercial	$145.60
Rate for Payer: Aetna Medicare Advantage	$114.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.70
Rate for Payer: Cigna Commercial	$191.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$84.29
Rate for Payer: Qualcare PPO/HMO/WC	$57.47
Rate for Payer: UnitedHealthcare Community & State	$9.23
Rate for Payer: Wellpoint Medicaid Managed Care	$10.15

BONE SCREW T7 2.7x14MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270673832
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.90
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

BONE SCREW T7 2.7x14MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270673832
Hospital Revenue Code	278
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$226.10
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.90
Rate for Payer: Qualcare PPO/HMO/WC	$89.25
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: Wellpoint Medicaid Managed Care	$15.77

BONE SCREW T7 2.7x16MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270673833
Hospital Revenue Code	278
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$143.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.90
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

BONE SCREW T7 2.7x16MM

Facility

$595.00

Service Code	HCPCS C1713
Hospital Charge Code	270673833
Hospital Revenue Code	278
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$226.10
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$130.90
Rate for Payer: Qualcare PPO/HMO/WC	$89.25
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: Wellpoint Medicaid Managed Care	$15.77

BONE SCREW T8 2.7MMXL38

Facility

$727.20

Service Code	HCPCS C1713
Hospital Charge Code	270700422
Hospital Revenue Code	278
Min. Negotiated Rate	$109.08
Max. Negotiated Rate	$175.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.98
Rate for Payer: Qualcare PPO/HMO/WC	$109.08

BONE SCREW T8 2.7MMXL38

Facility

$727.20

Service Code	HCPCS C1713
Hospital Charge Code	270700422
Hospital Revenue Code	278
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$363.60
Rate for Payer: Aetna Commercial	$276.34
Rate for Payer: Aetna Medicare Advantage	$218.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$185.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$185.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$185.44
Rate for Payer: Cigna Commercial	$363.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.98
Rate for Payer: Qualcare PPO/HMO/WC	$109.08
Rate for Payer: UnitedHealthcare Community & State	$17.53
Rate for Payer: Wellpoint Medicaid Managed Care	$19.27

BONE SDK CORTICAL 10 20 171020

Facility

$6,834.45

Hospital Charge Code	270617950
Hospital Revenue Code	272
Min. Negotiated Rate	$1,025.17
Max. Negotiated Rate	$1,025.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.17

BONE SDK CORTICAL 10 20 171020

Facility

$6,834.45

Hospital Charge Code	270617950
Hospital Revenue Code	272
Min. Negotiated Rate	$164.71
Max. Negotiated Rate	$3,417.22
Rate for Payer: Aetna Commercial	$2,597.09
Rate for Payer: Aetna Medicare Advantage	$2,050.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,742.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,742.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,742.78
Rate for Payer: Cigna Commercial	$3,417.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,050.34
Rate for Payer: Oxford Commercial	$1,366.89
Rate for Payer: Qualcare PPO/HMO/WC	$1,025.17
Rate for Payer: UnitedHealthcare Commercial	$1,366.89
Rate for Payer: UnitedHealthcare Community & State	$164.71
Rate for Payer: Wellpoint Medicaid Managed Care	$181.11

BONE SHAVER-MICRO HOOK

Facility

$2,225.00

Hospital Charge Code	270663202
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$1,112.50
Rate for Payer: Aetna Commercial	$845.50
Rate for Payer: Aetna Medicare Advantage	$667.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$567.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$567.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$567.38
Rate for Payer: Cigna Commercial	$1,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$667.50
Rate for Payer: Oxford Commercial	$445.00
Rate for Payer: Qualcare PPO/HMO/WC	$333.75
Rate for Payer: UnitedHealthcare Commercial	$445.00
Rate for Payer: UnitedHealthcare Community & State	$53.62
Rate for Payer: Wellpoint Medicaid Managed Care	$58.96

BONE SHAVER-MICRO HOOK

Facility

$2,225.00

Hospital Charge Code	270663202
Hospital Revenue Code	272
Min. Negotiated Rate	$333.75
Max. Negotiated Rate	$333.75
Rate for Payer: Qualcare PPO/HMO/WC	$333.75

BONE SOURCE 3CC 6184-0-100

Facility

$735.00

Service Code	HCPCS C1762
Hospital Charge Code	270335734
Hospital Revenue Code	278
Min. Negotiated Rate	$110.25
Max. Negotiated Rate	$177.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$161.70
Rate for Payer: Qualcare PPO/HMO/WC	$110.25

BONE SOURCE 3CC 6184-0-100

Facility

$735.00

Service Code	HCPCS C1762
Hospital Charge Code	270335734
Hospital Revenue Code	278
Min. Negotiated Rate	$17.71
Max. Negotiated Rate	$367.50
Rate for Payer: Aetna Commercial	$279.30
Rate for Payer: Aetna Medicare Advantage	$220.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$187.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$187.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$187.43
Rate for Payer: Cigna Commercial	$367.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$177.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$161.70
Rate for Payer: Qualcare PPO/HMO/WC	$110.25
Rate for Payer: UnitedHealthcare Community & State	$17.71
Rate for Payer: Wellpoint Medicaid Managed Care	$19.48

BONE STIM SPF 60 MICROAMP

Facility

$37,651.65

Hospital Charge Code	270677411
Hospital Revenue Code	278
Min. Negotiated Rate	$907.40
Max. Negotiated Rate	$18,825.83
Rate for Payer: Aetna Commercial	$14,307.63
Rate for Payer: Aetna Medicare Advantage	$11,295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,601.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,601.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,530.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,601.17
Rate for Payer: Cigna Commercial	$18,825.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,111.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,283.36
Rate for Payer: Qualcare PPO/HMO/WC	$5,647.75
Rate for Payer: UnitedHealthcare Community & State	$907.40
Rate for Payer: Wellpoint Medicaid Managed Care	$997.77

BONE STIM SPF 60 MICROAMP

Facility

$37,651.65

Hospital Charge Code	270677411
Hospital Revenue Code	278
Min. Negotiated Rate	$5,647.75
Max. Negotiated Rate	$9,111.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,530.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,111.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,283.36
Rate for Payer: Qualcare PPO/HMO/WC	$5,647.75

BONE STIMULATOR

Facility

$16,000.00

Service Code	HCPCS E0749
Hospital Charge Code	270657137
Hospital Revenue Code	278
Min. Negotiated Rate	$385.60
Max. Negotiated Rate	$8,000.00
Rate for Payer: Aetna Commercial	$6,080.00
Rate for Payer: Aetna Medicare Advantage	$4,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,080.00
Rate for Payer: Cigna Commercial	$8,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00
Rate for Payer: UnitedHealthcare Community & State	$385.60
Rate for Payer: Wellpoint Medicaid Managed Care	$424.00

BONE STIMULATOR

Facility

$16,000.00

Service Code	HCPCS E0749
Hospital Charge Code	270657137
Hospital Revenue Code	278
Min. Negotiated Rate	$2,400.00
Max. Negotiated Rate	$3,872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,520.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00

BONE STIMULATOR IMPLANTABLE

Facility

$44,350.00

Hospital Charge Code	270671560
Hospital Revenue Code	278
Min. Negotiated Rate	$1,068.84
Max. Negotiated Rate	$22,175.00
Rate for Payer: Aetna Commercial	$16,853.00
Rate for Payer: Aetna Medicare Advantage	$13,305.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,309.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,309.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,870.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,309.25
Rate for Payer: Cigna Commercial	$22,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,732.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,652.50
Rate for Payer: UnitedHealthcare Community & State	$1,068.84
Rate for Payer: Wellpoint Medicaid Managed Care	$1,175.28

BONE STIMULATOR IMPLANTABLE

Facility

$44,350.00

Hospital Charge Code	270671560
Hospital Revenue Code	278
Min. Negotiated Rate	$6,652.50
Max. Negotiated Rate	$10,732.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,870.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,732.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9,757.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,652.50

BONE SUBSTUTE 10CC

Facility

$20,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270687085
Hospital Revenue Code	278
Min. Negotiated Rate	$490.44
Max. Negotiated Rate	$10,175.00
Rate for Payer: Aetna Commercial	$7,733.00
Rate for Payer: Aetna Medicare Advantage	$6,105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,189.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,189.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,070.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,189.25
Rate for Payer: Cigna Commercial	$10,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,924.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,477.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,052.50
Rate for Payer: UnitedHealthcare Community & State	$490.44
Rate for Payer: Wellpoint Medicaid Managed Care	$539.27

Know your out-of-pocket cost for care.

All Charges