Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE DCP 2.7MM 6HOLE 52MM

Facility

$707.60

Service Code	HCPCS C1713
Hospital Charge Code	270604361
Hospital Revenue Code	278
Min. Negotiated Rate	$106.14
Max. Negotiated Rate	$171.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$141.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$155.67
Rate for Payer: Qualcare PPO/HMO/WC	$106.14

PLATE DCP 2.7MM 6HOLE 52MM

Facility

$707.60

Service Code	HCPCS C1713
Hospital Charge Code	270604361
Hospital Revenue Code	278
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$353.80
Rate for Payer: Aetna Commercial	$268.89
Rate for Payer: Aetna Medicare Advantage	$212.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$180.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$180.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$141.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$180.44
Rate for Payer: Cigna Commercial	$353.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$155.67
Rate for Payer: Qualcare PPO/HMO/WC	$106.14
Rate for Payer: UnitedHealthcare Community & State	$17.05
Rate for Payer: Wellpoint Medicaid Managed Care	$18.75

PLATE DCP 2.7MM 7H

Facility

$621.65

Hospital Charge Code	270604362
Hospital Revenue Code	278
Min. Negotiated Rate	$93.25
Max. Negotiated Rate	$150.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$136.76
Rate for Payer: Qualcare PPO/HMO/WC	$93.25

PLATE DCP 2.7MM 7H

Facility

$621.65

Hospital Charge Code	270604362
Hospital Revenue Code	278
Min. Negotiated Rate	$14.98
Max. Negotiated Rate	$310.82
Rate for Payer: Aetna Commercial	$236.23
Rate for Payer: Aetna Medicare Advantage	$186.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.52
Rate for Payer: Cigna Commercial	$310.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$136.76
Rate for Payer: Qualcare PPO/HMO/WC	$93.25
Rate for Payer: UnitedHealthcare Community & State	$14.98
Rate for Payer: Wellpoint Medicaid Managed Care	$16.47

PLATE DCP 2.7MM 8H 20MM

Facility

$683.25

Hospital Charge Code	270604363
Hospital Revenue Code	278
Min. Negotiated Rate	$16.47
Max. Negotiated Rate	$341.62
Rate for Payer: Aetna Commercial	$259.63
Rate for Payer: Aetna Medicare Advantage	$204.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.23
Rate for Payer: Cigna Commercial	$341.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$150.31
Rate for Payer: Qualcare PPO/HMO/WC	$102.49
Rate for Payer: UnitedHealthcare Community & State	$16.47
Rate for Payer: Wellpoint Medicaid Managed Care	$18.11

PLATE DCP 2.7MM 8H 20MM

Facility

$683.25

Hospital Charge Code	270604363
Hospital Revenue Code	278
Min. Negotiated Rate	$102.49
Max. Negotiated Rate	$165.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$150.31
Rate for Payer: Qualcare PPO/HMO/WC	$102.49

PLATE DCP 2.7MM 9H 20MM

Facility

$729.65

Hospital Charge Code	270604364
Hospital Revenue Code	278
Min. Negotiated Rate	$109.45
Max. Negotiated Rate	$176.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$160.52
Rate for Payer: Qualcare PPO/HMO/WC	$109.45

PLATE DCP 2.7MM 9H 20MM

Facility

$729.65

Hospital Charge Code	270604364
Hospital Revenue Code	278
Min. Negotiated Rate	$17.58
Max. Negotiated Rate	$364.82
Rate for Payer: Aetna Commercial	$277.27
Rate for Payer: Aetna Medicare Advantage	$218.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.06
Rate for Payer: Cigna Commercial	$364.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$160.52
Rate for Payer: Qualcare PPO/HMO/WC	$109.45
Rate for Payer: UnitedHealthcare Community & State	$17.58
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

PLATE DCP 3.5MM 12H

Facility

$660.85

Hospital Charge Code	270604403
Hospital Revenue Code	278
Min. Negotiated Rate	$99.13
Max. Negotiated Rate	$159.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.39
Rate for Payer: Qualcare PPO/HMO/WC	$99.13

PLATE DCP 3.5MM 12H

Facility

$660.85

Hospital Charge Code	270604403
Hospital Revenue Code	278
Min. Negotiated Rate	$15.93
Max. Negotiated Rate	$330.43
Rate for Payer: Aetna Commercial	$251.12
Rate for Payer: Aetna Medicare Advantage	$198.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.52
Rate for Payer: Cigna Commercial	$330.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.39
Rate for Payer: Qualcare PPO/HMO/WC	$99.13
Rate for Payer: UnitedHealthcare Community & State	$15.93
Rate for Payer: Wellpoint Medicaid Managed Care	$17.51

PLATE DCP 3.5MM 14H

Facility

$1,256.85

Hospital Charge Code	270604404
Hospital Revenue Code	278
Min. Negotiated Rate	$188.53
Max. Negotiated Rate	$304.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$276.51
Rate for Payer: Qualcare PPO/HMO/WC	$188.53

PLATE DCP 3.5MM 14H

Facility

$1,256.85

Hospital Charge Code	270604404
Hospital Revenue Code	278
Min. Negotiated Rate	$30.29
Max. Negotiated Rate	$628.42
Rate for Payer: Aetna Commercial	$477.60
Rate for Payer: Aetna Medicare Advantage	$377.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.50
Rate for Payer: Cigna Commercial	$628.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$276.51
Rate for Payer: Qualcare PPO/HMO/WC	$188.53
Rate for Payer: UnitedHealthcare Community & State	$30.29
Rate for Payer: Wellpoint Medicaid Managed Care	$33.31

PLATE DCP 3.5MM 18H

Facility

$1,625.65

Hospital Charge Code	270604405
Hospital Revenue Code	278
Min. Negotiated Rate	$243.85
Max. Negotiated Rate	$393.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.64
Rate for Payer: Qualcare PPO/HMO/WC	$243.85

PLATE DCP 3.5MM 18H

Facility

$1,625.65

Hospital Charge Code	270604405
Hospital Revenue Code	278
Min. Negotiated Rate	$39.18
Max. Negotiated Rate	$812.83
Rate for Payer: Aetna Commercial	$617.75
Rate for Payer: Aetna Medicare Advantage	$487.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.54
Rate for Payer: Cigna Commercial	$812.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.64
Rate for Payer: Qualcare PPO/HMO/WC	$243.85
Rate for Payer: UnitedHealthcare Community & State	$39.18
Rate for Payer: Wellpoint Medicaid Managed Care	$43.08

PLATE DCP 3.5MM 18 HL****

Facility

$848.00

Hospital Charge Code	2706044050
Hospital Revenue Code	279
Min. Negotiated Rate	$20.44
Max. Negotiated Rate	$424.00
Rate for Payer: Aetna Commercial	$322.24
Rate for Payer: Aetna Medicare Advantage	$254.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.24
Rate for Payer: Cigna Commercial	$424.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.40
Rate for Payer: Oxford Commercial	$169.60
Rate for Payer: Qualcare PPO/HMO/WC	$127.20
Rate for Payer: UnitedHealthcare Commercial	$169.60
Rate for Payer: UnitedHealthcare Community & State	$20.44
Rate for Payer: Wellpoint Medicaid Managed Care	$22.47

PLATE DCP 3.5MM 18 HL****

Facility

$848.00

Hospital Charge Code	2706044050
Hospital Revenue Code	279
Min. Negotiated Rate	$127.20
Max. Negotiated Rate	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$127.20

PLATE DCP 3.5MM 20H

Facility

$1,810.45

Hospital Charge Code	270604406
Hospital Revenue Code	278
Min. Negotiated Rate	$43.63
Max. Negotiated Rate	$905.23
Rate for Payer: Aetna Commercial	$687.97
Rate for Payer: Aetna Medicare Advantage	$543.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$362.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.66
Rate for Payer: Cigna Commercial	$905.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$438.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$398.30
Rate for Payer: Qualcare PPO/HMO/WC	$271.57
Rate for Payer: UnitedHealthcare Community & State	$43.63
Rate for Payer: Wellpoint Medicaid Managed Care	$47.98

PLATE DCP 3.5MM 20H

Facility

$1,810.45

Hospital Charge Code	270604406
Hospital Revenue Code	278
Min. Negotiated Rate	$271.57
Max. Negotiated Rate	$438.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$362.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$438.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$398.30
Rate for Payer: Qualcare PPO/HMO/WC	$271.57

PLATE DCP 3.5MM 22H

Facility

$1,992.85

Hospital Charge Code	270604407
Hospital Revenue Code	278
Min. Negotiated Rate	$298.93
Max. Negotiated Rate	$482.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$398.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$482.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$438.43
Rate for Payer: Qualcare PPO/HMO/WC	$298.93

PLATE DCP 3.5MM 22H

Facility

$1,992.85

Hospital Charge Code	270604407
Hospital Revenue Code	278
Min. Negotiated Rate	$48.03
Max. Negotiated Rate	$996.42
Rate for Payer: Aetna Commercial	$757.28
Rate for Payer: Aetna Medicare Advantage	$597.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$508.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$398.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$508.18
Rate for Payer: Cigna Commercial	$996.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$482.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$438.43
Rate for Payer: Qualcare PPO/HMO/WC	$298.93
Rate for Payer: UnitedHealthcare Community & State	$48.03
Rate for Payer: Wellpoint Medicaid Managed Care	$52.81

PLATE DCP 3.5MM 2H

Facility

$414.45

Hospital Charge Code	270604394
Hospital Revenue Code	278
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$207.22
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$91.18
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

PLATE DCP 3.5MM 2H

Facility

$414.45

Hospital Charge Code	270604394
Hospital Revenue Code	278
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$100.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$82.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$91.18
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

PLATE DCP 3.5MM 3H

Facility

$422.45

Hospital Charge Code	270604395
Hospital Revenue Code	278
Min. Negotiated Rate	$63.37
Max. Negotiated Rate	$102.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.94
Rate for Payer: Qualcare PPO/HMO/WC	$63.37

PLATE DCP 3.5MM 3H

Facility

$422.45

Hospital Charge Code	270604395
Hospital Revenue Code	278
Min. Negotiated Rate	$10.18
Max. Negotiated Rate	$211.22
Rate for Payer: Aetna Commercial	$160.53
Rate for Payer: Aetna Medicare Advantage	$126.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.72
Rate for Payer: Cigna Commercial	$211.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$92.94
Rate for Payer: Qualcare PPO/HMO/WC	$63.37
Rate for Payer: UnitedHealthcare Community & State	$10.18
Rate for Payer: Wellpoint Medicaid Managed Care	$11.19

PLATE DCP 3.5MM 4H

Facility

$442.45

Hospital Charge Code	270604396
Hospital Revenue Code	278
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$221.22
Rate for Payer: Aetna Commercial	$168.13
Rate for Payer: Aetna Medicare Advantage	$132.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.82
Rate for Payer: Cigna Commercial	$221.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$97.34
Rate for Payer: Qualcare PPO/HMO/WC	$66.37
Rate for Payer: UnitedHealthcare Community & State	$10.66
Rate for Payer: Wellpoint Medicaid Managed Care	$11.72

Know your out-of-pocket cost for care.

All Charges