Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE DHS 135 DEG 5H/94MM

Facility

$2,274.25

Service Code	HCPCS C1713
Hospital Charge Code	270651719
Hospital Revenue Code	278
Min. Negotiated Rate	$341.14
Max. Negotiated Rate	$550.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$454.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$550.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$500.33
Rate for Payer: Qualcare PPO/HMO/WC	$341.14

PLATE DHS 140 DEG 5H/94MM

Facility

$2,481.25

Service Code	HCPCS C1713
Hospital Charge Code	270603818
Hospital Revenue Code	278
Min. Negotiated Rate	$372.19
Max. Negotiated Rate	$600.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$496.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$545.88
Rate for Payer: Qualcare PPO/HMO/WC	$372.19

PLATE DHS 140 DEG 5H/94MM

Facility

$2,481.25

Service Code	HCPCS C1713
Hospital Charge Code	270603818
Hospital Revenue Code	278
Min. Negotiated Rate	$59.80
Max. Negotiated Rate	$1,240.62
Rate for Payer: Aetna Commercial	$942.88
Rate for Payer: Aetna Medicare Advantage	$744.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$632.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$632.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$496.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$632.72
Rate for Payer: Cigna Commercial	$1,240.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$545.88
Rate for Payer: Qualcare PPO/HMO/WC	$372.19
Rate for Payer: UnitedHealthcare Community & State	$59.80
Rate for Payer: Wellpoint Medicaid Managed Care	$65.75

PLATE DHS 25MM 4 HL 140 DEG

Facility

$1,932.00

Hospital Charge Code	270603836
Hospital Revenue Code	278
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$467.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80

PLATE DHS 25MM 4 HL 140 DEG

Facility

$1,932.00

Hospital Charge Code	270603836
Hospital Revenue Code	278
Min. Negotiated Rate	$46.56
Max. Negotiated Rate	$966.00
Rate for Payer: Aetna Commercial	$734.16
Rate for Payer: Aetna Medicare Advantage	$579.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$492.66
Rate for Payer: Cigna Commercial	$966.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80
Rate for Payer: UnitedHealthcare Community & State	$46.56
Rate for Payer: Wellpoint Medicaid Managed Care	$51.20

PLATE DHS 25MM 4 HL 145 DEG

Facility

$1,932.00

Hospital Charge Code	270603839
Hospital Revenue Code	278
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$467.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80

PLATE DHS 25MM 4 HL 145 DEG

Facility

$1,932.00

Hospital Charge Code	270603839
Hospital Revenue Code	278
Min. Negotiated Rate	$46.56
Max. Negotiated Rate	$966.00
Rate for Payer: Aetna Commercial	$734.16
Rate for Payer: Aetna Medicare Advantage	$579.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$492.66
Rate for Payer: Cigna Commercial	$966.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80
Rate for Payer: UnitedHealthcare Community & State	$46.56
Rate for Payer: Wellpoint Medicaid Managed Care	$51.20

PLATE DHS 25MM 4 HL 150 DEG

Facility

$1,932.00

Hospital Charge Code	270603842
Hospital Revenue Code	278
Min. Negotiated Rate	$46.56
Max. Negotiated Rate	$966.00
Rate for Payer: Aetna Commercial	$734.16
Rate for Payer: Aetna Medicare Advantage	$579.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$492.66
Rate for Payer: Cigna Commercial	$966.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80
Rate for Payer: UnitedHealthcare Community & State	$46.56
Rate for Payer: Wellpoint Medicaid Managed Care	$51.20

PLATE DHS 25MM 4 HL 150 DEG

Facility

$1,932.00

Hospital Charge Code	270603842
Hospital Revenue Code	278
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$467.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80

PLATE DHS 25MM 5 HL 135 DEG

Facility

$1,932.00

Hospital Charge Code	270603834
Hospital Revenue Code	278
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$467.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80

PLATE DHS 25MM 5 HL 135 DEG

Facility

$1,932.00

Hospital Charge Code	270603834
Hospital Revenue Code	278
Min. Negotiated Rate	$46.56
Max. Negotiated Rate	$966.00
Rate for Payer: Aetna Commercial	$734.16
Rate for Payer: Aetna Medicare Advantage	$579.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$492.66
Rate for Payer: Cigna Commercial	$966.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80
Rate for Payer: UnitedHealthcare Community & State	$46.56
Rate for Payer: Wellpoint Medicaid Managed Care	$51.20

PLATE DHS 25MM 5 HL 140 DEG

Facility

$1,932.00

Hospital Charge Code	270603837
Hospital Revenue Code	278
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$467.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80

PLATE DHS 25MM 5 HL 140 DEG

Facility

$1,932.00

Hospital Charge Code	270603837
Hospital Revenue Code	278
Min. Negotiated Rate	$46.56
Max. Negotiated Rate	$966.00
Rate for Payer: Aetna Commercial	$734.16
Rate for Payer: Aetna Medicare Advantage	$579.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$492.66
Rate for Payer: Cigna Commercial	$966.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80
Rate for Payer: UnitedHealthcare Community & State	$46.56
Rate for Payer: Wellpoint Medicaid Managed Care	$51.20

PLATE DHS 25MM 5 HL 145 DEG

Facility

$1,932.00

Hospital Charge Code	270603840
Hospital Revenue Code	278
Min. Negotiated Rate	$46.56
Max. Negotiated Rate	$966.00
Rate for Payer: Aetna Commercial	$734.16
Rate for Payer: Aetna Medicare Advantage	$579.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$492.66
Rate for Payer: Cigna Commercial	$966.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80
Rate for Payer: UnitedHealthcare Community & State	$46.56
Rate for Payer: Wellpoint Medicaid Managed Care	$51.20

PLATE DHS 25MM 5 HL 145 DEG

Facility

$1,932.00

Hospital Charge Code	270603840
Hospital Revenue Code	278
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$467.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80

PLATE DHS 25MM 5 HL 150 DEG

Facility

$1,932.00

Hospital Charge Code	270603843
Hospital Revenue Code	278
Min. Negotiated Rate	$46.56
Max. Negotiated Rate	$966.00
Rate for Payer: Aetna Commercial	$734.16
Rate for Payer: Aetna Medicare Advantage	$579.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$492.66
Rate for Payer: Cigna Commercial	$966.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80
Rate for Payer: UnitedHealthcare Community & State	$46.56
Rate for Payer: Wellpoint Medicaid Managed Care	$51.20

PLATE DHS 25MM 5 HL 150 DEG

Facility

$1,932.00

Hospital Charge Code	270603843
Hospital Revenue Code	278
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$467.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80

PLATE DHS 25MM 6 HL 135 DEG

Facility

$1,932.00

Hospital Charge Code	270603835
Hospital Revenue Code	278
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$467.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80

PLATE DHS 25MM 6 HL 135 DEG

Facility

$1,932.00

Hospital Charge Code	270603835
Hospital Revenue Code	278
Min. Negotiated Rate	$46.56
Max. Negotiated Rate	$966.00
Rate for Payer: Aetna Commercial	$734.16
Rate for Payer: Aetna Medicare Advantage	$579.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$492.66
Rate for Payer: Cigna Commercial	$966.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80
Rate for Payer: UnitedHealthcare Community & State	$46.56
Rate for Payer: Wellpoint Medicaid Managed Care	$51.20

PLATE DHS 25MM 6 HL 140 DEG

Facility

$1,932.00

Hospital Charge Code	270603838
Hospital Revenue Code	278
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$467.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80

PLATE DHS 25MM 6 HL 140 DEG

Facility

$1,932.00

Hospital Charge Code	270603838
Hospital Revenue Code	278
Min. Negotiated Rate	$46.56
Max. Negotiated Rate	$966.00
Rate for Payer: Aetna Commercial	$734.16
Rate for Payer: Aetna Medicare Advantage	$579.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$492.66
Rate for Payer: Cigna Commercial	$966.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80
Rate for Payer: UnitedHealthcare Community & State	$46.56
Rate for Payer: Wellpoint Medicaid Managed Care	$51.20

PLATE DHS 25MM 6 HL 145 DEG

Facility

$1,932.00

Hospital Charge Code	270603841
Hospital Revenue Code	278
Min. Negotiated Rate	$46.56
Max. Negotiated Rate	$966.00
Rate for Payer: Aetna Commercial	$734.16
Rate for Payer: Aetna Medicare Advantage	$579.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$492.66
Rate for Payer: Cigna Commercial	$966.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80
Rate for Payer: UnitedHealthcare Community & State	$46.56
Rate for Payer: Wellpoint Medicaid Managed Care	$51.20

PLATE DHS 25MM 6 HL 145 DEG

Facility

$1,932.00

Hospital Charge Code	270603841
Hospital Revenue Code	278
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$467.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80

PLATE DHS 25MM 6 HL 150 DEG

Facility

$1,932.00

Hospital Charge Code	270603844
Hospital Revenue Code	278
Min. Negotiated Rate	$46.56
Max. Negotiated Rate	$966.00
Rate for Payer: Aetna Commercial	$734.16
Rate for Payer: Aetna Medicare Advantage	$579.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$492.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$492.66
Rate for Payer: Cigna Commercial	$966.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80
Rate for Payer: UnitedHealthcare Community & State	$46.56
Rate for Payer: Wellpoint Medicaid Managed Care	$51.20

PLATE DHS 25MM 6 HL 150 DEG

Facility

$1,932.00

Hospital Charge Code	270603844
Hospital Revenue Code	278
Min. Negotiated Rate	$289.80
Max. Negotiated Rate	$467.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$386.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$467.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$425.04
Rate for Payer: Qualcare PPO/HMO/WC	$289.80

Know your out-of-pocket cost for care.

All Charges