Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE LC-DCP 3.5x116MM 9HOLE

Facility

$710.70

Service Code	HCPCS C1713
Hospital Charge Code	270603344
Hospital Revenue Code	278
Min. Negotiated Rate	$106.61
Max. Negotiated Rate	$171.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$142.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$156.35
Rate for Payer: Qualcare PPO/HMO/WC	$106.61

PLATE LC-DCP 3.5x64MM 5HOLE

Facility

$599.45

Service Code	HCPCS C1713
Hospital Charge Code	270630538
Hospital Revenue Code	278
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$299.73
Rate for Payer: Aetna Commercial	$227.79
Rate for Payer: Aetna Medicare Advantage	$179.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.86
Rate for Payer: Cigna Commercial	$299.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$131.88
Rate for Payer: Qualcare PPO/HMO/WC	$89.92
Rate for Payer: UnitedHealthcare Community & State	$14.45
Rate for Payer: Wellpoint Medicaid Managed Care	$15.89

PLATE LC-DCP 3.5x64MM 5HOLE

Facility

$599.45

Service Code	HCPCS C1713
Hospital Charge Code	270630538
Hospital Revenue Code	278
Min. Negotiated Rate	$89.92
Max. Negotiated Rate	$145.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$131.88
Rate for Payer: Qualcare PPO/HMO/WC	$89.92

PLATE LC-DCP 3.5x77MM 6HOLE

Facility

$1,667.70

Service Code	HCPCS C1713
Hospital Charge Code	270601896
Hospital Revenue Code	278
Min. Negotiated Rate	$250.16
Max. Negotiated Rate	$403.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$333.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$403.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$366.89
Rate for Payer: Qualcare PPO/HMO/WC	$250.16

PLATE LC-DCP 3.5x77MM 6HOLE

Facility

$1,667.70

Service Code	HCPCS C1713
Hospital Charge Code	270601896
Hospital Revenue Code	278
Min. Negotiated Rate	$40.19
Max. Negotiated Rate	$833.85
Rate for Payer: Aetna Commercial	$633.73
Rate for Payer: Aetna Medicare Advantage	$500.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$425.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$425.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$333.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$425.26
Rate for Payer: Cigna Commercial	$833.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$403.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$366.89
Rate for Payer: Qualcare PPO/HMO/WC	$250.16
Rate for Payer: UnitedHealthcare Community & State	$40.19
Rate for Payer: Wellpoint Medicaid Managed Care	$44.19

PLATE LC-DCP 3.5x90MM 7HOLE

Facility

$665.15

Service Code	HCPCS C1713
Hospital Charge Code	270601895
Hospital Revenue Code	278
Min. Negotiated Rate	$16.03
Max. Negotiated Rate	$332.57
Rate for Payer: Aetna Commercial	$252.76
Rate for Payer: Aetna Medicare Advantage	$199.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.61
Rate for Payer: Cigna Commercial	$332.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$146.33
Rate for Payer: Qualcare PPO/HMO/WC	$99.77
Rate for Payer: UnitedHealthcare Community & State	$16.03
Rate for Payer: Wellpoint Medicaid Managed Care	$17.63

PLATE LC-DCP 3.5x90MM 7HOLE

Facility

$665.15

Service Code	HCPCS C1713
Hospital Charge Code	270601895
Hospital Revenue Code	278
Min. Negotiated Rate	$99.77
Max. Negotiated Rate	$160.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$146.33
Rate for Payer: Qualcare PPO/HMO/WC	$99.77

PLATE LC DCP 4HOLE 2.4mm 31mm

Facility

$1,402.85

Service Code	HCPCS C1713
Hospital Charge Code	270651720
Hospital Revenue Code	278
Min. Negotiated Rate	$33.81
Max. Negotiated Rate	$701.42
Rate for Payer: Aetna Commercial	$533.08
Rate for Payer: Aetna Medicare Advantage	$420.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$357.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$357.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$280.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$357.73
Rate for Payer: Cigna Commercial	$701.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$308.63
Rate for Payer: Qualcare PPO/HMO/WC	$210.43
Rate for Payer: UnitedHealthcare Community & State	$33.81
Rate for Payer: Wellpoint Medicaid Managed Care	$37.18

PLATE LC DCP 4HOLE 2.4mm 31mm

Facility

$1,402.85

Service Code	HCPCS C1713
Hospital Charge Code	270651720
Hospital Revenue Code	278
Min. Negotiated Rate	$210.43
Max. Negotiated Rate	$339.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$280.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$339.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$308.63
Rate for Payer: Qualcare PPO/HMO/WC	$210.43

PLATE LC DCP 6HOLE 2.4mm 47mm

Facility

$1,575.90

Service Code	HCPCS C1713
Hospital Charge Code	270651721
Hospital Revenue Code	278
Min. Negotiated Rate	$236.38
Max. Negotiated Rate	$381.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$346.70
Rate for Payer: Qualcare PPO/HMO/WC	$236.38

PLATE LC DCP 6HOLE 2.4mm 47mm

Facility

$1,575.90

Service Code	HCPCS C1713
Hospital Charge Code	270651721
Hospital Revenue Code	278
Min. Negotiated Rate	$37.98
Max. Negotiated Rate	$787.95
Rate for Payer: Aetna Commercial	$598.84
Rate for Payer: Aetna Medicare Advantage	$472.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.85
Rate for Payer: Cigna Commercial	$787.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$346.70
Rate for Payer: Qualcare PPO/HMO/WC	$236.38
Rate for Payer: UnitedHealthcare Community & State	$37.98
Rate for Payer: Wellpoint Medicaid Managed Care	$41.76

PLATE LC-DCP TITN 3.5MM 10H

Facility

$715.25

Service Code	HCPCS C1713
Hospital Charge Code	270603345
Hospital Revenue Code	278
Min. Negotiated Rate	$17.24
Max. Negotiated Rate	$357.62
Rate for Payer: Aetna Commercial	$271.80
Rate for Payer: Aetna Medicare Advantage	$214.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$182.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$182.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$182.39
Rate for Payer: Cigna Commercial	$357.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$157.35
Rate for Payer: Qualcare PPO/HMO/WC	$107.29
Rate for Payer: UnitedHealthcare Community & State	$17.24
Rate for Payer: Wellpoint Medicaid Managed Care	$18.95

PLATE LC-DCP TITN 3.5MM 10H

Facility

$715.25

Service Code	HCPCS C1713
Hospital Charge Code	270603345
Hospital Revenue Code	278
Min. Negotiated Rate	$107.29
Max. Negotiated Rate	$173.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$157.35
Rate for Payer: Qualcare PPO/HMO/WC	$107.29

PLATE LC-DCP TITN 3.5MM 11H

Facility

$744.00

Hospital Charge Code	270603347
Hospital Revenue Code	278
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$372.00
Rate for Payer: Aetna Commercial	$282.72
Rate for Payer: Aetna Medicare Advantage	$223.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.72
Rate for Payer: Cigna Commercial	$372.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.68
Rate for Payer: Qualcare PPO/HMO/WC	$111.60
Rate for Payer: UnitedHealthcare Community & State	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$19.72

PLATE LC-DCP TITN 3.5MM 11H

Facility

$744.00

Hospital Charge Code	270603347
Hospital Revenue Code	278
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$180.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.68
Rate for Payer: Qualcare PPO/HMO/WC	$111.60

PLATE LC-DCP TITN 3.5MM 12H

Facility

$791.25

Hospital Charge Code	270604055
Hospital Revenue Code	278
Min. Negotiated Rate	$118.69
Max. Negotiated Rate	$191.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$158.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$174.07
Rate for Payer: Qualcare PPO/HMO/WC	$118.69

PLATE LC-DCP TITN 3.5MM 12H

Facility

$791.25

Hospital Charge Code	270603349
Hospital Revenue Code	278
Min. Negotiated Rate	$19.07
Max. Negotiated Rate	$395.62
Rate for Payer: Aetna Commercial	$300.68
Rate for Payer: Aetna Medicare Advantage	$237.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$158.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.77
Rate for Payer: Cigna Commercial	$395.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$174.07
Rate for Payer: Qualcare PPO/HMO/WC	$118.69
Rate for Payer: UnitedHealthcare Community & State	$19.07
Rate for Payer: Wellpoint Medicaid Managed Care	$20.97

PLATE LC-DCP TITN 3.5MM 12H

Facility

$791.25

Hospital Charge Code	270604055
Hospital Revenue Code	278
Min. Negotiated Rate	$19.07
Max. Negotiated Rate	$395.62
Rate for Payer: Aetna Commercial	$300.68
Rate for Payer: Aetna Medicare Advantage	$237.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$158.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.77
Rate for Payer: Cigna Commercial	$395.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$174.07
Rate for Payer: Qualcare PPO/HMO/WC	$118.69
Rate for Payer: UnitedHealthcare Community & State	$19.07
Rate for Payer: Wellpoint Medicaid Managed Care	$20.97

PLATE LC-DCP TITN 3.5MM 12H

Facility

$791.25

Hospital Charge Code	270603349
Hospital Revenue Code	278
Min. Negotiated Rate	$118.69
Max. Negotiated Rate	$191.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$158.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$174.07
Rate for Payer: Qualcare PPO/HMO/WC	$118.69

PLATE LC-DCP TITN 3.5MM 14H

Facility

$1,503.25

Hospital Charge Code	270603350
Hospital Revenue Code	278
Min. Negotiated Rate	$36.23
Max. Negotiated Rate	$751.62
Rate for Payer: Aetna Commercial	$571.24
Rate for Payer: Aetna Medicare Advantage	$450.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$383.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$383.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$383.33
Rate for Payer: Cigna Commercial	$751.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.71
Rate for Payer: Qualcare PPO/HMO/WC	$225.49
Rate for Payer: UnitedHealthcare Community & State	$36.23
Rate for Payer: Wellpoint Medicaid Managed Care	$39.84

PLATE LC-DCP TITN 3.5MM 14H

Facility

$1,503.25

Hospital Charge Code	270603350
Hospital Revenue Code	278
Min. Negotiated Rate	$225.49
Max. Negotiated Rate	$363.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.71
Rate for Payer: Qualcare PPO/HMO/WC	$225.49

PLATE LC-DCP TITN 3.5MM 15H

Facility

$1,609.65

Hospital Charge Code	270604056
Hospital Revenue Code	278
Min. Negotiated Rate	$38.79
Max. Negotiated Rate	$804.83
Rate for Payer: Aetna Commercial	$611.67
Rate for Payer: Aetna Medicare Advantage	$482.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$410.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$410.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$321.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$410.46
Rate for Payer: Cigna Commercial	$804.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$389.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$354.12
Rate for Payer: Qualcare PPO/HMO/WC	$241.45
Rate for Payer: UnitedHealthcare Community & State	$38.79
Rate for Payer: Wellpoint Medicaid Managed Care	$42.66

PLATE LC-DCP TITN 3.5MM 15H

Facility

$1,609.65

Hospital Charge Code	270604056
Hospital Revenue Code	278
Min. Negotiated Rate	$241.45
Max. Negotiated Rate	$389.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$321.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$389.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$354.12
Rate for Payer: Qualcare PPO/HMO/WC	$241.45

PLATE LC-DCP TITN 3.5MM 16H

Facility

$1,724.85

Hospital Charge Code	270604058
Hospital Revenue Code	278
Min. Negotiated Rate	$258.73
Max. Negotiated Rate	$417.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$344.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$417.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$379.47
Rate for Payer: Qualcare PPO/HMO/WC	$258.73

PLATE LC-DCP TITN 3.5MM 16H

Facility

$1,724.85

Hospital Charge Code	270604058
Hospital Revenue Code	278
Min. Negotiated Rate	$41.57
Max. Negotiated Rate	$862.42
Rate for Payer: Aetna Commercial	$655.44
Rate for Payer: Aetna Medicare Advantage	$517.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$439.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$439.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$344.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.84
Rate for Payer: Cigna Commercial	$862.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$417.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$379.47
Rate for Payer: Qualcare PPO/HMO/WC	$258.73
Rate for Payer: UnitedHealthcare Community & State	$41.57
Rate for Payer: Wellpoint Medicaid Managed Care	$45.71

Know your out-of-pocket cost for care.

All Charges