Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE PYRENEES LVL 2 38MM

Facility

$6,940.00

Service Code	HCPCS C1713
Hospital Charge Code	270670296
Hospital Revenue Code	278
Min. Negotiated Rate	$167.25
Max. Negotiated Rate	$3,470.00
Rate for Payer: Aetna Commercial	$2,637.20
Rate for Payer: Aetna Medicare Advantage	$2,082.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,769.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,769.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,769.70
Rate for Payer: Cigna Commercial	$3,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,679.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,526.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.00
Rate for Payer: UnitedHealthcare Community & State	$167.25
Rate for Payer: Wellpoint Medicaid Managed Care	$183.91

PLATE PYRENEES LVL 2 40MM

Facility

$6,940.00

Service Code	HCPCS C1713
Hospital Charge Code	270670297
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.00
Max. Negotiated Rate	$1,679.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,679.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,526.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.00

PLATE PYRENEES LVL 2 40MM

Facility

$6,940.00

Service Code	HCPCS C1713
Hospital Charge Code	270670297
Hospital Revenue Code	278
Min. Negotiated Rate	$167.25
Max. Negotiated Rate	$3,470.00
Rate for Payer: Aetna Commercial	$2,637.20
Rate for Payer: Aetna Medicare Advantage	$2,082.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,769.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,769.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,769.70
Rate for Payer: Cigna Commercial	$3,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,679.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,526.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.00
Rate for Payer: UnitedHealthcare Community & State	$167.25
Rate for Payer: Wellpoint Medicaid Managed Care	$183.91

PLATE PYRENEES LVL 2 42MM

Facility

$6,940.00

Hospital Charge Code	270670298
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.00
Max. Negotiated Rate	$1,679.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,679.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,526.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.00

PLATE PYRENEES LVL 2 42MM

Facility

$6,940.00

Hospital Charge Code	270670298
Hospital Revenue Code	278
Min. Negotiated Rate	$167.25
Max. Negotiated Rate	$3,470.00
Rate for Payer: Aetna Commercial	$2,637.20
Rate for Payer: Aetna Medicare Advantage	$2,082.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,769.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,769.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,769.70
Rate for Payer: Cigna Commercial	$3,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,679.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,526.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.00
Rate for Payer: UnitedHealthcare Community & State	$167.25
Rate for Payer: Wellpoint Medicaid Managed Care	$183.91

PLATE PYRENEES LVL 2 44MM

Facility

$6,940.00

Hospital Charge Code	670299
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.00
Max. Negotiated Rate	$1,679.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,679.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,526.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.00

PLATE PYRENEES LVL 2 44MM

Facility

$6,940.00

Hospital Charge Code	670299
Hospital Revenue Code	278
Min. Negotiated Rate	$167.25
Max. Negotiated Rate	$3,470.00
Rate for Payer: Aetna Commercial	$2,637.20
Rate for Payer: Aetna Medicare Advantage	$2,082.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,769.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,769.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,769.70
Rate for Payer: Cigna Commercial	$3,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,679.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,526.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.00
Rate for Payer: UnitedHealthcare Community & State	$167.25
Rate for Payer: Wellpoint Medicaid Managed Care	$183.91

PLATE PYRENEES LVL 2 46MM

Facility

$6,940.00

Hospital Charge Code	270670300
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.00
Max. Negotiated Rate	$1,679.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,679.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,526.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.00

PLATE PYRENEES LVL 2 46MM

Facility

$6,940.00

Hospital Charge Code	270670300
Hospital Revenue Code	278
Min. Negotiated Rate	$167.25
Max. Negotiated Rate	$3,470.00
Rate for Payer: Aetna Commercial	$2,637.20
Rate for Payer: Aetna Medicare Advantage	$2,082.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,769.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,769.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,769.70
Rate for Payer: Cigna Commercial	$3,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,679.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,526.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.00
Rate for Payer: UnitedHealthcare Community & State	$167.25
Rate for Payer: Wellpoint Medicaid Managed Care	$183.91

PLATE PYRENEES LVL 2 48MM

Facility

$6,940.00

Hospital Charge Code	270670301
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.00
Max. Negotiated Rate	$1,679.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,679.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,526.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.00

PLATE PYRENEES LVL 2 48MM

Facility

$6,940.00

Hospital Charge Code	270670301
Hospital Revenue Code	278
Min. Negotiated Rate	$167.25
Max. Negotiated Rate	$3,470.00
Rate for Payer: Aetna Commercial	$2,637.20
Rate for Payer: Aetna Medicare Advantage	$2,082.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,769.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,769.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,769.70
Rate for Payer: Cigna Commercial	$3,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,679.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,526.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.00
Rate for Payer: UnitedHealthcare Community & State	$167.25
Rate for Payer: Wellpoint Medicaid Managed Care	$183.91

PLATE PYRENEES LVL 2 50MM

Facility

$6,940.00

Hospital Charge Code	270670302
Hospital Revenue Code	278
Min. Negotiated Rate	$167.25
Max. Negotiated Rate	$3,470.00
Rate for Payer: Aetna Commercial	$2,637.20
Rate for Payer: Aetna Medicare Advantage	$2,082.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,769.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,769.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,769.70
Rate for Payer: Cigna Commercial	$3,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,679.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,526.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.00
Rate for Payer: UnitedHealthcare Community & State	$167.25
Rate for Payer: Wellpoint Medicaid Managed Care	$183.91

PLATE PYRENEES LVL 2 50MM

Facility

$6,940.00

Hospital Charge Code	270670302
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.00
Max. Negotiated Rate	$1,679.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,679.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,526.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.00

PLATE PYRENEES LVL 2 52MM

Facility

$6,940.00

Hospital Charge Code	270670303
Hospital Revenue Code	278
Min. Negotiated Rate	$167.25
Max. Negotiated Rate	$3,470.00
Rate for Payer: Aetna Commercial	$2,637.20
Rate for Payer: Aetna Medicare Advantage	$2,082.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,769.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,769.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,769.70
Rate for Payer: Cigna Commercial	$3,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,679.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,526.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.00
Rate for Payer: UnitedHealthcare Community & State	$167.25
Rate for Payer: Wellpoint Medicaid Managed Care	$183.91

PLATE PYRENEES LVL 2 52MM

Facility

$6,940.00

Hospital Charge Code	270670303
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.00
Max. Negotiated Rate	$1,679.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,679.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,526.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.00

PLATE PYRENEES LVL 2 54MM

Facility

$6,940.00

Hospital Charge Code	270670304
Hospital Revenue Code	278
Min. Negotiated Rate	$167.25
Max. Negotiated Rate	$3,470.00
Rate for Payer: Aetna Commercial	$2,637.20
Rate for Payer: Aetna Medicare Advantage	$2,082.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,769.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,769.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,769.70
Rate for Payer: Cigna Commercial	$3,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,679.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,526.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.00
Rate for Payer: UnitedHealthcare Community & State	$167.25
Rate for Payer: Wellpoint Medicaid Managed Care	$183.91

PLATE PYRENEES LVL 2 54MM

Facility

$6,940.00

Hospital Charge Code	270670304
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.00
Max. Negotiated Rate	$1,679.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,388.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,679.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,526.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,041.00

PLATE PYRENEES LVL 3 48MM

Facility

$7,845.00

Hospital Charge Code	270670305
Hospital Revenue Code	278
Min. Negotiated Rate	$189.06
Max. Negotiated Rate	$3,922.50
Rate for Payer: Aetna Commercial	$2,981.10
Rate for Payer: Aetna Medicare Advantage	$2,353.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,000.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,000.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,000.47
Rate for Payer: Cigna Commercial	$3,922.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,725.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.75
Rate for Payer: UnitedHealthcare Community & State	$189.06
Rate for Payer: Wellpoint Medicaid Managed Care	$207.89

PLATE PYRENEES LVL 3 48MM

Facility

$7,845.00

Hospital Charge Code	270670305
Hospital Revenue Code	278
Min. Negotiated Rate	$1,176.75
Max. Negotiated Rate	$1,898.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,725.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.75

PLATE PYRENEES LVL 3 51MM

Facility

$7,845.00

Hospital Charge Code	270670306
Hospital Revenue Code	278
Min. Negotiated Rate	$1,176.75
Max. Negotiated Rate	$1,898.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,725.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.75

PLATE PYRENEES LVL 3 51MM

Facility

$7,845.00

Hospital Charge Code	270670306
Hospital Revenue Code	278
Min. Negotiated Rate	$189.06
Max. Negotiated Rate	$3,922.50
Rate for Payer: Aetna Commercial	$2,981.10
Rate for Payer: Aetna Medicare Advantage	$2,353.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,000.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,000.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,000.47
Rate for Payer: Cigna Commercial	$3,922.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,725.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.75
Rate for Payer: UnitedHealthcare Community & State	$189.06
Rate for Payer: Wellpoint Medicaid Managed Care	$207.89

PLATE PYRENEES LVL 3 54MM

Facility

$7,845.00

Hospital Charge Code	270648864
Hospital Revenue Code	278
Min. Negotiated Rate	$1,176.75
Max. Negotiated Rate	$1,898.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,725.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.75

PLATE PYRENEES LVL 3 54MM

Facility

$7,845.00

Hospital Charge Code	270648864
Hospital Revenue Code	278
Min. Negotiated Rate	$189.06
Max. Negotiated Rate	$3,922.50
Rate for Payer: Aetna Commercial	$2,981.10
Rate for Payer: Aetna Medicare Advantage	$2,353.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,000.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,000.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,000.47
Rate for Payer: Cigna Commercial	$3,922.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,725.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.75
Rate for Payer: UnitedHealthcare Community & State	$189.06
Rate for Payer: Wellpoint Medicaid Managed Care	$207.89

PLATE PYRENEES LVL 3 57MM

Facility

$7,845.00

Hospital Charge Code	270670307
Hospital Revenue Code	278
Min. Negotiated Rate	$189.06
Max. Negotiated Rate	$3,922.50
Rate for Payer: Aetna Commercial	$2,981.10
Rate for Payer: Aetna Medicare Advantage	$2,353.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,000.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,000.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,000.47
Rate for Payer: Cigna Commercial	$3,922.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,725.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.75
Rate for Payer: UnitedHealthcare Community & State	$189.06
Rate for Payer: Wellpoint Medicaid Managed Care	$207.89

PLATE PYRENEES LVL 3 57MM

Facility

$7,845.00

Hospital Charge Code	270670307
Hospital Revenue Code	278
Min. Negotiated Rate	$1,176.75
Max. Negotiated Rate	$1,898.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,569.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,898.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,725.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.75

Know your out-of-pocket cost for care.

All Charges