Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE PYRENEES LVL 3 60MM

Facility

$7,845.00

Service Code	HCPCS C1713
Hospital Charge Code	270670308
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 60MM

Facility

$7,845.00

Service Code	HCPCS C1713
Hospital Charge Code	270670308
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 63MM

Facility

$7,845.00

Service Code	HCPCS C1713
Hospital Charge Code	270670309
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 63MM

Facility

$7,845.00

Service Code	HCPCS C1713
Hospital Charge Code	270670309
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 66MM

Facility

$7,845.00

Hospital Charge Code	270670310
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 66MM

Facility

$7,845.00

Hospital Charge Code	270670310
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 69MM

Facility

$7,845.00

Hospital Charge Code	270670311
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 69MM

Facility

$7,845.00

Hospital Charge Code	270670311
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 72MM

Facility

$7,845.00

Hospital Charge Code	270670312
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 72MM

Facility

$7,845.00

Hospital Charge Code	270670312
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 75MM

Facility

$7,845.00

Hospital Charge Code	270670313
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 75MM

Facility

$7,845.00

Hospital Charge Code	270670313
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 78MM

Facility

$7,845.00

Hospital Charge Code	270670314
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 78MM

Facility

$7,845.00

Hospital Charge Code	270670314
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 4 101MM

Facility

$8,545.00

Hospital Charge Code	270670315
Hospital Revenue Code	278
Min. Negotiated Rate	$205.93
Max. Negotiated Rate	$4,272.50
Rate for Payer: Aetna Commercial	$3,247.10
Rate for Payer: Aetna Medicare Advantage	$2,563.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,178.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,178.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,709.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,178.97
Rate for Payer: Cigna Commercial	$4,272.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,067.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,879.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,281.75
Rate for Payer: UnitedHealthcare Community & State	$205.93
Rate for Payer: Wellpoint Medicaid Managed Care	$226.44

PLATE PYRENEES LVL 4 101MM

Facility

$8,545.00

Hospital Charge Code	270670315
Hospital Revenue Code	278
Min. Negotiated Rate	$1,281.75
Max. Negotiated Rate	$2,067.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,709.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,067.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,879.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,281.75

PLATE PYRENEES LVL 4 61MM

Facility

$8,545.00

Hospital Charge Code	270670316
Hospital Revenue Code	278
Min. Negotiated Rate	$1,281.75
Max. Negotiated Rate	$2,067.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,709.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,067.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,879.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,281.75

PLATE PYRENEES LVL 4 61MM

Facility

$8,545.00

Hospital Charge Code	270670316
Hospital Revenue Code	278
Min. Negotiated Rate	$205.93
Max. Negotiated Rate	$4,272.50
Rate for Payer: Aetna Commercial	$3,247.10
Rate for Payer: Aetna Medicare Advantage	$2,563.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,178.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,178.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,709.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,178.97
Rate for Payer: Cigna Commercial	$4,272.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,067.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,879.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,281.75
Rate for Payer: UnitedHealthcare Community & State	$205.93
Rate for Payer: Wellpoint Medicaid Managed Care	$226.44

PLATE PYRENEES LVL 4 65MM

Facility

$8,545.00

Hospital Charge Code	270670317
Hospital Revenue Code	278
Min. Negotiated Rate	$205.93
Max. Negotiated Rate	$4,272.50
Rate for Payer: Aetna Commercial	$3,247.10
Rate for Payer: Aetna Medicare Advantage	$2,563.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,178.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,178.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,709.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,178.97
Rate for Payer: Cigna Commercial	$4,272.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,067.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,879.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,281.75
Rate for Payer: UnitedHealthcare Community & State	$205.93
Rate for Payer: Wellpoint Medicaid Managed Care	$226.44

PLATE PYRENEES LVL 4 65MM

Facility

$8,545.00

Hospital Charge Code	270670317
Hospital Revenue Code	278
Min. Negotiated Rate	$1,281.75
Max. Negotiated Rate	$2,067.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,709.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,067.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,879.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,281.75

PLATE PYRENEES LVL 4 69MM

Facility

$8,545.00

Hospital Charge Code	270670318
Hospital Revenue Code	278
Min. Negotiated Rate	$205.93
Max. Negotiated Rate	$4,272.50
Rate for Payer: Aetna Commercial	$3,247.10
Rate for Payer: Aetna Medicare Advantage	$2,563.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,178.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,178.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,709.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,178.97
Rate for Payer: Cigna Commercial	$4,272.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,067.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,879.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,281.75
Rate for Payer: UnitedHealthcare Community & State	$205.93
Rate for Payer: Wellpoint Medicaid Managed Care	$226.44

PLATE PYRENEES LVL 4 69MM

Facility

$8,545.00

Hospital Charge Code	270670318
Hospital Revenue Code	278
Min. Negotiated Rate	$1,281.75
Max. Negotiated Rate	$2,067.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,709.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,067.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,879.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,281.75

PLATE PYRENEES LVL 4 73MM

Facility

$8,545.00

Hospital Charge Code	270670319
Hospital Revenue Code	278
Min. Negotiated Rate	$205.93
Max. Negotiated Rate	$4,272.50
Rate for Payer: Aetna Commercial	$3,247.10
Rate for Payer: Aetna Medicare Advantage	$2,563.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,178.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,178.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,709.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,178.97
Rate for Payer: Cigna Commercial	$4,272.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,067.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,879.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,281.75
Rate for Payer: UnitedHealthcare Community & State	$205.93
Rate for Payer: Wellpoint Medicaid Managed Care	$226.44

PLATE PYRENEES LVL 4 73MM

Facility

$8,545.00

Hospital Charge Code	270670319
Hospital Revenue Code	278
Min. Negotiated Rate	$1,281.75
Max. Negotiated Rate	$2,067.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,709.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,067.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,879.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,281.75

PLATE PYRENEES LVL 4 77MM

Facility

$8,545.00

Hospital Charge Code	270670320
Hospital Revenue Code	278
Min. Negotiated Rate	$1,281.75
Max. Negotiated Rate	$2,067.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,709.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,067.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,879.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,281.75

Know your out-of-pocket cost for care.

All Charges