Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE SKY 3 LEVEL TI 48MM

Facility

$7,250.00

Hospital Charge Code	270668252
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

PLATE SKY 3 LEVEL TI 48MM

Facility

$7,250.00

Hospital Charge Code	270668252
Hospital Revenue Code	278
Min. Negotiated Rate	$174.72
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$174.72
Rate for Payer: Wellpoint Medicaid Managed Care	$192.12

PLATE SKY 3 LEVEL TI 51MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270666240
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

PLATE SKY 3 LEVEL TI 51MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270666240
Hospital Revenue Code	278
Min. Negotiated Rate	$174.72
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$174.72
Rate for Payer: Wellpoint Medicaid Managed Care	$192.12

PLATE SKY 3 LEVEL TI 54MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270673370
Hospital Revenue Code	278
Min. Negotiated Rate	$174.72
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$174.72
Rate for Payer: Wellpoint Medicaid Managed Care	$192.12

PLATE SKY 3 LEVEL TI 54MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270673370
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

PLATE SKY 3 LEVEL TI 57MM

Facility

$7,250.00

Hospital Charge Code	270668466
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

PLATE SKY 3 LEVEL TI 57MM

Facility

$7,250.00

Hospital Charge Code	270668466
Hospital Revenue Code	278
Min. Negotiated Rate	$174.72
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$174.72
Rate for Payer: Wellpoint Medicaid Managed Care	$192.12

PLATE SKYKINE 32MM

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270686918
Hospital Revenue Code	278
Min. Negotiated Rate	$162.68
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$162.68
Rate for Payer: Wellpoint Medicaid Managed Care	$178.88

PLATE SKYKINE 32MM

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270686918
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

PLATE SKYL ANT CERV 16X54MM 3L

Facility

$8,265.00

Service Code	HCPCS C1713
Hospital Charge Code	270694859
Hospital Revenue Code	278
Min. Negotiated Rate	$1,239.75
Max. Negotiated Rate	$2,000.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,653.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,000.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,818.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,239.75

PLATE SKYL ANT CERV 16X54MM 3L

Facility

$8,265.00

Service Code	HCPCS C1713
Hospital Charge Code	270694859
Hospital Revenue Code	278
Min. Negotiated Rate	$199.19
Max. Negotiated Rate	$4,132.50
Rate for Payer: Aetna Commercial	$3,140.70
Rate for Payer: Aetna Medicare Advantage	$2,479.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,107.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,107.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,653.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,107.57
Rate for Payer: Cigna Commercial	$4,132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,000.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,818.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,239.75
Rate for Payer: UnitedHealthcare Community & State	$199.19
Rate for Payer: Wellpoint Medicaid Managed Care	$219.02

PLATE SKYLINE 32MM

Facility

$6,042.00

Service Code	HCPCS C1713
Hospital Charge Code	270686937
Hospital Revenue Code	278
Min. Negotiated Rate	$145.61
Max. Negotiated Rate	$3,021.00
Rate for Payer: Aetna Commercial	$2,295.96
Rate for Payer: Aetna Medicare Advantage	$1,812.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,540.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,540.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,208.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,540.71
Rate for Payer: Cigna Commercial	$3,021.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,329.24
Rate for Payer: Qualcare PPO/HMO/WC	$906.30
Rate for Payer: UnitedHealthcare Community & State	$145.61
Rate for Payer: Wellpoint Medicaid Managed Care	$160.11

PLATE SKYLINE 32MM

Facility

$6,042.00

Service Code	HCPCS C1713
Hospital Charge Code	270686937
Hospital Revenue Code	278
Min. Negotiated Rate	$906.30
Max. Negotiated Rate	$1,462.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,208.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,329.24
Rate for Payer: Qualcare PPO/HMO/WC	$906.30

PLATE SKYLINE 34MM

Facility

$6,042.00

Service Code	HCPCS C1713
Hospital Charge Code	270689203
Hospital Revenue Code	278
Min. Negotiated Rate	$145.61
Max. Negotiated Rate	$3,021.00
Rate for Payer: Aetna Commercial	$2,295.96
Rate for Payer: Aetna Medicare Advantage	$1,812.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,540.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,540.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,208.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,540.71
Rate for Payer: Cigna Commercial	$3,021.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,329.24
Rate for Payer: Qualcare PPO/HMO/WC	$906.30
Rate for Payer: UnitedHealthcare Community & State	$145.61
Rate for Payer: Wellpoint Medicaid Managed Care	$160.11

PLATE SKYLINE 34MM

Facility

$6,042.00

Service Code	HCPCS C1713
Hospital Charge Code	270689203
Hospital Revenue Code	278
Min. Negotiated Rate	$906.30
Max. Negotiated Rate	$1,462.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,208.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,329.24
Rate for Payer: Qualcare PPO/HMO/WC	$906.30

PLATE SKYLINE 34 MM LEVEL 2

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270681013
Hospital Revenue Code	278
Min. Negotiated Rate	$162.68
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$162.68
Rate for Payer: Wellpoint Medicaid Managed Care	$178.88

PLATE SKYLINE 34 MM LEVEL 2

Facility

$6,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270681013
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

PLATE SKYLINE 42 MM

Facility

$7,290.00

Service Code	HCPCS C1713
Hospital Charge Code	270686283
Hospital Revenue Code	278
Min. Negotiated Rate	$1,093.50
Max. Negotiated Rate	$1,764.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,458.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,603.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,093.50

PLATE SKYLINE 42 MM

Facility

$7,290.00

Service Code	HCPCS C1713
Hospital Charge Code	270686283
Hospital Revenue Code	278
Min. Negotiated Rate	$175.69
Max. Negotiated Rate	$3,645.00
Rate for Payer: Aetna Commercial	$2,770.20
Rate for Payer: Aetna Medicare Advantage	$2,187.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,858.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,858.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,458.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,858.95
Rate for Payer: Cigna Commercial	$3,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,603.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,093.50
Rate for Payer: UnitedHealthcare Community & State	$175.69
Rate for Payer: Wellpoint Medicaid Managed Care	$193.19

PLATE SKYLINE 48 MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270681583
Hospital Revenue Code	278
Min. Negotiated Rate	$174.72
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$174.72
Rate for Payer: Wellpoint Medicaid Managed Care	$192.12

PLATE SKYLINE 48 MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270681583
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

PLATE SKYLINE 54MM

Facility

$11,075.00

Hospital Charge Code	270665835
Hospital Revenue Code	278
Min. Negotiated Rate	$266.91
Max. Negotiated Rate	$5,537.50
Rate for Payer: Aetna Commercial	$4,208.50
Rate for Payer: Aetna Medicare Advantage	$3,322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,824.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,824.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,824.12
Rate for Payer: Cigna Commercial	$5,537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,680.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,436.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,661.25
Rate for Payer: UnitedHealthcare Community & State	$266.91
Rate for Payer: Wellpoint Medicaid Managed Care	$293.49

PLATE SKYLINE 54MM

Facility

$11,075.00

Hospital Charge Code	270665835
Hospital Revenue Code	278
Min. Negotiated Rate	$1,661.25
Max. Negotiated Rate	$2,680.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,680.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,436.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,661.25

PLATE SLIM 34MM HP 34 MM

Facility

$15,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270694191
Hospital Revenue Code	278
Min. Negotiated Rate	$2,332.50
Max. Negotiated Rate	$3,763.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,763.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,421.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.50

Know your out-of-pocket cost for care.

All Charges