Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE SUPRA 90 150mm 118109006

Facility

$2,084.85

Hospital Charge Code	270605765
Hospital Revenue Code	278
Min. Negotiated Rate	$50.24
Max. Negotiated Rate	$1,042.42
Rate for Payer: Aetna Commercial	$792.24
Rate for Payer: Aetna Medicare Advantage	$625.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$531.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$531.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$416.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$531.64
Rate for Payer: Cigna Commercial	$1,042.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$504.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$458.67
Rate for Payer: Qualcare PPO/HMO/WC	$312.73
Rate for Payer: UnitedHealthcare Community & State	$50.24
Rate for Payer: Wellpoint Medicaid Managed Care	$55.25

PLATE SUPRA 90 150mm 118109006

Facility

$2,084.85

Hospital Charge Code	270605765
Hospital Revenue Code	278
Min. Negotiated Rate	$312.73
Max. Negotiated Rate	$504.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$416.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$504.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$458.67
Rate for Payer: Qualcare PPO/HMO/WC	$312.73

PLATE SUPRA 90 205mm 118109008

Facility

$2,112.00

Hospital Charge Code	270625766
Hospital Revenue Code	278
Min. Negotiated Rate	$316.80
Max. Negotiated Rate	$511.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$422.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$511.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$464.64
Rate for Payer: Qualcare PPO/HMO/WC	$316.80

PLATE SUPRA 90 205mm 118109008

Facility

$2,112.00

Hospital Charge Code	270625766
Hospital Revenue Code	278
Min. Negotiated Rate	$50.90
Max. Negotiated Rate	$1,056.00
Rate for Payer: Aetna Commercial	$802.56
Rate for Payer: Aetna Medicare Advantage	$633.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$538.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$538.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$422.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$538.56
Rate for Payer: Cigna Commercial	$1,056.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$511.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$464.64
Rate for Payer: Qualcare PPO/HMO/WC	$316.80
Rate for Payer: UnitedHealthcare Community & State	$50.90
Rate for Payer: Wellpoint Medicaid Managed Care	$55.97

PLATE SUPR MID CURV 10H 122MM

Facility

$8,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270673668
Hospital Revenue Code	278
Min. Negotiated Rate	$201.24
Max. Negotiated Rate	$4,175.00
Rate for Payer: Aetna Commercial	$3,173.00
Rate for Payer: Aetna Medicare Advantage	$2,505.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,129.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,129.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,129.25
Rate for Payer: Cigna Commercial	$4,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,020.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,837.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,252.50
Rate for Payer: UnitedHealthcare Community & State	$201.24
Rate for Payer: Wellpoint Medicaid Managed Care	$221.28

PLATE SUPR MID CURV 10H 122MM

Facility

$8,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270673668
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$2,020.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,670.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,020.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,837.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,252.50

PLATE SYN 12H 1.5 SCR 446.22

Facility

$1,220.00

Hospital Charge Code	270619572
Hospital Revenue Code	278
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$610.00
Rate for Payer: Aetna Commercial	$463.60
Rate for Payer: Aetna Medicare Advantage	$366.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$311.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$311.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$311.10
Rate for Payer: Cigna Commercial	$610.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$268.40
Rate for Payer: Qualcare PPO/HMO/WC	$183.00
Rate for Payer: UnitedHealthcare Community & State	$29.40
Rate for Payer: Wellpoint Medicaid Managed Care	$32.33

PLATE SYN 12H 1.5 SCR 446.22

Facility

$1,220.00

Hospital Charge Code	270619572
Hospital Revenue Code	278
Min. Negotiated Rate	$183.00
Max. Negotiated Rate	$295.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$268.40
Rate for Payer: Qualcare PPO/HMO/WC	$183.00

PLATE SYN 1/3 TUB 10H

Facility

$248.85

Hospital Charge Code	270604307
Hospital Revenue Code	278
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$124.42
Rate for Payer: Aetna Commercial	$94.56
Rate for Payer: Aetna Medicare Advantage	$74.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.46
Rate for Payer: Cigna Commercial	$124.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.75
Rate for Payer: Qualcare PPO/HMO/WC	$37.33
Rate for Payer: UnitedHealthcare Community & State	$6.00
Rate for Payer: Wellpoint Medicaid Managed Care	$6.59

PLATE SYN 1/3 TUB 10H

Facility

$307.25

Hospital Charge Code	270601913
Hospital Revenue Code	278
Min. Negotiated Rate	$7.40
Max. Negotiated Rate	$153.62
Rate for Payer: Aetna Commercial	$116.75
Rate for Payer: Aetna Medicare Advantage	$92.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.35
Rate for Payer: Cigna Commercial	$153.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$67.59
Rate for Payer: Qualcare PPO/HMO/WC	$46.09
Rate for Payer: UnitedHealthcare Community & State	$7.40
Rate for Payer: Wellpoint Medicaid Managed Care	$8.14

PLATE SYN 1/3 TUB 10H

Facility

$248.85

Hospital Charge Code	270604307
Hospital Revenue Code	278
Min. Negotiated Rate	$37.33
Max. Negotiated Rate	$60.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.75
Rate for Payer: Qualcare PPO/HMO/WC	$37.33

PLATE SYN 1/3 TUB 10H

Facility

$307.25

Hospital Charge Code	270601913
Hospital Revenue Code	278
Min. Negotiated Rate	$46.09
Max. Negotiated Rate	$74.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$67.59
Rate for Payer: Qualcare PPO/HMO/WC	$46.09

PLATE SYN 1/3 TUB 2H

Facility

$192.85

Hospital Charge Code	270604299
Hospital Revenue Code	278
Min. Negotiated Rate	$28.93
Max. Negotiated Rate	$46.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$42.43
Rate for Payer: Qualcare PPO/HMO/WC	$28.93

PLATE SYN 1/3 TUB 2H

Facility

$192.85

Hospital Charge Code	270604299
Hospital Revenue Code	278
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$96.42
Rate for Payer: Aetna Commercial	$73.28
Rate for Payer: Aetna Medicare Advantage	$57.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.18
Rate for Payer: Cigna Commercial	$96.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$42.43
Rate for Payer: Qualcare PPO/HMO/WC	$28.93
Rate for Payer: UnitedHealthcare Community & State	$4.65
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

PLATE SYN 1/3 TUB 2H

Facility

$233.65

Hospital Charge Code	270601905
Hospital Revenue Code	278
Min. Negotiated Rate	$35.05
Max. Negotiated Rate	$56.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$51.40
Rate for Payer: Qualcare PPO/HMO/WC	$35.05

PLATE SYN 1/3 TUB 2H

Facility

$233.65

Hospital Charge Code	270601905
Hospital Revenue Code	278
Min. Negotiated Rate	$5.63
Max. Negotiated Rate	$116.83
Rate for Payer: Aetna Commercial	$88.79
Rate for Payer: Aetna Medicare Advantage	$70.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.58
Rate for Payer: Cigna Commercial	$116.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$51.40
Rate for Payer: Qualcare PPO/HMO/WC	$35.05
Rate for Payer: UnitedHealthcare Community & State	$5.63
Rate for Payer: Wellpoint Medicaid Managed Care	$6.19

PLATE SYN 1/3 TUB 3H

Facility

$200.85

Hospital Charge Code	270604300
Hospital Revenue Code	278
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$100.42
Rate for Payer: Aetna Commercial	$76.32
Rate for Payer: Aetna Medicare Advantage	$60.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.22
Rate for Payer: Cigna Commercial	$100.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$44.19
Rate for Payer: Qualcare PPO/HMO/WC	$30.13
Rate for Payer: UnitedHealthcare Community & State	$4.84
Rate for Payer: Wellpoint Medicaid Managed Care	$5.32

PLATE SYN 1/3 TUB 3H

Facility

$240.85

Hospital Charge Code	270601906
Hospital Revenue Code	278
Min. Negotiated Rate	$36.13
Max. Negotiated Rate	$58.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.99
Rate for Payer: Qualcare PPO/HMO/WC	$36.13

PLATE SYN 1/3 TUB 3H

Facility

$200.85

Hospital Charge Code	270604300
Hospital Revenue Code	278
Min. Negotiated Rate	$30.13
Max. Negotiated Rate	$48.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$44.19
Rate for Payer: Qualcare PPO/HMO/WC	$30.13

PLATE SYN 1/3 TUB 3H

Facility

$240.85

Hospital Charge Code	270601906
Hospital Revenue Code	278
Min. Negotiated Rate	$5.80
Max. Negotiated Rate	$120.42
Rate for Payer: Aetna Commercial	$91.52
Rate for Payer: Aetna Medicare Advantage	$72.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.42
Rate for Payer: Cigna Commercial	$120.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.99
Rate for Payer: Qualcare PPO/HMO/WC	$36.13
Rate for Payer: UnitedHealthcare Community & State	$5.80
Rate for Payer: Wellpoint Medicaid Managed Care	$6.38

PLATE SYN 1/3 TUB 4H

Facility

$233.65

Hospital Charge Code	270604301
Hospital Revenue Code	278
Min. Negotiated Rate	$5.63
Max. Negotiated Rate	$116.83
Rate for Payer: Aetna Commercial	$88.79
Rate for Payer: Aetna Medicare Advantage	$70.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.58
Rate for Payer: Cigna Commercial	$116.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$51.40
Rate for Payer: Qualcare PPO/HMO/WC	$35.05
Rate for Payer: UnitedHealthcare Community & State	$5.63
Rate for Payer: Wellpoint Medicaid Managed Care	$6.19

PLATE SYN 1/3 TUB 4H

Facility

$233.65

Hospital Charge Code	270604301
Hospital Revenue Code	278
Min. Negotiated Rate	$35.05
Max. Negotiated Rate	$56.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$51.40
Rate for Payer: Qualcare PPO/HMO/WC	$35.05

PLATE SYN 1/3 TUB 5H 241.35

Facility

$254.45

Hospital Charge Code	270604302
Hospital Revenue Code	278
Min. Negotiated Rate	$38.17
Max. Negotiated Rate	$61.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.98
Rate for Payer: Qualcare PPO/HMO/WC	$38.17

PLATE SYN 1/3 TUB 5H 241.35

Facility

$254.45

Hospital Charge Code	270604302
Hospital Revenue Code	278
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$127.22
Rate for Payer: Aetna Commercial	$96.69
Rate for Payer: Aetna Medicare Advantage	$76.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.88
Rate for Payer: Cigna Commercial	$127.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.98
Rate for Payer: Qualcare PPO/HMO/WC	$38.17
Rate for Payer: UnitedHealthcare Community & State	$6.13
Rate for Payer: Wellpoint Medicaid Managed Care	$6.74

PLATE SYN 1/3 TUB 6H

Facility

$240.85

Hospital Charge Code	270604303
Hospital Revenue Code	278
Min. Negotiated Rate	$5.80
Max. Negotiated Rate	$120.42
Rate for Payer: Aetna Commercial	$91.52
Rate for Payer: Aetna Medicare Advantage	$72.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.42
Rate for Payer: Cigna Commercial	$120.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.99
Rate for Payer: Qualcare PPO/HMO/WC	$36.13
Rate for Payer: UnitedHealthcare Community & State	$5.80
Rate for Payer: Wellpoint Medicaid Managed Care	$6.38

Know your out-of-pocket cost for care.

All Charges