Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE SYN 3.5 7 HL 423.57

Facility

$369.00

Hospital Charge Code	1603760
Hospital Revenue Code	274
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$184.50
Rate for Payer: Aetna Commercial	$140.22
Rate for Payer: Aetna Medicare Advantage	$110.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$73.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.09
Rate for Payer: Cigna Commercial	$184.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$81.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.35
Rate for Payer: UnitedHealthcare Community & State	$8.89
Rate for Payer: Wellpoint Medicaid Managed Care	$9.78

PLATE SYN 3.5 8 HL 423.58

Facility

$379.00

Hospital Charge Code	1603778
Hospital Revenue Code	274
Min. Negotiated Rate	$56.85
Max. Negotiated Rate	$91.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$83.38
Rate for Payer: Qualcare PPO/HMO/WC	$56.85

PLATE SYN 3.5 8 HL 423.58

Facility

$379.00

Hospital Charge Code	1603778
Hospital Revenue Code	274
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$189.50
Rate for Payer: Aetna Commercial	$144.02
Rate for Payer: Aetna Medicare Advantage	$113.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.64
Rate for Payer: Cigna Commercial	$189.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$83.38
Rate for Payer: Qualcare PPO/HMO/WC	$56.85
Rate for Payer: UnitedHealthcare Community & State	$9.13
Rate for Payer: Wellpoint Medicaid Managed Care	$10.04

PLATE SYN 3.5 9H

Facility

$683.25

Hospital Charge Code	270601898
Hospital Revenue Code	278
Min. Negotiated Rate	$16.47
Max. Negotiated Rate	$341.62
Rate for Payer: Aetna Commercial	$259.63
Rate for Payer: Aetna Medicare Advantage	$204.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.23
Rate for Payer: Cigna Commercial	$341.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$150.31
Rate for Payer: Qualcare PPO/HMO/WC	$102.49
Rate for Payer: UnitedHealthcare Community & State	$16.47
Rate for Payer: Wellpoint Medicaid Managed Care	$18.11

PLATE SYN 3.5 9H

Facility

$683.25

Hospital Charge Code	270601898
Hospital Revenue Code	278
Min. Negotiated Rate	$102.49
Max. Negotiated Rate	$165.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$150.31
Rate for Payer: Qualcare PPO/HMO/WC	$102.49

PLATE SYN 3.5 9 HL 423.59

Facility

$399.00

Hospital Charge Code	1603786
Hospital Revenue Code	274
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$199.50
Rate for Payer: Aetna Commercial	$151.62
Rate for Payer: Aetna Medicare Advantage	$119.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.75
Rate for Payer: Cigna Commercial	$199.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$87.78
Rate for Payer: Qualcare PPO/HMO/WC	$59.85
Rate for Payer: UnitedHealthcare Community & State	$9.62
Rate for Payer: Wellpoint Medicaid Managed Care	$10.57

PLATE SYN 3.5 9 HL 423.59

Facility

$399.00

Hospital Charge Code	1603786
Hospital Revenue Code	274
Min. Negotiated Rate	$59.85
Max. Negotiated Rate	$96.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$87.78
Rate for Payer: Qualcare PPO/HMO/WC	$59.85

PLATE SYN ADAPT 9 20H 446.10

Facility

$1,433.65

Hospital Charge Code	270621201
Hospital Revenue Code	278
Min. Negotiated Rate	$215.05
Max. Negotiated Rate	$346.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$315.40
Rate for Payer: Qualcare PPO/HMO/WC	$215.05

PLATE SYN ADAPT 9 20H 446.10

Facility

$1,433.65

Hospital Charge Code	270621201
Hospital Revenue Code	278
Min. Negotiated Rate	$34.55
Max. Negotiated Rate	$716.83
Rate for Payer: Aetna Commercial	$544.79
Rate for Payer: Aetna Medicare Advantage	$430.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.58
Rate for Payer: Cigna Commercial	$716.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$315.40
Rate for Payer: Qualcare PPO/HMO/WC	$215.05
Rate for Payer: UnitedHealthcare Community & State	$34.55
Rate for Payer: Wellpoint Medicaid Managed Care	$37.99

PLATE SYN ADAPT 9 24H 421.10

Facility

$2,216.00

Hospital Charge Code	270617340
Hospital Revenue Code	278
Min. Negotiated Rate	$53.41
Max. Negotiated Rate	$1,108.00
Rate for Payer: Aetna Commercial	$842.08
Rate for Payer: Aetna Medicare Advantage	$664.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$565.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$565.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$443.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$565.08
Rate for Payer: Cigna Commercial	$1,108.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$536.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$487.52
Rate for Payer: Qualcare PPO/HMO/WC	$332.40
Rate for Payer: UnitedHealthcare Community & State	$53.41
Rate for Payer: Wellpoint Medicaid Managed Care	$58.72

PLATE SYN ADAPT 9 24H 421.10

Facility

$2,216.00

Hospital Charge Code	270617340
Hospital Revenue Code	278
Min. Negotiated Rate	$332.40
Max. Negotiated Rate	$536.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$443.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$536.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$487.52
Rate for Payer: Qualcare PPO/HMO/WC	$332.40

PLATE SYN BOX 15 X 5 421.095

Facility

$836.85

Hospital Charge Code	270620362
Hospital Revenue Code	278
Min. Negotiated Rate	$20.17
Max. Negotiated Rate	$418.43
Rate for Payer: Aetna Commercial	$318.00
Rate for Payer: Aetna Medicare Advantage	$251.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$213.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$213.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$167.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$213.40
Rate for Payer: Cigna Commercial	$418.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$184.11
Rate for Payer: Qualcare PPO/HMO/WC	$125.53
Rate for Payer: UnitedHealthcare Community & State	$20.17
Rate for Payer: Wellpoint Medicaid Managed Care	$22.18

PLATE SYN BOX 15 X 5 421.095

Facility

$836.85

Hospital Charge Code	270620362
Hospital Revenue Code	278
Min. Negotiated Rate	$125.53
Max. Negotiated Rate	$202.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$167.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$184.11
Rate for Payer: Qualcare PPO/HMO/WC	$125.53

PLATE SYN BROAD 9H 226.59

Facility

$1,027.25

Service Code	HCPCS C1713
Hospital Charge Code	270619713
Hospital Revenue Code	278
Min. Negotiated Rate	$24.76
Max. Negotiated Rate	$513.62
Rate for Payer: Aetna Commercial	$390.36
Rate for Payer: Aetna Medicare Advantage	$308.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.95
Rate for Payer: Cigna Commercial	$513.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$226.00
Rate for Payer: Qualcare PPO/HMO/WC	$154.09
Rate for Payer: UnitedHealthcare Community & State	$24.76
Rate for Payer: Wellpoint Medicaid Managed Care	$27.22

PLATE SYN BROAD 9H 226.59

Facility

$1,027.25

Service Code	HCPCS C1713
Hospital Charge Code	270619713
Hospital Revenue Code	278
Min. Negotiated Rate	$154.09
Max. Negotiated Rate	$248.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$226.00
Rate for Payer: Qualcare PPO/HMO/WC	$154.09

PLATE SYN CALC 60MM 241.61

Facility

$1,847.25

Hospital Charge Code	270616217
Hospital Revenue Code	278
Min. Negotiated Rate	$44.52
Max. Negotiated Rate	$923.62
Rate for Payer: Aetna Commercial	$701.96
Rate for Payer: Aetna Medicare Advantage	$554.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$471.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$471.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$369.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$471.05
Rate for Payer: Cigna Commercial	$923.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$447.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$406.39
Rate for Payer: Qualcare PPO/HMO/WC	$277.09
Rate for Payer: UnitedHealthcare Community & State	$44.52
Rate for Payer: Wellpoint Medicaid Managed Care	$48.95

PLATE SYN CALC 60MM 241.61

Facility

$1,847.25

Hospital Charge Code	270616217
Hospital Revenue Code	278
Min. Negotiated Rate	$277.09
Max. Negotiated Rate	$447.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$369.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$447.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$406.39
Rate for Payer: Qualcare PPO/HMO/WC	$277.09

PLATE SYN CALC 60MM 441.61

Facility

$1,892.85

Hospital Charge Code	270603402
Hospital Revenue Code	278
Min. Negotiated Rate	$283.93
Max. Negotiated Rate	$458.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$378.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$458.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$416.43
Rate for Payer: Qualcare PPO/HMO/WC	$283.93

PLATE SYN CALC 60MM 441.61

Facility

$1,892.85

Hospital Charge Code	270603402
Hospital Revenue Code	278
Min. Negotiated Rate	$45.62
Max. Negotiated Rate	$946.42
Rate for Payer: Aetna Commercial	$719.28
Rate for Payer: Aetna Medicare Advantage	$567.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$482.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$482.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$378.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$482.68
Rate for Payer: Cigna Commercial	$946.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$458.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$416.43
Rate for Payer: Qualcare PPO/HMO/WC	$283.93
Rate for Payer: UnitedHealthcare Community & State	$45.62
Rate for Payer: Wellpoint Medicaid Managed Care	$50.16

PLATE SYN CERVICAL LCK 487.214

Facility

$4,330.45

Hospital Charge Code	270609421
Hospital Revenue Code	278
Min. Negotiated Rate	$104.36
Max. Negotiated Rate	$2,165.22
Rate for Payer: Aetna Commercial	$1,645.57
Rate for Payer: Aetna Medicare Advantage	$1,299.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,104.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,104.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$866.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,104.26
Rate for Payer: Cigna Commercial	$2,165.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,047.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$952.70
Rate for Payer: Qualcare PPO/HMO/WC	$649.57
Rate for Payer: UnitedHealthcare Community & State	$104.36
Rate for Payer: Wellpoint Medicaid Managed Care	$114.76

PLATE SYN CERVICAL LCK 487.214

Facility

$4,330.45

Hospital Charge Code	270609421
Hospital Revenue Code	278
Min. Negotiated Rate	$649.57
Max. Negotiated Rate	$1,047.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$866.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,047.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$952.70
Rate for Payer: Qualcare PPO/HMO/WC	$649.57

PLATE SYN CLVRLF 3H

Facility

$1,058.45

Hospital Charge Code	270604297
Hospital Revenue Code	278
Min. Negotiated Rate	$25.51
Max. Negotiated Rate	$529.23
Rate for Payer: Aetna Commercial	$402.21
Rate for Payer: Aetna Medicare Advantage	$317.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$269.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$269.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$211.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$269.90
Rate for Payer: Cigna Commercial	$529.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$256.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$232.86
Rate for Payer: Qualcare PPO/HMO/WC	$158.77
Rate for Payer: UnitedHealthcare Community & State	$25.51
Rate for Payer: Wellpoint Medicaid Managed Care	$28.05

PLATE SYN CLVRLF 3H

Facility

$1,058.45

Hospital Charge Code	270604297
Hospital Revenue Code	278
Min. Negotiated Rate	$158.77
Max. Negotiated Rate	$256.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$211.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$256.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$232.86
Rate for Payer: Qualcare PPO/HMO/WC	$158.77

PLATE SYN CLVRLF 4H

Facility

$1,135.25

Hospital Charge Code	270604298
Hospital Revenue Code	278
Min. Negotiated Rate	$27.36
Max. Negotiated Rate	$567.62
Rate for Payer: Aetna Commercial	$431.39
Rate for Payer: Aetna Medicare Advantage	$340.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$289.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$289.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$289.49
Rate for Payer: Cigna Commercial	$567.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$249.75
Rate for Payer: Qualcare PPO/HMO/WC	$170.29
Rate for Payer: UnitedHealthcare Community & State	$27.36
Rate for Payer: Wellpoint Medicaid Managed Care	$30.08

PLATE SYN CLVRLF 4H

Facility

$1,135.25

Hospital Charge Code	270604298
Hospital Revenue Code	278
Min. Negotiated Rate	$170.29
Max. Negotiated Rate	$274.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$249.75
Rate for Payer: Qualcare PPO/HMO/WC	$170.29

Know your out-of-pocket cost for care.

All Charges