Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLATE VA-LCP 2.7/3.5 2H LT ST

Facility

$4,125.15

Service Code	HCPCS C1713
Hospital Charge Code	270673548
Hospital Revenue Code	278
Min. Negotiated Rate	$618.77
Max. Negotiated Rate	$998.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$907.53
Rate for Payer: Qualcare PPO/HMO/WC	$618.77

PLATE VA-LCP 2.7/3.5 2H LT ST

Facility

$4,613.35

Service Code	HCPCS C1713
Hospital Charge Code	270649738
Hospital Revenue Code	278
Min. Negotiated Rate	$111.18
Max. Negotiated Rate	$2,306.68
Rate for Payer: Aetna Commercial	$1,753.07
Rate for Payer: Aetna Medicare Advantage	$1,384.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,176.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,176.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,176.40
Rate for Payer: Cigna Commercial	$2,306.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,116.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,014.94
Rate for Payer: Qualcare PPO/HMO/WC	$692.00
Rate for Payer: UnitedHealthcare Community & State	$111.18
Rate for Payer: Wellpoint Medicaid Managed Care	$122.25

PLATE VA-LCP 2.7/3.5 2H LT ST

Facility

$4,613.35

Service Code	HCPCS C1713
Hospital Charge Code	270649738
Hospital Revenue Code	278
Min. Negotiated Rate	$692.00
Max. Negotiated Rate	$1,116.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,116.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,014.94
Rate for Payer: Qualcare PPO/HMO/WC	$692.00

PLATE VA-LCP 2.7/3.5 2H LT ST

Facility

$4,125.15

Service Code	HCPCS C1713
Hospital Charge Code	270673548
Hospital Revenue Code	278
Min. Negotiated Rate	$99.42
Max. Negotiated Rate	$2,062.57
Rate for Payer: Aetna Commercial	$1,567.56
Rate for Payer: Aetna Medicare Advantage	$1,237.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.91
Rate for Payer: Cigna Commercial	$2,062.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$907.53
Rate for Payer: Qualcare PPO/HMO/WC	$618.77
Rate for Payer: UnitedHealthcare Community & State	$99.42
Rate for Payer: Wellpoint Medicaid Managed Care	$109.32

PLATE VA-LCP 2.7/3.5 2H/R/73MM

Facility

$3,918.10

Hospital Charge Code	270677621
Hospital Revenue Code	278
Min. Negotiated Rate	$94.43
Max. Negotiated Rate	$1,959.05
Rate for Payer: Aetna Commercial	$1,488.88
Rate for Payer: Aetna Medicare Advantage	$1,175.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$999.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$999.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$783.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$999.12
Rate for Payer: Cigna Commercial	$1,959.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$948.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$861.98
Rate for Payer: Qualcare PPO/HMO/WC	$587.72
Rate for Payer: UnitedHealthcare Community & State	$94.43
Rate for Payer: Wellpoint Medicaid Managed Care	$103.83

PLATE VA-LCP 2.7/3.5 2H/R/73MM

Facility

$3,918.10

Hospital Charge Code	270677621
Hospital Revenue Code	278
Min. Negotiated Rate	$587.72
Max. Negotiated Rate	$948.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$783.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$948.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$861.98
Rate for Payer: Qualcare PPO/HMO/WC	$587.72

PLATE VA-LCP 2.7/3.5 2H/R/90MM

Facility

$4,406.35

Hospital Charge Code	270677623
Hospital Revenue Code	278
Min. Negotiated Rate	$660.95
Max. Negotiated Rate	$1,066.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$969.40
Rate for Payer: Qualcare PPO/HMO/WC	$660.95

PLATE VA-LCP 2.7/3.5 2H/R/90MM

Facility

$4,406.35

Hospital Charge Code	270677623
Hospital Revenue Code	278
Min. Negotiated Rate	$106.19
Max. Negotiated Rate	$2,203.18
Rate for Payer: Aetna Commercial	$1,674.41
Rate for Payer: Aetna Medicare Advantage	$1,321.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,123.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,123.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,123.62
Rate for Payer: Cigna Commercial	$2,203.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$969.40
Rate for Payer: Qualcare PPO/HMO/WC	$660.95
Rate for Payer: UnitedHealthcare Community & State	$106.19
Rate for Payer: Wellpoint Medicaid Managed Care	$116.77

PLATE VA-LCP 2.7/3.5 2H RT ST

Facility

$4,613.35

Service Code	HCPCS C1713
Hospital Charge Code	270669498
Hospital Revenue Code	278
Min. Negotiated Rate	$692.00
Max. Negotiated Rate	$1,116.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,116.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,014.94
Rate for Payer: Qualcare PPO/HMO/WC	$692.00

PLATE VA-LCP 2.7/3.5 2H RT ST

Facility

$4,613.35

Service Code	HCPCS C1713
Hospital Charge Code	270669498
Hospital Revenue Code	278
Min. Negotiated Rate	$111.18
Max. Negotiated Rate	$2,306.68
Rate for Payer: Aetna Commercial	$1,753.07
Rate for Payer: Aetna Medicare Advantage	$1,384.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,176.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,176.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,176.40
Rate for Payer: Cigna Commercial	$2,306.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,116.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,014.94
Rate for Payer: Qualcare PPO/HMO/WC	$692.00
Rate for Payer: UnitedHealthcare Community & State	$111.18
Rate for Payer: Wellpoint Medicaid Managed Care	$122.25

PLATE VA-LCP 2.7/3.5 4H/L/116

Facility

$4,406.35

Hospital Charge Code	270677626
Hospital Revenue Code	278
Min. Negotiated Rate	$106.19
Max. Negotiated Rate	$2,203.18
Rate for Payer: Aetna Commercial	$1,674.41
Rate for Payer: Aetna Medicare Advantage	$1,321.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,123.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,123.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,123.62
Rate for Payer: Cigna Commercial	$2,203.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$969.40
Rate for Payer: Qualcare PPO/HMO/WC	$660.95
Rate for Payer: UnitedHealthcare Community & State	$106.19
Rate for Payer: Wellpoint Medicaid Managed Care	$116.77

PLATE VA-LCP 2.7/3.5 4H/L/116

Facility

$4,406.35

Hospital Charge Code	270677626
Hospital Revenue Code	278
Min. Negotiated Rate	$660.95
Max. Negotiated Rate	$1,066.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$969.40
Rate for Payer: Qualcare PPO/HMO/WC	$660.95

PLATE VA-LCP 2.7/3.5 4H/R/116

Facility

$4,406.35

Hospital Charge Code	270677624
Hospital Revenue Code	278
Min. Negotiated Rate	$660.95
Max. Negotiated Rate	$1,066.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$969.40
Rate for Payer: Qualcare PPO/HMO/WC	$660.95

PLATE VA-LCP 2.7/3.5 4H/R/116

Facility

$4,406.35

Hospital Charge Code	270677624
Hospital Revenue Code	278
Min. Negotiated Rate	$106.19
Max. Negotiated Rate	$2,203.18
Rate for Payer: Aetna Commercial	$1,674.41
Rate for Payer: Aetna Medicare Advantage	$1,321.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,123.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,123.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,123.62
Rate for Payer: Cigna Commercial	$2,203.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$969.40
Rate for Payer: Qualcare PPO/HMO/WC	$660.95
Rate for Payer: UnitedHealthcare Community & State	$106.19
Rate for Payer: Wellpoint Medicaid Managed Care	$116.77

PLATE VA-LCP 2.7/3.5 4H RT ST

Facility

$4,613.35

Service Code	HCPCS C1713
Hospital Charge Code	270676979
Hospital Revenue Code	278
Min. Negotiated Rate	$111.18
Max. Negotiated Rate	$2,306.68
Rate for Payer: Aetna Commercial	$1,753.07
Rate for Payer: Aetna Medicare Advantage	$1,384.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,176.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,176.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,176.40
Rate for Payer: Cigna Commercial	$2,306.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,116.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,014.94
Rate for Payer: Qualcare PPO/HMO/WC	$692.00
Rate for Payer: UnitedHealthcare Community & State	$111.18
Rate for Payer: Wellpoint Medicaid Managed Care	$122.25

PLATE VA-LCP 2.7/3.5 4H RT ST

Facility

$4,613.35

Service Code	HCPCS C1713
Hospital Charge Code	270676979
Hospital Revenue Code	278
Min. Negotiated Rate	$692.00
Max. Negotiated Rate	$1,116.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,116.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,014.94
Rate for Payer: Qualcare PPO/HMO/WC	$692.00

PLATE VA-LCP 2.7 3.5 6H L 142

Facility

$4,406.35

Service Code	HCPCS C1713
Hospital Charge Code	270677627
Hospital Revenue Code	278
Min. Negotiated Rate	$660.95
Max. Negotiated Rate	$1,066.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$969.40
Rate for Payer: Qualcare PPO/HMO/WC	$660.95

PLATE VA-LCP 2.7 3.5 6H L 142

Facility

$4,406.35

Service Code	HCPCS C1713
Hospital Charge Code	270677627
Hospital Revenue Code	278
Min. Negotiated Rate	$106.19
Max. Negotiated Rate	$2,203.18
Rate for Payer: Aetna Commercial	$1,674.41
Rate for Payer: Aetna Medicare Advantage	$1,321.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,123.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,123.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,123.62
Rate for Payer: Cigna Commercial	$2,203.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$969.40
Rate for Payer: Qualcare PPO/HMO/WC	$660.95
Rate for Payer: UnitedHealthcare Community & State	$106.19
Rate for Payer: Wellpoint Medicaid Managed Care	$116.77

PLATE VA-LCP 2.7/3.5 6H/R/142

Facility

$4,406.35

Hospital Charge Code	270677625
Hospital Revenue Code	278
Min. Negotiated Rate	$660.95
Max. Negotiated Rate	$1,066.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$969.40
Rate for Payer: Qualcare PPO/HMO/WC	$660.95

PLATE VA-LCP 2.7/3.5 6H/R/142

Facility

$4,406.35

Hospital Charge Code	270677625
Hospital Revenue Code	278
Min. Negotiated Rate	$106.19
Max. Negotiated Rate	$2,203.18
Rate for Payer: Aetna Commercial	$1,674.41
Rate for Payer: Aetna Medicare Advantage	$1,321.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,123.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,123.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$881.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,123.62
Rate for Payer: Cigna Commercial	$2,203.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,066.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$969.40
Rate for Payer: Qualcare PPO/HMO/WC	$660.95
Rate for Payer: UnitedHealthcare Community & State	$106.19
Rate for Payer: Wellpoint Medicaid Managed Care	$116.77

PLATE VA-LCP 2.7/3.5 6H RT ST

Facility

$4,613.35

Service Code	HCPCS C1713
Hospital Charge Code	270669932
Hospital Revenue Code	278
Min. Negotiated Rate	$692.00
Max. Negotiated Rate	$1,116.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,116.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,014.94
Rate for Payer: Qualcare PPO/HMO/WC	$692.00

PLATE VA-LCP 2.7/3.5 6H RT ST

Facility

$4,613.35

Service Code	HCPCS C1713
Hospital Charge Code	270669932
Hospital Revenue Code	278
Min. Negotiated Rate	$111.18
Max. Negotiated Rate	$2,306.68
Rate for Payer: Aetna Commercial	$1,753.07
Rate for Payer: Aetna Medicare Advantage	$1,384.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,176.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,176.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$922.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,176.40
Rate for Payer: Cigna Commercial	$2,306.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,116.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,014.94
Rate for Payer: Qualcare PPO/HMO/WC	$692.00
Rate for Payer: UnitedHealthcare Community & State	$111.18
Rate for Payer: Wellpoint Medicaid Managed Care	$122.25

PLATE VA-LCP 2.7/3.5MM 10H LT

Facility

$6,878.35

Hospital Charge Code	270677598
Hospital Revenue Code	278
Min. Negotiated Rate	$165.77
Max. Negotiated Rate	$3,439.18
Rate for Payer: Aetna Commercial	$2,613.77
Rate for Payer: Aetna Medicare Advantage	$2,063.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.98
Rate for Payer: Cigna Commercial	$3,439.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,664.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,513.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.75
Rate for Payer: UnitedHealthcare Community & State	$165.77
Rate for Payer: Wellpoint Medicaid Managed Care	$182.28

PLATE VA-LCP 2.7/3.5MM 10H LT

Facility

$670.80

Service Code	HCPCS C1713
Hospital Charge Code	270689600
Hospital Revenue Code	278
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$335.40
Rate for Payer: Aetna Commercial	$254.90
Rate for Payer: Aetna Medicare Advantage	$201.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.05
Rate for Payer: Cigna Commercial	$335.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$147.58
Rate for Payer: Qualcare PPO/HMO/WC	$100.62
Rate for Payer: UnitedHealthcare Community & State	$16.17
Rate for Payer: Wellpoint Medicaid Managed Care	$17.78

PLATE VA-LCP 2.7/3.5MM 10H LT

Facility

$6,878.35

Hospital Charge Code	270677598
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.75
Max. Negotiated Rate	$1,664.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,664.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,513.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.75

Know your out-of-pocket cost for care.

All Charges