Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$100.62
Max. Negotiated Rate	$162.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.16
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

PLATE VA-LCP 2.7/3.5MM 10H RT

Facility

$6,671.30

Service Code	HCPCS C1713
Hospital Charge Code	270675893
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.70
Max. Negotiated Rate	$1,614.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,334.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,614.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,467.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,000.70

PLATE VA-LCP 2.7/3.5MM 10H RT

Facility

$6,878.35

Hospital Charge Code	270677597
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 RT

Facility

$6,878.35

Hospital Charge Code	270677597
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

PLATE VA-LCP 2.7/3.5MM 10H RT

Facility

$6,671.30

Service Code	HCPCS C1713
Hospital Charge Code	270675893
Hospital Revenue Code	278
Min. Negotiated Rate	$160.78
Max. Negotiated Rate	$3,335.65
Rate for Payer: Aetna Commercial	$2,535.09
Rate for Payer: Aetna Medicare Advantage	$2,001.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,701.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,701.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,334.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,701.18
Rate for Payer: Cigna Commercial	$3,335.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,614.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,467.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,000.70
Rate for Payer: UnitedHealthcare Community & State	$160.78
Rate for Payer: Wellpoint Medicaid Managed Care	$176.79

PLATE VA-LCP 2.7/3.5MM 10H RT

Facility

$6,464.30

Hospital Charge Code	270677599
Hospital Revenue Code	278
Min. Negotiated Rate	$969.64
Max. Negotiated Rate	$1,564.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,292.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,564.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,422.15
Rate for Payer: Qualcare PPO/HMO/WC	$969.64

PLATE VA-LCP 2.7/3.5MM 10H RT

Facility

$6,464.30

Hospital Charge Code	270677599
Hospital Revenue Code	278
Min. Negotiated Rate	$155.79
Max. Negotiated Rate	$3,232.15
Rate for Payer: Aetna Commercial	$2,456.43
Rate for Payer: Aetna Medicare Advantage	$1,939.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,648.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,648.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,292.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,648.40
Rate for Payer: Cigna Commercial	$3,232.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,564.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,422.15
Rate for Payer: Qualcare PPO/HMO/WC	$969.64
Rate for Payer: UnitedHealthcare Community & State	$155.79
Rate for Payer: Wellpoint Medicaid Managed Care	$171.30

PLATE VA-LCP 2.7/3.5MM 12H LT

Facility

$7,752.80

Service Code	HCPCS C1713
Hospital Charge Code	270676154
Hospital Revenue Code	278
Min. Negotiated Rate	$186.84
Max. Negotiated Rate	$3,876.40
Rate for Payer: Aetna Commercial	$2,946.06
Rate for Payer: Aetna Medicare Advantage	$2,325.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.96
Rate for Payer: Cigna Commercial	$3,876.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,876.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.92
Rate for Payer: UnitedHealthcare Community & State	$186.84
Rate for Payer: Wellpoint Medicaid Managed Care	$205.45

PLATE VA-LCP 2.7/3.5MM 12H LT

Facility

$7,752.80

Service Code	HCPCS C1713
Hospital Charge Code	270676154
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.92
Max. Negotiated Rate	$1,876.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,876.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.92

PLATEVA-LCP2.7/3.5MM142MM6HLT

Facility

$6,182.15

Service Code	HCPCS C1713
Hospital Charge Code	270695501
Hospital Revenue Code	278
Min. Negotiated Rate	$927.32
Max. Negotiated Rate	$1,496.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,236.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,496.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,360.07
Rate for Payer: Qualcare PPO/HMO/WC	$927.32

PLATEVA-LCP2.7/3.5MM142MM6HLT

Facility

$6,182.15

Service Code	HCPCS C1713
Hospital Charge Code	270695501
Hospital Revenue Code	278
Min. Negotiated Rate	$148.99
Max. Negotiated Rate	$3,091.07
Rate for Payer: Aetna Commercial	$2,349.22
Rate for Payer: Aetna Medicare Advantage	$1,854.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,576.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,576.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,236.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,576.45
Rate for Payer: Cigna Commercial	$3,091.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,496.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,360.07
Rate for Payer: Qualcare PPO/HMO/WC	$927.32
Rate for Payer: UnitedHealthcare Community & State	$148.99
Rate for Payer: Wellpoint Medicaid Managed Care	$163.83

PLATE VA-LCP 2.7/3.5MM 14H RT

Facility

$10,200.50

Service Code	HCPCS C1713
Hospital Charge Code	270693277
Hospital Revenue Code	278
Min. Negotiated Rate	$1,530.08
Max. Negotiated Rate	$2,468.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,040.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,468.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,244.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,530.08

PLATE VA-LCP 2.7/3.5MM 14H RT

Facility

$10,200.50

Service Code	HCPCS C1713
Hospital Charge Code	270693277
Hospital Revenue Code	278
Min. Negotiated Rate	$245.83
Max. Negotiated Rate	$5,100.25
Rate for Payer: Aetna Commercial	$3,876.19
Rate for Payer: Aetna Medicare Advantage	$3,060.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,601.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,601.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,040.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,601.13
Rate for Payer: Cigna Commercial	$5,100.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,468.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,244.11
Rate for Payer: Qualcare PPO/HMO/WC	$1,530.08
Rate for Payer: UnitedHealthcare Community & State	$245.83
Rate for Payer: Wellpoint Medicaid Managed Care	$270.31

PLATE VA-LCP 2.7/3.5MM 4H

Facility

$7,233.70

Service Code	HCPCS C1713
Hospital Charge Code	270679060
Hospital Revenue Code	278
Min. Negotiated Rate	$174.33
Max. Negotiated Rate	$3,616.85
Rate for Payer: Aetna Commercial	$2,748.81
Rate for Payer: Aetna Medicare Advantage	$2,170.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,844.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,844.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,446.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,844.59
Rate for Payer: Cigna Commercial	$3,616.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,750.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,591.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.06
Rate for Payer: UnitedHealthcare Community & State	$174.33
Rate for Payer: Wellpoint Medicaid Managed Care	$191.69

PLATE VA-LCP 2.7/3.5MM 4H

Facility

$7,233.70

Service Code	HCPCS C1713
Hospital Charge Code	270679060
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.06
Max. Negotiated Rate	$1,750.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,446.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,750.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,591.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,085.06

PLATE VA-LCP 2.7/3.5MM 4H 6T

Facility

$6,665.15

Service Code	HCPCS C1713
Hospital Charge Code	270677596
Hospital Revenue Code	278
Min. Negotiated Rate	$999.77
Max. Negotiated Rate	$1,612.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,333.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,612.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,466.33
Rate for Payer: Qualcare PPO/HMO/WC	$999.77

PLATE VA-LCP 2.7/3.5MM 4H 6T

Facility

$6,665.15

Service Code	HCPCS C1713
Hospital Charge Code	270677596
Hospital Revenue Code	278
Min. Negotiated Rate	$160.63
Max. Negotiated Rate	$3,332.57
Rate for Payer: Aetna Commercial	$2,532.76
Rate for Payer: Aetna Medicare Advantage	$1,999.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,699.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,699.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,333.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,699.61
Rate for Payer: Cigna Commercial	$3,332.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,612.97
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,466.33
Rate for Payer: Qualcare PPO/HMO/WC	$999.77
Rate for Payer: UnitedHealthcare Community & State	$160.63
Rate for Payer: Wellpoint Medicaid Managed Care	$176.63

PLATE VA-LCP 2.7/3.5MM 4H 6T S

Facility

$6,872.15

Service Code	HCPCS C1713
Hospital Charge Code	270678670
Hospital Revenue Code	278
Min. Negotiated Rate	$165.62
Max. Negotiated Rate	$3,436.07
Rate for Payer: Aetna Commercial	$2,611.42
Rate for Payer: Aetna Medicare Advantage	$2,061.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,752.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,752.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,374.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,752.40
Rate for Payer: Cigna Commercial	$3,436.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,511.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,030.82
Rate for Payer: UnitedHealthcare Community & State	$165.62
Rate for Payer: Wellpoint Medicaid Managed Care	$182.11

PLATE VA-LCP 2.7/3.5MM 4H 6T S

Facility

$6,872.15

Service Code	HCPCS C1713
Hospital Charge Code	270678670
Hospital Revenue Code	278
Min. Negotiated Rate	$1,030.82
Max. Negotiated Rate	$1,663.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,374.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,511.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,030.82

PLATE VA-LCP 2.7/3.5MM 6H LT

Facility

$6,541.55

Service Code	HCPCS C1713
Hospital Charge Code	270678038
Hospital Revenue Code	278
Min. Negotiated Rate	$981.23
Max. Negotiated Rate	$1,583.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,308.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,583.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,439.14
Rate for Payer: Qualcare PPO/HMO/WC	$981.23

PLATE VA-LCP 2.7/3.5MM 6H LT

Facility

$6,541.55

Service Code	HCPCS C1713
Hospital Charge Code	270678038
Hospital Revenue Code	278
Min. Negotiated Rate	$157.65
Max. Negotiated Rate	$3,270.78
Rate for Payer: Aetna Commercial	$2,485.79
Rate for Payer: Aetna Medicare Advantage	$1,962.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,668.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,668.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,308.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,668.10
Rate for Payer: Cigna Commercial	$3,270.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,583.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,439.14
Rate for Payer: Qualcare PPO/HMO/WC	$981.23
Rate for Payer: UnitedHealthcare Community & State	$157.65
Rate for Payer: Wellpoint Medicaid Managed Care	$173.35

PLATE VA-LCP 2.7/3.5MM 6H RT

Facility

$6,742.40

Service Code	HCPCS C1713
Hospital Charge Code	270660907
Hospital Revenue Code	278
Min. Negotiated Rate	$162.49
Max. Negotiated Rate	$3,371.20
Rate for Payer: Aetna Commercial	$2,562.11
Rate for Payer: Aetna Medicare Advantage	$2,022.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,719.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,719.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,719.31
Rate for Payer: Cigna Commercial	$3,371.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,483.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.36
Rate for Payer: UnitedHealthcare Community & State	$162.49
Rate for Payer: Wellpoint Medicaid Managed Care	$178.67

PLATE VA-LCP 2.7/3.5MM 6H RT

Facility

$6,742.40

Service Code	HCPCS C1713
Hospital Charge Code	270660907
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.36
Max. Negotiated Rate	$1,631.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,631.66
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,483.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,011.36

PLATE VA-LCP2.7/3.5MM TIB 6HRT

Facility

$9,204.65

Service Code	HCPCS C1713
Hospital Charge Code	270696119
Hospital Revenue Code	278
Min. Negotiated Rate	$1,380.70
Max. Negotiated Rate	$2,227.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,840.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,227.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,025.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,380.70

PLATE VA-LCP2.7/3.5MM TIB 6HRT

Facility

$9,204.65

Service Code	HCPCS C1713
Hospital Charge Code	270696119
Hospital Revenue Code	278
Min. Negotiated Rate	$221.83
Max. Negotiated Rate	$4,602.32
Rate for Payer: Aetna Commercial	$3,497.77
Rate for Payer: Aetna Medicare Advantage	$2,761.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,347.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,347.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,840.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,347.19
Rate for Payer: Cigna Commercial	$4,602.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,227.53
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,025.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,380.70
Rate for Payer: UnitedHealthcare Community & State	$221.83
Rate for Payer: Wellpoint Medicaid Managed Care	$243.92

Know your out-of-pocket cost for care.

All Charges