Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLT CLOVER VA-LCP 2.7 MM FUS

Facility

$4,868.60

Service Code	HCPCS C1713
Hospital Charge Code	270691568
Hospital Revenue Code	278
Min. Negotiated Rate	$730.29
Max. Negotiated Rate	$1,178.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$973.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,178.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,071.09
Rate for Payer: Qualcare PPO/HMO/WC	$730.29

PLT CLOVER VA-LCP 2.7 MM FUS

Facility

$4,868.60

Service Code	HCPCS C1713
Hospital Charge Code	270691568
Hospital Revenue Code	278
Min. Negotiated Rate	$117.33
Max. Negotiated Rate	$2,434.30
Rate for Payer: Aetna Commercial	$1,850.07
Rate for Payer: Aetna Medicare Advantage	$1,460.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,241.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,241.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$973.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,241.49
Rate for Payer: Cigna Commercial	$2,434.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,178.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,071.09
Rate for Payer: Qualcare PPO/HMO/WC	$730.29
Rate for Payer: UnitedHealthcare Community & State	$117.33
Rate for Payer: Wellpoint Medicaid Managed Care	$129.02

PLT COUNT (BLUE TOP TURE)

Facility

$43.25

Service Code	HCPCS 85049
Hospital Charge Code	3002129
Hospital Revenue Code	301
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$6.49
Rate for Payer: Qualcare PPO/HMO/WC	$6.49

PLT COUNT (BLUE TOP TURE)

Facility

$43.25

Service Code	HCPCS 85049
Hospital Charge Code	3002129
Hospital Revenue Code	301
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$12.19
Rate for Payer: Aetna Medicare Advantage	$14.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.17
Rate for Payer: Cigna Commercial	$21.62
Rate for Payer: Cigna Medicare Advantage	$4.48
Rate for Payer: Clover Medicare Advantage	$4.26
Rate for Payer: EmblemHealth Commercial	$13.44
Rate for Payer: Humana Medicare Advantage	$4.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.97
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$3.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.48
Rate for Payer: Wellcare Medicare Advantage	$4.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1.15

PLT DBL Y 7mm MATR MID04503378

Facility

$1,205.00

Hospital Charge Code	270640450
Hospital Revenue Code	278
Min. Negotiated Rate	$29.04
Max. Negotiated Rate	$602.50
Rate for Payer: Aetna Commercial	$457.90
Rate for Payer: Aetna Medicare Advantage	$361.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$307.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$307.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$241.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$307.27
Rate for Payer: Cigna Commercial	$602.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$291.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$265.10
Rate for Payer: Qualcare PPO/HMO/WC	$180.75
Rate for Payer: UnitedHealthcare Community & State	$29.04
Rate for Payer: Wellpoint Medicaid Managed Care	$31.93

PLT DBL Y 7mm MATR MID04503378

Facility

$1,205.00

Hospital Charge Code	270640450
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$291.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$241.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$291.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$265.10
Rate for Payer: Qualcare PPO/HMO/WC	$180.75

PLTE 10HLE NRW T-PLTE 57-10310

Facility

$3,250.00

Hospital Charge Code	270655359
Hospital Revenue Code	278
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

PLTE 10HLE NRW T-PLTE 57-10310

Facility

$3,250.00

Hospital Charge Code	270655359
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

PLTE 1.2MM 16HL STGHT 57-05116

Facility

$2,500.00

Hospital Charge Code	270648754
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

PLTE 1.2MM 16HL STGHT 57-05116

Facility

$2,500.00

Hospital Charge Code	270648754
Hospital Revenue Code	278
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

PLTE 16HLE STRGHT LCK 57-10316

Facility

$3,250.00

Hospital Charge Code	270655363
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

PLTE 16HLE STRGHT LCK 57-10316

Facility

$3,250.00

Hospital Charge Code	270655363
Hospital Revenue Code	278
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$715.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Community & State	$78.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.12

PLTE 3HL LFT DSTL SML234801403

Facility

$3,160.10

Hospital Charge Code	270637348
Hospital Revenue Code	278
Min. Negotiated Rate	$76.16
Max. Negotiated Rate	$1,580.05
Rate for Payer: Aetna Commercial	$1,200.84
Rate for Payer: Aetna Medicare Advantage	$948.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$805.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$805.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$632.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$805.83
Rate for Payer: Cigna Commercial	$1,580.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$764.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$695.22
Rate for Payer: Qualcare PPO/HMO/WC	$474.01
Rate for Payer: UnitedHealthcare Community & State	$76.16
Rate for Payer: Wellpoint Medicaid Managed Care	$83.74

PLTE 3HL LFT DSTL SML234801403

Facility

$3,160.10

Hospital Charge Code	270637348
Hospital Revenue Code	278
Min. Negotiated Rate	$474.01
Max. Negotiated Rate	$764.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$632.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$764.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$695.22
Rate for Payer: Qualcare PPO/HMO/WC	$474.01

PLTE 3HL LFT DSTL SML234802203

Facility

$3,160.10

Hospital Charge Code	270637349
Hospital Revenue Code	278
Min. Negotiated Rate	$474.01
Max. Negotiated Rate	$764.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$632.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$764.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$695.22
Rate for Payer: Qualcare PPO/HMO/WC	$474.01

PLTE 3HL LFT DSTL SML234802203

Facility

$3,160.10

Hospital Charge Code	270637349
Hospital Revenue Code	278
Min. Negotiated Rate	$76.16
Max. Negotiated Rate	$1,580.05
Rate for Payer: Aetna Commercial	$1,200.84
Rate for Payer: Aetna Medicare Advantage	$948.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$805.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$805.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$632.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$805.83
Rate for Payer: Cigna Commercial	$1,580.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$764.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$695.22
Rate for Payer: Qualcare PPO/HMO/WC	$474.01
Rate for Payer: UnitedHealthcare Community & State	$76.16
Rate for Payer: Wellpoint Medicaid Managed Care	$83.74

PLT ECT 1/3 TUBULAR 2-HOLE

Facility

$50.90

Hospital Charge Code	1602895
Hospital Revenue Code	274
Min. Negotiated Rate	$7.63
Max. Negotiated Rate	$12.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.63

PLT ECT 1/3 TUBULAR 2-HOLE

Facility

$50.90

Hospital Charge Code	1602895
Hospital Revenue Code	274
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.45
Rate for Payer: Aetna Commercial	$19.34
Rate for Payer: Aetna Medicare Advantage	$15.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.98
Rate for Payer: Cigna Commercial	$25.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.32
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.63
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

PLTE LT VOLAR SMART LCK5425376

Facility

$4,995.00

Hospital Charge Code	270640883
Hospital Revenue Code	278
Min. Negotiated Rate	$120.38
Max. Negotiated Rate	$2,497.50
Rate for Payer: Aetna Commercial	$1,898.10
Rate for Payer: Aetna Medicare Advantage	$1,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,273.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,273.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,273.72
Rate for Payer: Cigna Commercial	$2,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,098.90
Rate for Payer: Qualcare PPO/HMO/WC	$749.25
Rate for Payer: UnitedHealthcare Community & State	$120.38
Rate for Payer: Wellpoint Medicaid Managed Care	$132.37

PLTE LT VOLAR SMART LCK5425376

Facility

$4,995.00

Hospital Charge Code	270640883
Hospital Revenue Code	278
Min. Negotiated Rate	$749.25
Max. Negotiated Rate	$1,208.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,098.90
Rate for Payer: Qualcare PPO/HMO/WC	$749.25

PLT FIB 10 HOLES RT2347-017-10

Facility

$2,422.90

Hospital Charge Code	270634935
Hospital Revenue Code	278
Min. Negotiated Rate	$58.39
Max. Negotiated Rate	$1,211.45
Rate for Payer: Aetna Commercial	$920.70
Rate for Payer: Aetna Medicare Advantage	$726.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$617.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$617.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$484.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$617.84
Rate for Payer: Cigna Commercial	$1,211.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$586.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$533.04
Rate for Payer: Qualcare PPO/HMO/WC	$363.44
Rate for Payer: UnitedHealthcare Community & State	$58.39
Rate for Payer: Wellpoint Medicaid Managed Care	$64.21

PLT FIB 10 HOLES RT2347-017-10

Facility

$2,422.90

Hospital Charge Code	270634935
Hospital Revenue Code	278
Min. Negotiated Rate	$363.44
Max. Negotiated Rate	$586.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$484.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$586.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$533.04
Rate for Payer: Qualcare PPO/HMO/WC	$363.44

PLT/FRACTURE 4 HOLES W BAR

Facility

$1,969.90

Service Code	HCPCS C1713
Hospital Charge Code	270705883
Hospital Revenue Code	278
Min. Negotiated Rate	$295.49
Max. Negotiated Rate	$476.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$393.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$476.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$433.38
Rate for Payer: Qualcare PPO/HMO/WC	$295.49

PLT/FRACTURE 4 HOLES W BAR

Facility

$1,969.90

Service Code	HCPCS C1713
Hospital Charge Code	270705883
Hospital Revenue Code	278
Min. Negotiated Rate	$47.47
Max. Negotiated Rate	$984.95
Rate for Payer: Aetna Commercial	$748.56
Rate for Payer: Aetna Medicare Advantage	$590.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$502.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$502.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$393.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$502.32
Rate for Payer: Cigna Commercial	$984.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$476.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$433.38
Rate for Payer: Qualcare PPO/HMO/WC	$295.49
Rate for Payer: UnitedHealthcare Community & State	$47.47
Rate for Payer: Wellpoint Medicaid Managed Care	$52.20

PLT LEUK REDU APH/PHER CMV-NEG

Facility

$3,302.85

Hospital Charge Code	3101531
Hospital Revenue Code	390
Min. Negotiated Rate	$79.60
Max. Negotiated Rate	$1,651.42
Rate for Payer: Aetna Commercial	$1,255.08
Rate for Payer: Aetna Medicare Advantage	$990.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$842.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$842.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$842.23
Rate for Payer: Cigna Commercial	$1,651.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$990.86
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$495.43
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$79.60
Rate for Payer: Wellpoint Medicaid Managed Care	$87.53

Know your out-of-pocket cost for care.

All Charges