Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLT LEUK REDU APH/PHER CMV-NEG

Facility

$3,302.85

Hospital Charge Code	3101531
Hospital Revenue Code	390
Min. Negotiated Rate	$495.43
Max. Negotiated Rate	$495.43
Rate for Payer: Qualcare PPO/HMO/WC	$495.43

PLT/MINI 4 HOLES WITH BAR

Facility

$553.45

Service Code	HCPCS C1713
Hospital Charge Code	270705884
Hospital Revenue Code	278
Min. Negotiated Rate	$13.34
Max. Negotiated Rate	$276.73
Rate for Payer: Aetna Commercial	$210.31
Rate for Payer: Aetna Medicare Advantage	$166.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.13
Rate for Payer: Cigna Commercial	$276.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.76
Rate for Payer: Qualcare PPO/HMO/WC	$83.02
Rate for Payer: UnitedHealthcare Community & State	$13.34
Rate for Payer: Wellpoint Medicaid Managed Care	$14.67

PLT/MINI 4 HOLES WITH BAR

Facility

$553.45

Service Code	HCPCS C1713
Hospital Charge Code	270705884
Hospital Revenue Code	278
Min. Negotiated Rate	$83.02
Max. Negotiated Rate	$133.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.76
Rate for Payer: Qualcare PPO/HMO/WC	$83.02

PLT MSH 1.3m RIGID 30m 421.018

Facility

$3,343.25

Hospital Charge Code	270635019
Hospital Revenue Code	278
Min. Negotiated Rate	$501.49
Max. Negotiated Rate	$809.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$668.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$809.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$735.51
Rate for Payer: Qualcare PPO/HMO/WC	$501.49

PLT MSH 1.3m RIGID 30m 421.018

Facility

$3,343.25

Hospital Charge Code	270635019
Hospital Revenue Code	278
Min. Negotiated Rate	$80.57
Max. Negotiated Rate	$1,671.62
Rate for Payer: Aetna Commercial	$1,270.43
Rate for Payer: Aetna Medicare Advantage	$1,002.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$852.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$852.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$668.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$852.53
Rate for Payer: Cigna Commercial	$1,671.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$809.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$735.51
Rate for Payer: Qualcare PPO/HMO/WC	$501.49
Rate for Payer: UnitedHealthcare Community & State	$80.57
Rate for Payer: Wellpoint Medicaid Managed Care	$88.60

PLT NARROW SELF COMP 2-5 H***

Facility

$212.00

Hospital Charge Code	1602523
Hospital Revenue Code	274
Min. Negotiated Rate	$31.80
Max. Negotiated Rate	$51.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$46.64
Rate for Payer: Qualcare PPO/HMO/WC	$31.80

PLT NARROW SELF COMP 2-5 H***

Facility

$212.00

Hospital Charge Code	1602523
Hospital Revenue Code	274
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$106.00
Rate for Payer: Aetna Commercial	$80.56
Rate for Payer: Aetna Medicare Advantage	$63.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.06
Rate for Payer: Cigna Commercial	$106.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$46.64
Rate for Payer: Qualcare PPO/HMO/WC	$31.80
Rate for Payer: UnitedHealthcare Community & State	$5.11
Rate for Payer: Wellpoint Medicaid Managed Care	$5.62

PLT NARROW SELF COMP 6-9 H***

Facility

$237.00

Hospital Charge Code	1602531
Hospital Revenue Code	274
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$57.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.14
Rate for Payer: Qualcare PPO/HMO/WC	$35.55

PLT NARROW SELF COMP 6-9 H***

Facility

$237.00

Hospital Charge Code	1602531
Hospital Revenue Code	274
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$118.50
Rate for Payer: Aetna Commercial	$90.06
Rate for Payer: Aetna Medicare Advantage	$71.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.44
Rate for Payer: Cigna Commercial	$118.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.14
Rate for Payer: Qualcare PPO/HMO/WC	$35.55
Rate for Payer: UnitedHealthcare Community & State	$5.71
Rate for Payer: Wellpoint Medicaid Managed Care	$6.28

PLT NARROW STANDARD 10&13 HOLE

Facility

$213.50

Hospital Charge Code	1603018
Hospital Revenue Code	274
Min. Negotiated Rate	$32.02
Max. Negotiated Rate	$51.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$46.97
Rate for Payer: Qualcare PPO/HMO/WC	$32.02

PLT NARROW STANDARD 10&13 HOLE

Facility

$213.50

Hospital Charge Code	1603018
Hospital Revenue Code	274
Min. Negotiated Rate	$5.15
Max. Negotiated Rate	$106.75
Rate for Payer: Aetna Commercial	$81.13
Rate for Payer: Aetna Medicare Advantage	$64.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.44
Rate for Payer: Cigna Commercial	$106.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$46.97
Rate for Payer: Qualcare PPO/HMO/WC	$32.02
Rate for Payer: UnitedHealthcare Community & State	$5.15
Rate for Payer: Wellpoint Medicaid Managed Care	$5.66

PLT NARROW STANDARD 14 HOLE

Facility

$251.00

Hospital Charge Code	1603026
Hospital Revenue Code	274
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$125.50
Rate for Payer: Aetna Commercial	$95.38
Rate for Payer: Aetna Medicare Advantage	$75.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.00
Rate for Payer: Cigna Commercial	$125.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.22
Rate for Payer: Qualcare PPO/HMO/WC	$37.65
Rate for Payer: UnitedHealthcare Community & State	$6.05
Rate for Payer: Wellpoint Medicaid Managed Care	$6.65

PLT NARROW STANDARD 14 HOLE

Facility

$251.00

Hospital Charge Code	1603026
Hospital Revenue Code	274
Min. Negotiated Rate	$37.65
Max. Negotiated Rate	$60.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.22
Rate for Payer: Qualcare PPO/HMO/WC	$37.65

PLT NARROW STANDARD 2 HOLE

Facility

$148.50

Hospital Charge Code	1602952
Hospital Revenue Code	274
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$74.25
Rate for Payer: Aetna Commercial	$56.43
Rate for Payer: Aetna Medicare Advantage	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.87
Rate for Payer: Cigna Commercial	$74.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$22.27
Rate for Payer: UnitedHealthcare Community & State	$3.58
Rate for Payer: Wellpoint Medicaid Managed Care	$3.94

PLT NARROW STANDARD 2 HOLE

Facility

$148.50

Hospital Charge Code	1602952
Hospital Revenue Code	274
Min. Negotiated Rate	$22.27
Max. Negotiated Rate	$35.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$22.27

PLT NARROW STANDARD 3&4 HOLE

Facility

$149.55

Hospital Charge Code	1602960
Hospital Revenue Code	274
Min. Negotiated Rate	$22.43
Max. Negotiated Rate	$36.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$32.90
Rate for Payer: Qualcare PPO/HMO/WC	$22.43

PLT NARROW STANDARD 3&4 HOLE

Facility

$149.55

Hospital Charge Code	1602960
Hospital Revenue Code	274
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$74.78
Rate for Payer: Aetna Commercial	$56.83
Rate for Payer: Aetna Medicare Advantage	$44.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.14
Rate for Payer: Cigna Commercial	$74.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$32.90
Rate for Payer: Qualcare PPO/HMO/WC	$22.43
Rate for Payer: UnitedHealthcare Community & State	$3.60
Rate for Payer: Wellpoint Medicaid Managed Care	$3.96

PLT NARROW STANDARD 5 HOLE

Facility

$151.80

Hospital Charge Code	1602978
Hospital Revenue Code	274
Min. Negotiated Rate	$22.77
Max. Negotiated Rate	$36.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$33.40
Rate for Payer: Qualcare PPO/HMO/WC	$22.77

PLT NARROW STANDARD 5 HOLE

Facility

$151.80

Hospital Charge Code	1602978
Hospital Revenue Code	274
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$75.90
Rate for Payer: Aetna Commercial	$57.68
Rate for Payer: Aetna Medicare Advantage	$45.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.71
Rate for Payer: Cigna Commercial	$75.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$33.40
Rate for Payer: Qualcare PPO/HMO/WC	$22.77
Rate for Payer: UnitedHealthcare Community & State	$3.66
Rate for Payer: Wellpoint Medicaid Managed Care	$4.02

PLT NARROW STANDARD 6 HOLE

Facility

$170.00

Hospital Charge Code	1602986
Hospital Revenue Code	274
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$41.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$37.40
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

PLT NARROW STANDARD 6 HOLE

Facility

$170.00

Hospital Charge Code	1602986
Hospital Revenue Code	274
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$85.00
Rate for Payer: Aetna Commercial	$64.60
Rate for Payer: Aetna Medicare Advantage	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.35
Rate for Payer: Cigna Commercial	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$37.40
Rate for Payer: Qualcare PPO/HMO/WC	$25.50
Rate for Payer: UnitedHealthcare Community & State	$4.10
Rate for Payer: Wellpoint Medicaid Managed Care	$4.50

PLT NARROW STANDARD 7&8 HOLE

Facility

$174.05

Hospital Charge Code	1602994
Hospital Revenue Code	274
Min. Negotiated Rate	$26.11
Max. Negotiated Rate	$42.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.29
Rate for Payer: Qualcare PPO/HMO/WC	$26.11

PLT NARROW STANDARD 7&8 HOLE

Facility

$174.05

Hospital Charge Code	1602994
Hospital Revenue Code	274
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$87.03
Rate for Payer: Aetna Commercial	$66.14
Rate for Payer: Aetna Medicare Advantage	$52.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.38
Rate for Payer: Cigna Commercial	$87.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.29
Rate for Payer: Qualcare PPO/HMO/WC	$26.11
Rate for Payer: UnitedHealthcare Community & State	$4.19
Rate for Payer: Wellpoint Medicaid Managed Care	$4.61

PLT NARROW STANDARD 9 HOLE

Facility

$181.15

Hospital Charge Code	1603000
Hospital Revenue Code	274
Min. Negotiated Rate	$27.17
Max. Negotiated Rate	$43.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$39.85
Rate for Payer: Qualcare PPO/HMO/WC	$27.17

PLT NARROW STANDARD 9 HOLE

Facility

$181.15

Hospital Charge Code	1603000
Hospital Revenue Code	274
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$90.58
Rate for Payer: Aetna Commercial	$68.84
Rate for Payer: Aetna Medicare Advantage	$54.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.19
Rate for Payer: Cigna Commercial	$90.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$39.85
Rate for Payer: Qualcare PPO/HMO/WC	$27.17
Rate for Payer: UnitedHealthcare Community & State	$4.37
Rate for Payer: Wellpoint Medicaid Managed Care	$4.80

Know your out-of-pocket cost for care.

All Charges