Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PLT NARR SELF COMP10-12 HL***

Facility

$300.00

Hospital Charge Code	1602549
Hospital Revenue Code	274
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$66.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Community & State	$7.23
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

PLT NARR SELF COMP10-12 HL***

Facility

$300.00

Hospital Charge Code	1602549
Hospital Revenue Code	274
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$66.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

PLT NARR SELF COMP 13HL*****

Facility

$365.00

Hospital Charge Code	1602556
Hospital Revenue Code	274
Min. Negotiated Rate	$54.75
Max. Negotiated Rate	$88.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$73.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$80.30
Rate for Payer: Qualcare PPO/HMO/WC	$54.75

PLT NARR SELF COMP 13HL*****

Facility

$365.00

Hospital Charge Code	1602556
Hospital Revenue Code	274
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$182.50
Rate for Payer: Aetna Commercial	$138.70
Rate for Payer: Aetna Medicare Advantage	$109.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$73.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.08
Rate for Payer: Cigna Commercial	$182.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$80.30
Rate for Payer: Qualcare PPO/HMO/WC	$54.75
Rate for Payer: UnitedHealthcare Community & State	$8.80
Rate for Payer: Wellpoint Medicaid Managed Care	$9.67

PLT PEG TIB SZ 3 NXGN 59703501

Facility

$8,235.30

Hospital Charge Code	270638276
Hospital Revenue Code	278
Min. Negotiated Rate	$1,235.30
Max. Negotiated Rate	$1,992.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,647.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,992.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,811.77
Rate for Payer: Qualcare PPO/HMO/WC	$1,235.30

PLT PEG TIB SZ 3 NXGN 59703501

Facility

$8,235.30

Hospital Charge Code	270638276
Hospital Revenue Code	278
Min. Negotiated Rate	$198.47
Max. Negotiated Rate	$4,117.65
Rate for Payer: Aetna Commercial	$3,129.41
Rate for Payer: Aetna Medicare Advantage	$2,470.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,647.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,100.00
Rate for Payer: Cigna Commercial	$4,117.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,992.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,811.77
Rate for Payer: Qualcare PPO/HMO/WC	$1,235.30
Rate for Payer: UnitedHealthcare Community & State	$198.47
Rate for Payer: Wellpoint Medicaid Managed Care	$218.24

PLT PERIAR 6 HOLE RT2347-17-06

Facility

$2,008.40

Hospital Charge Code	270634933
Hospital Revenue Code	278
Min. Negotiated Rate	$48.40
Max. Negotiated Rate	$1,004.20
Rate for Payer: Aetna Commercial	$763.19
Rate for Payer: Aetna Medicare Advantage	$602.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$512.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$512.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$401.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$512.14
Rate for Payer: Cigna Commercial	$1,004.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$441.85
Rate for Payer: Qualcare PPO/HMO/WC	$301.26
Rate for Payer: UnitedHealthcare Community & State	$48.40
Rate for Payer: Wellpoint Medicaid Managed Care	$53.22

PLT PERIAR 6 HOLE RT2347-17-06

Facility

$2,008.40

Hospital Charge Code	270634933
Hospital Revenue Code	278
Min. Negotiated Rate	$301.26
Max. Negotiated Rate	$486.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$401.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$486.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$441.85
Rate for Payer: Qualcare PPO/HMO/WC	$301.26

PLT PERI FIB 4HOLE RT 23471704

Facility

$2,076.30

Hospital Charge Code	270640540
Hospital Revenue Code	278
Min. Negotiated Rate	$311.44
Max. Negotiated Rate	$502.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$415.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$502.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$456.79
Rate for Payer: Qualcare PPO/HMO/WC	$311.44

PLT PERI FIB 4HOLE RT 23471704

Facility

$2,076.30

Hospital Charge Code	270640540
Hospital Revenue Code	278
Min. Negotiated Rate	$50.04
Max. Negotiated Rate	$1,038.15
Rate for Payer: Aetna Commercial	$788.99
Rate for Payer: Aetna Medicare Advantage	$622.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$529.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$529.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$415.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$529.46
Rate for Payer: Cigna Commercial	$1,038.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$502.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$456.79
Rate for Payer: Qualcare PPO/HMO/WC	$311.44
Rate for Payer: UnitedHealthcare Community & State	$50.04
Rate for Payer: Wellpoint Medicaid Managed Care	$55.02

PLT PERMTR CALCAN FRAC SM RT

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270693864
Hospital Revenue Code	278
Min. Negotiated Rate	$131.95
Max. Negotiated Rate	$2,737.50
Rate for Payer: Aetna Commercial	$2,080.50
Rate for Payer: Aetna Medicare Advantage	$1,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,396.12
Rate for Payer: Cigna Commercial	$2,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,204.50
Rate for Payer: Qualcare PPO/HMO/WC	$821.25
Rate for Payer: UnitedHealthcare Community & State	$131.95
Rate for Payer: Wellpoint Medicaid Managed Care	$145.09

PLT PERMTR CALCAN FRAC SM RT

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270693864
Hospital Revenue Code	278
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$1,324.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,204.50
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

PLT PHER LEUK REDU CMV-NEG IRR

Facility

$4,463.55

Hospital Charge Code	3101529
Hospital Revenue Code	390
Min. Negotiated Rate	$107.57
Max. Negotiated Rate	$2,231.78
Rate for Payer: Aetna Commercial	$1,696.15
Rate for Payer: Aetna Medicare Advantage	$1,339.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,138.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,138.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,138.21
Rate for Payer: Cigna Commercial	$2,231.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,339.07
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$669.53
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$107.57
Rate for Payer: Wellpoint Medicaid Managed Care	$118.28

PLT PHER LEUK REDU CMV-NEG IRR

Facility

$4,463.55

Hospital Charge Code	3101529
Hospital Revenue Code	390
Min. Negotiated Rate	$669.53
Max. Negotiated Rate	$669.53
Rate for Payer: Qualcare PPO/HMO/WC	$669.53

PLT PRX HUM HI LT 4H 90MM

Facility

$7,095.00

Service Code	HCPCS C1713
Hospital Charge Code	270693599
Hospital Revenue Code	278
Min. Negotiated Rate	$170.99
Max. Negotiated Rate	$3,547.50
Rate for Payer: Aetna Commercial	$2,696.10
Rate for Payer: Aetna Medicare Advantage	$2,128.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,809.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,809.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,419.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,809.22
Rate for Payer: Cigna Commercial	$3,547.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,560.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,064.25
Rate for Payer: UnitedHealthcare Community & State	$170.99
Rate for Payer: Wellpoint Medicaid Managed Care	$188.02

PLT PRX HUM HI LT 4H 90MM

Facility

$7,095.00

Service Code	HCPCS C1713
Hospital Charge Code	270693599
Hospital Revenue Code	278
Min. Negotiated Rate	$1,064.25
Max. Negotiated Rate	$1,716.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,419.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,560.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,064.25

PLT SPINAL HA MIS FUSION

Facility

$40,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270693153
Hospital Revenue Code	278
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$9,680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,680.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PLT SPINAL HA MIS FUSION

Facility

$40,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270693153
Hospital Revenue Code	278
Min. Negotiated Rate	$964.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$15,200.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,680.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Community & State	$964.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,060.00

PLT SPINAL LAT 18X12X55MM 10D

Facility

$29,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693154
Hospital Revenue Code	278
Min. Negotiated Rate	$4,387.50
Max. Negotiated Rate	$7,078.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,435.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50

PLT SPINAL LAT 18X12X55MM 10D

Facility

$29,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270693154
Hospital Revenue Code	278
Min. Negotiated Rate	$704.92
Max. Negotiated Rate	$14,625.00
Rate for Payer: Aetna Commercial	$11,115.00
Rate for Payer: Aetna Medicare Advantage	$8,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,458.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,458.75
Rate for Payer: Cigna Commercial	$14,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,078.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,435.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,387.50
Rate for Payer: UnitedHealthcare Community & State	$704.92
Rate for Payer: Wellpoint Medicaid Managed Care	$775.12

PLT SYNP Ti FAN 108m 085201215

Facility

$5,100.00

Hospital Charge Code	270640739
Hospital Revenue Code	278
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$1,234.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,020.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,234.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,122.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

PLT SYNP Ti FAN 108m 085201215

Facility

$5,100.00

Hospital Charge Code	270640739
Hospital Revenue Code	278
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,234.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,122.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

PLT TIB 4.5m PLT 4H RT23470504

Facility

$3,182.65

Hospital Charge Code	270635862
Hospital Revenue Code	278
Min. Negotiated Rate	$477.40
Max. Negotiated Rate	$770.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$636.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$770.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$700.18
Rate for Payer: Qualcare PPO/HMO/WC	$477.40

PLT TIB 4.5m PLT 4H RT23470504

Facility

$3,182.65

Hospital Charge Code	270635862
Hospital Revenue Code	278
Min. Negotiated Rate	$76.70
Max. Negotiated Rate	$1,591.33
Rate for Payer: Aetna Commercial	$1,209.41
Rate for Payer: Aetna Medicare Advantage	$954.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$811.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$811.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$636.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$811.58
Rate for Payer: Cigna Commercial	$1,591.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$770.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$700.18
Rate for Payer: Qualcare PPO/HMO/WC	$477.40
Rate for Payer: UnitedHealthcare Community & State	$76.70
Rate for Payer: Wellpoint Medicaid Managed Care	$84.34

PLT VA-LCP AC 2.7X3.5MM 9H89MM

Facility

$5,051.60

Service Code	HCPCS C1713
Hospital Charge Code	270693550
Hospital Revenue Code	278
Min. Negotiated Rate	$121.74
Max. Negotiated Rate	$2,525.80
Rate for Payer: Aetna Commercial	$1,919.61
Rate for Payer: Aetna Medicare Advantage	$1,515.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,288.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,288.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,010.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,288.16
Rate for Payer: Cigna Commercial	$2,525.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,222.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,111.35
Rate for Payer: Qualcare PPO/HMO/WC	$757.74
Rate for Payer: UnitedHealthcare Community & State	$121.74
Rate for Payer: Wellpoint Medicaid Managed Care	$133.87

Know your out-of-pocket cost for care.

All Charges