Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CONNECTOR FLEXFLO Y PORT 836

Facility

$54.45

Hospital Charge Code	270600960
Hospital Revenue Code	272
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$27.23
Rate for Payer: Aetna Commercial	$20.69
Rate for Payer: Aetna Medicare Advantage	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.88
Rate for Payer: Cigna Commercial	$27.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.34
Rate for Payer: Oxford Commercial	$10.89
Rate for Payer: Qualcare PPO/HMO/WC	$8.17
Rate for Payer: UnitedHealthcare Commercial	$10.89
Rate for Payer: UnitedHealthcare Community & State	$1.31
Rate for Payer: Wellpoint Medicaid Managed Care	$1.44

CONNECTOR FLEXFLO Y PORT 836

Facility

$54.45

Hospital Charge Code	270600960
Hospital Revenue Code	272
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$8.17
Rate for Payer: Qualcare PPO/HMO/WC	$8.17

CONNECTOR FLEXIBLE 3 15X22MM

Facility

$6.24

Hospital Charge Code	270655632
Hospital Revenue Code	270
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$0.94
Rate for Payer: Qualcare PPO/HMO/WC	$0.94

CONNECTOR FLEXIBLE 3 15X22MM

Facility

$6.24

Hospital Charge Code	270655632
Hospital Revenue Code	270
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.12
Rate for Payer: Aetna Commercial	$2.37
Rate for Payer: Aetna Medicare Advantage	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.59
Rate for Payer: Cigna Commercial	$3.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.87
Rate for Payer: Oxford Commercial	$1.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.94
Rate for Payer: UnitedHealthcare Commercial	$1.25
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

CONNECTOR IV SWABABLE

Facility

$7.00

Hospital Charge Code	270650184
Hospital Revenue Code	270
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

CONNECTOR IV SWABABLE

Facility

$7.00

Hospital Charge Code	270650184
Hospital Revenue Code	270
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

CONNECTOR LAT 5.5 TI A1

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270667966
Hospital Revenue Code	278
Min. Negotiated Rate	$153.64
Max. Negotiated Rate	$3,187.50
Rate for Payer: Aetna Commercial	$2,422.50
Rate for Payer: Aetna Medicare Advantage	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,625.62
Rate for Payer: Cigna Commercial	$3,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25
Rate for Payer: UnitedHealthcare Community & State	$153.64
Rate for Payer: Wellpoint Medicaid Managed Care	$168.94

CONNECTOR LAT 5.5 TI A1

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270667966
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

CONNECTOR LAT 5.5 TI A2

Facility

$6,375.00

Hospital Charge Code	270669376
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

CONNECTOR LAT 5.5 TI A2

Facility

$6,375.00

Hospital Charge Code	270669376
Hospital Revenue Code	278
Min. Negotiated Rate	$153.64
Max. Negotiated Rate	$3,187.50
Rate for Payer: Aetna Commercial	$2,422.50
Rate for Payer: Aetna Medicare Advantage	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,625.62
Rate for Payer: Cigna Commercial	$3,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25
Rate for Payer: UnitedHealthcare Community & State	$153.64
Rate for Payer: Wellpoint Medicaid Managed Care	$168.94

CONNECTOR LAT 5.5 TI A3

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270667965
Hospital Revenue Code	278
Min. Negotiated Rate	$956.25
Max. Negotiated Rate	$1,542.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25

CONNECTOR LAT 5.5 TI A3

Facility

$6,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270667965
Hospital Revenue Code	278
Min. Negotiated Rate	$153.64
Max. Negotiated Rate	$3,187.50
Rate for Payer: Aetna Commercial	$2,422.50
Rate for Payer: Aetna Medicare Advantage	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,625.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,625.62
Rate for Payer: Cigna Commercial	$3,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,542.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,402.50
Rate for Payer: Qualcare PPO/HMO/WC	$956.25
Rate for Payer: UnitedHealthcare Community & State	$153.64
Rate for Payer: Wellpoint Medicaid Managed Care	$168.94

CONNECTOR LOTUS TRANSV 30-36MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270697976
Hospital Revenue Code	278
Min. Negotiated Rate	$57.84
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$528.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Community & State	$57.84
Rate for Payer: Wellpoint Medicaid Managed Care	$63.60

CONNECTOR LOTUS TRANSV 30-36MM

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270697976
Hospital Revenue Code	278
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$580.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$480.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$528.00
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

CONNECTOR MATRIX #1

Facility

$5,925.00

Service Code	HCPCS C1713
Hospital Charge Code	270691063
Hospital Revenue Code	278
Min. Negotiated Rate	$142.79
Max. Negotiated Rate	$2,962.50
Rate for Payer: Aetna Commercial	$2,251.50
Rate for Payer: Aetna Medicare Advantage	$1,777.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,510.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,510.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,510.88
Rate for Payer: Cigna Commercial	$2,962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,433.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,303.50
Rate for Payer: Qualcare PPO/HMO/WC	$888.75
Rate for Payer: UnitedHealthcare Community & State	$142.79
Rate for Payer: Wellpoint Medicaid Managed Care	$157.01

CONNECTOR MATRIX #1

Facility

$5,925.00

Service Code	HCPCS C1713
Hospital Charge Code	270691063
Hospital Revenue Code	278
Min. Negotiated Rate	$888.75
Max. Negotiated Rate	$1,433.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,433.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,303.50
Rate for Payer: Qualcare PPO/HMO/WC	$888.75

CONNECTOR M SMARTSTITCH

Facility

$875.00

Hospital Charge Code	270668395
Hospital Revenue Code	272
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$21.09
Rate for Payer: Wellpoint Medicaid Managed Care	$23.19

CONNECTOR M SMARTSTITCH

Facility

$875.00

Hospital Charge Code	270668395
Hospital Revenue Code	272
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

CONNECTOR NEURO RT ANG 45104

Facility

$321.60

Hospital Charge Code	270603331
Hospital Revenue Code	272
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$160.80
Rate for Payer: Aetna Commercial	$122.21
Rate for Payer: Aetna Medicare Advantage	$96.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.01
Rate for Payer: Cigna Commercial	$160.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.48
Rate for Payer: Oxford Commercial	$64.32
Rate for Payer: Qualcare PPO/HMO/WC	$48.24
Rate for Payer: UnitedHealthcare Commercial	$64.32
Rate for Payer: UnitedHealthcare Community & State	$7.75
Rate for Payer: Wellpoint Medicaid Managed Care	$8.52

CONNECTOR NEURO RT ANG 45104

Facility

$321.60

Hospital Charge Code	270603331
Hospital Revenue Code	272
Min. Negotiated Rate	$48.24
Max. Negotiated Rate	$48.24
Rate for Payer: Qualcare PPO/HMO/WC	$48.24

CONNECTOR NEURO STR 45103

Facility

$332.00

Hospital Charge Code	270603367
Hospital Revenue Code	272
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$166.00
Rate for Payer: Aetna Commercial	$126.16
Rate for Payer: Aetna Medicare Advantage	$99.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.66
Rate for Payer: Cigna Commercial	$166.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.60
Rate for Payer: Oxford Commercial	$66.40
Rate for Payer: Qualcare PPO/HMO/WC	$49.80
Rate for Payer: UnitedHealthcare Commercial	$66.40
Rate for Payer: UnitedHealthcare Community & State	$8.00
Rate for Payer: Wellpoint Medicaid Managed Care	$8.80

CONNECTOR NEURO STR 45103

Facility

$332.00

Hospital Charge Code	270603367
Hospital Revenue Code	272
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$49.80
Rate for Payer: Qualcare PPO/HMO/WC	$49.80

CONNECTOR OFFSET 11MM

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698270
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

CONNECTOR OFFSET 11MM

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698270
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

CONNECTOR OFFSET 12MM

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270698267
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

Know your out-of-pocket cost for care.

All Charges