Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COUMADIN/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60632758
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

COUMADIN/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60632757
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

COUMADIN/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60632757
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

COUMADIN/2.5MG/TAB

Facility

$3.00

Hospital Charge Code	60632758
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

COUMADIN 4MG

Facility

$14.94

Service Code	NDC 56016870
Hospital Charge Code	60635727
Hospital Revenue Code	250
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$2.24
Rate for Payer: Qualcare PPO/HMO/WC	$2.24

COUMADIN 4MG

Facility

$14.94

Service Code	NDC 56016870
Hospital Charge Code	60635727
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.47
Rate for Payer: Aetna Commercial	$5.68
Rate for Payer: Aetna Medicare Advantage	$4.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.81
Rate for Payer: Cigna Commercial	$7.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.48
Rate for Payer: Oxford Commercial	$2.99
Rate for Payer: Qualcare PPO/HMO/WC	$2.24
Rate for Payer: UnitedHealthcare Commercial	$2.99
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

COUMADIN/5MG/TAB

Facility

$3.00

Hospital Charge Code	60632755
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

COUMADIN/5MG/TAB

Facility

$3.00

Hospital Charge Code	60632755
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

COUNSELING/RISK FACTOR 15 MINS

Facility

$134.00

Service Code	HCPCS 99401
Hospital Charge Code	9200095
Hospital Revenue Code	761
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$67.00
Rate for Payer: Aetna Commercial	$50.92
Rate for Payer: Aetna Medicare Advantage	$40.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.17
Rate for Payer: Cigna Commercial	$67.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.20
Rate for Payer: Oxford Commercial	$26.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.10
Rate for Payer: UnitedHealthcare Commercial	$26.80
Rate for Payer: UnitedHealthcare Community & State	$3.23
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

COUNSELING/RISK FACTOR 15 MINS

Facility

$134.00

Service Code	HCPCS 99401
Hospital Charge Code	9200095
Hospital Revenue Code	761
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$20.10
Rate for Payer: Qualcare PPO/HMO/WC	$20.10

COUNTERSINK

Facility

$624.20

Hospital Charge Code	270665618
Hospital Revenue Code	278
Min. Negotiated Rate	$93.63
Max. Negotiated Rate	$151.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.32
Rate for Payer: Qualcare PPO/HMO/WC	$93.63

COUNTERSINK

Facility

$1,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270669670
Hospital Revenue Code	278
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$411.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$374.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

COUNTERSINK

Facility

$624.20

Hospital Charge Code	270665618
Hospital Revenue Code	278
Min. Negotiated Rate	$15.04
Max. Negotiated Rate	$312.10
Rate for Payer: Aetna Commercial	$237.20
Rate for Payer: Aetna Medicare Advantage	$187.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.17
Rate for Payer: Cigna Commercial	$312.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.06
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.32
Rate for Payer: Qualcare PPO/HMO/WC	$93.63
Rate for Payer: UnitedHealthcare Community & State	$15.04
Rate for Payer: Wellpoint Medicaid Managed Care	$16.54

COUNTERSINK

Facility

$1,545.00

Hospital Charge Code	270688016
Hospital Revenue Code	272
Min. Negotiated Rate	$37.23
Max. Negotiated Rate	$772.50
Rate for Payer: Aetna Commercial	$587.10
Rate for Payer: Aetna Medicare Advantage	$463.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$393.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$393.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$393.98
Rate for Payer: Cigna Commercial	$772.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.50
Rate for Payer: Oxford Commercial	$309.00
Rate for Payer: Qualcare PPO/HMO/WC	$231.75
Rate for Payer: UnitedHealthcare Commercial	$309.00
Rate for Payer: UnitedHealthcare Community & State	$37.23
Rate for Payer: Wellpoint Medicaid Managed Care	$40.94

COUNTERSINK

Facility

$1,545.00

Hospital Charge Code	270688016
Hospital Revenue Code	272
Min. Negotiated Rate	$231.75
Max. Negotiated Rate	$231.75
Rate for Payer: Qualcare PPO/HMO/WC	$231.75

COUNTERSINK

Facility

$1,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270669670
Hospital Revenue Code	278
Min. Negotiated Rate	$40.97
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$646.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$374.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Community & State	$40.97
Rate for Payer: Wellpoint Medicaid Managed Care	$45.05

COUNTERSINK 2.5

Facility

$680.00

Hospital Charge Code	270692677
Hospital Revenue Code	272
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$102.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00

COUNTERSINK 2.5

Facility

$680.00

Hospital Charge Code	270692677
Hospital Revenue Code	272
Min. Negotiated Rate	$16.39
Max. Negotiated Rate	$340.00
Rate for Payer: Aetna Commercial	$258.40
Rate for Payer: Aetna Medicare Advantage	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.40
Rate for Payer: Cigna Commercial	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.00
Rate for Payer: Oxford Commercial	$136.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00
Rate for Payer: UnitedHealthcare Commercial	$136.00
Rate for Payer: UnitedHealthcare Community & State	$16.39
Rate for Payer: Wellpoint Medicaid Managed Care	$18.02

COUNTERSINK 2.7/3.5MM

Facility

$940.00

Service Code	HCPCS C1713
Hospital Charge Code	270667254
Hospital Revenue Code	278
Min. Negotiated Rate	$22.65
Max. Negotiated Rate	$470.00
Rate for Payer: Aetna Commercial	$357.20
Rate for Payer: Aetna Medicare Advantage	$282.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$239.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$239.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$239.70
Rate for Payer: Cigna Commercial	$470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$206.80
Rate for Payer: Qualcare PPO/HMO/WC	$141.00
Rate for Payer: UnitedHealthcare Community & State	$22.65
Rate for Payer: Wellpoint Medicaid Managed Care	$24.91

COUNTERSINK 2.7/3.5MM

Facility

$940.00

Service Code	HCPCS C1713
Hospital Charge Code	270667254
Hospital Revenue Code	278
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$227.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$206.80
Rate for Payer: Qualcare PPO/HMO/WC	$141.00

COUNTERSINK 4.00 HEADLESS

Facility

$1,550.00

Hospital Charge Code	270690337
Hospital Revenue Code	272
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$775.00
Rate for Payer: Aetna Commercial	$589.00
Rate for Payer: Aetna Medicare Advantage	$465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$395.25
Rate for Payer: Cigna Commercial	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.00
Rate for Payer: Oxford Commercial	$310.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.50
Rate for Payer: UnitedHealthcare Commercial	$310.00
Rate for Payer: UnitedHealthcare Community & State	$37.35
Rate for Payer: Wellpoint Medicaid Managed Care	$41.08

COUNTERSINK 4.00 HEADLESS

Facility

$1,550.00

Hospital Charge Code	270690337
Hospital Revenue Code	272
Min. Negotiated Rate	$232.50
Max. Negotiated Rate	$232.50
Rate for Payer: Qualcare PPO/HMO/WC	$232.50

COUNTERSINK 4 5MM

Facility

$1,000.00

Hospital Charge Code	270680218
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

COUNTERSINK 4 5MM

Facility

$1,000.00

Hospital Charge Code	270680218
Hospital Revenue Code	272
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

COUNTERSINK 4MM CANN HD DRVR

Facility

$660.00

Hospital Charge Code	270700812
Hospital Revenue Code	272
Min. Negotiated Rate	$15.91
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$250.80
Rate for Payer: Aetna Medicare Advantage	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.30
Rate for Payer: Cigna Commercial	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.00
Rate for Payer: Oxford Commercial	$132.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.00
Rate for Payer: UnitedHealthcare Commercial	$132.00
Rate for Payer: UnitedHealthcare Community & State	$15.91
Rate for Payer: Wellpoint Medicaid Managed Care	$17.49

Know your out-of-pocket cost for care.

All Charges