Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COUNTERSINK HD 2.0MM

Facility

$852.50

Service Code	HCPCS C1713
Hospital Charge Code	270700628
Hospital Revenue Code	278
Min. Negotiated Rate	$127.88
Max. Negotiated Rate	$206.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.55
Rate for Payer: Qualcare PPO/HMO/WC	$127.88

COUNTERSINK HD 2.0MM

Facility

$852.50

Service Code	HCPCS C1713
Hospital Charge Code	270700628
Hospital Revenue Code	278
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$426.25
Rate for Payer: Aetna Commercial	$323.95
Rate for Payer: Aetna Medicare Advantage	$255.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$217.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$217.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$217.39
Rate for Payer: Cigna Commercial	$426.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.55
Rate for Payer: Qualcare PPO/HMO/WC	$127.88
Rate for Payer: UnitedHealthcare Community & State	$20.55
Rate for Payer: Wellpoint Medicaid Managed Care	$22.59

COUNTERSINK HEADLESS

Facility

$375.00

Hospital Charge Code	270677346
Hospital Revenue Code	278
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

COUNTERSINK HEADLESS

Facility

$375.00

Hospital Charge Code	270677346
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

COUNTERSINK MAXTORQUE 4MM

Facility

$845.00

Hospital Charge Code	270700798
Hospital Revenue Code	272
Min. Negotiated Rate	$20.36
Max. Negotiated Rate	$422.50
Rate for Payer: Aetna Commercial	$321.10
Rate for Payer: Aetna Medicare Advantage	$253.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.47
Rate for Payer: Cigna Commercial	$422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.50
Rate for Payer: Oxford Commercial	$169.00
Rate for Payer: Qualcare PPO/HMO/WC	$126.75
Rate for Payer: UnitedHealthcare Commercial	$169.00
Rate for Payer: UnitedHealthcare Community & State	$20.36
Rate for Payer: Wellpoint Medicaid Managed Care	$22.39

COUNTERSINK MAXTORQUE 4MM

Facility

$845.00

Hospital Charge Code	270700798
Hospital Revenue Code	272
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$126.75
Rate for Payer: Qualcare PPO/HMO/WC	$126.75

COUNTERSINK SCRW LAGPOST 3.5MM

Facility

$595.00

Hospital Charge Code	270698472
Hospital Revenue Code	272
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$297.50
Rate for Payer: Aetna Commercial	$226.10
Rate for Payer: Aetna Medicare Advantage	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.72
Rate for Payer: Cigna Commercial	$297.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.50
Rate for Payer: Oxford Commercial	$119.00
Rate for Payer: Qualcare PPO/HMO/WC	$89.25
Rate for Payer: UnitedHealthcare Commercial	$119.00
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: Wellpoint Medicaid Managed Care	$15.77

COUNTERSINK SCRW LAGPOST 3.5MM

Facility

$595.00

Hospital Charge Code	270698472
Hospital Revenue Code	272
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$89.25
Rate for Payer: Qualcare PPO/HMO/WC	$89.25

COUNTERSNK CANN SCRW 2.0/2.4MM

Facility

$1,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270686731
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$248.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

COUNTERSNK CANN SCRW 2.0/2.4MM

Facility

$1,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270686731
Hospital Revenue Code	278
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Community & State	$24.70
Rate for Payer: Wellpoint Medicaid Managed Care	$27.16

COUNTER SPONGE POCKET

Facility

$3.05

Hospital Charge Code	270661369
Hospital Revenue Code	272
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.46
Rate for Payer: Qualcare PPO/HMO/WC	$0.46

COUNTER SPONGE POCKET

Facility

$3.05

Hospital Charge Code	270661369
Hospital Revenue Code	272
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.52
Rate for Payer: Aetna Commercial	$1.16
Rate for Payer: Aetna Medicare Advantage	$0.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.78
Rate for Payer: Cigna Commercial	$1.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.92
Rate for Payer: Oxford Commercial	$0.61
Rate for Payer: Qualcare PPO/HMO/WC	$0.46
Rate for Payer: UnitedHealthcare Commercial	$0.61
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

COUPLER 20MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695590
Hospital Revenue Code	278
Min. Negotiated Rate	$174.72
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$174.72
Rate for Payer: Wellpoint Medicaid Managed Care	$192.12

COUPLER 20MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270695590
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

COUPLER 2.0MM

Facility

$1,650.00

Hospital Charge Code	270675009
Hospital Revenue Code	272
Min. Negotiated Rate	$39.77
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$627.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$495.00
Rate for Payer: Oxford Commercial	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50
Rate for Payer: UnitedHealthcare Commercial	$330.00
Rate for Payer: UnitedHealthcare Community & State	$39.77
Rate for Payer: Wellpoint Medicaid Managed Care	$43.73

COUPLER 2.0MM

Facility

$1,650.00

Hospital Charge Code	270675009
Hospital Revenue Code	272
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

COUPLER 2.5MM

Facility

$1,650.00

Hospital Charge Code	270675008
Hospital Revenue Code	272
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

COUPLER 2.5MM

Facility

$1,650.00

Hospital Charge Code	270675008
Hospital Revenue Code	272
Min. Negotiated Rate	$39.77
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$627.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$495.00
Rate for Payer: Oxford Commercial	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50
Rate for Payer: UnitedHealthcare Commercial	$330.00
Rate for Payer: UnitedHealthcare Community & State	$39.77
Rate for Payer: Wellpoint Medicaid Managed Care	$43.73

COUPLER 3.5 MM

Facility

$1,650.00

Hospital Charge Code	270665524
Hospital Revenue Code	272
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$247.50

COUPLER 3.5 MM

Facility

$1,650.00

Hospital Charge Code	270665524
Hospital Revenue Code	272
Min. Negotiated Rate	$39.77
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$627.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$495.00
Rate for Payer: Oxford Commercial	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50
Rate for Payer: UnitedHealthcare Commercial	$330.00
Rate for Payer: UnitedHealthcare Community & State	$39.77
Rate for Payer: Wellpoint Medicaid Managed Care	$43.73

COUPLER FIXED LENGTH 22MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270696320
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

COUPLER FIXED LENGTH 22MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270696320
Hospital Revenue Code	278
Min. Negotiated Rate	$174.72
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$174.72
Rate for Payer: Wellpoint Medicaid Managed Care	$192.12

COUPLER FIXED LENGTH 28MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270698196
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

COUPLER FIXED LENGTH 28MM

Facility

$7,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270698196
Hospital Revenue Code	278
Min. Negotiated Rate	$174.72
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$174.72
Rate for Payer: Wellpoint Medicaid Managed Care	$192.12

COUPLING HMD 5/3-4 4940-1-020

Facility

$1,595.25

Hospital Charge Code	270619340
Hospital Revenue Code	272
Min. Negotiated Rate	$239.29
Max. Negotiated Rate	$239.29
Rate for Payer: Qualcare PPO/HMO/WC	$239.29

Know your out-of-pocket cost for care.

All Charges