Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FIBERTACK SUT ANCHOR KNOTLESS

Facility

$2,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270695226
Hospital Revenue Code	278
Min. Negotiated Rate	$71.70
Max. Negotiated Rate	$1,487.50
Rate for Payer: Aetna Commercial	$1,130.50
Rate for Payer: Aetna Medicare Advantage	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.62
Rate for Payer: Cigna Commercial	$1,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$719.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$654.50
Rate for Payer: Qualcare PPO/HMO/WC	$446.25
Rate for Payer: UnitedHealthcare Community & State	$71.70
Rate for Payer: Wellpoint Medicaid Managed Care	$78.84

FIBER TAK

Facility

$2,100.00

Service Code	HCPCS C1781
Hospital Charge Code	270688600
Hospital Revenue Code	278
Min. Negotiated Rate	$50.61
Max. Negotiated Rate	$1,050.00
Rate for Payer: Aetna Commercial	$798.00
Rate for Payer: Aetna Medicare Advantage	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$535.50
Rate for Payer: Cigna Commercial	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$462.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00
Rate for Payer: UnitedHealthcare Community & State	$50.61
Rate for Payer: Wellpoint Medicaid Managed Care	$55.65

FIBER TAK

Facility

$2,100.00

Service Code	HCPCS C1781
Hospital Charge Code	270688600
Hospital Revenue Code	278
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$508.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$462.00
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

FIBERTAK

Facility

$1,925.00

Service Code	HCPCS C1713
Hospital Charge Code	270681070
Hospital Revenue Code	278
Min. Negotiated Rate	$46.39
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$731.50
Rate for Payer: Aetna Medicare Advantage	$577.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Community & State	$46.39
Rate for Payer: Wellpoint Medicaid Managed Care	$51.01

FIBERTAK

Facility

$1,925.00

Service Code	HCPCS C1713
Hospital Charge Code	270681070
Hospital Revenue Code	278
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$465.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

FIBERTAK 1.3MM

Facility

$11,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270682058
Hospital Revenue Code	278
Min. Negotiated Rate	$280.16
Max. Negotiated Rate	$5,812.50
Rate for Payer: Aetna Commercial	$4,417.50
Rate for Payer: Aetna Medicare Advantage	$3,487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,964.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,964.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,964.38
Rate for Payer: Cigna Commercial	$5,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,813.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,557.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.75
Rate for Payer: UnitedHealthcare Community & State	$280.16
Rate for Payer: Wellpoint Medicaid Managed Care	$308.06

FIBERTAK 1.3MM

Facility

$11,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270682058
Hospital Revenue Code	278
Min. Negotiated Rate	$1,743.75
Max. Negotiated Rate	$2,813.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,813.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,557.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.75

FIBERTAK BIT DRILL

Facility

$475.00

Hospital Charge Code	270681073
Hospital Revenue Code	272
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.50
Rate for Payer: Oxford Commercial	$95.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Commercial	$95.00
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

FIBERTAK BIT DRILL

Facility

$475.00

Hospital Charge Code	270681073
Hospital Revenue Code	272
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$71.25
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

FIBERTAK BLUE AND STTPE WH/BLK

Facility

$2,548.00

Service Code	HCPCS C1713
Hospital Charge Code	270699200
Hospital Revenue Code	278
Min. Negotiated Rate	$61.41
Max. Negotiated Rate	$1,274.00
Rate for Payer: Aetna Commercial	$968.24
Rate for Payer: Aetna Medicare Advantage	$764.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$649.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$649.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$509.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$649.74
Rate for Payer: Cigna Commercial	$1,274.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$616.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$560.56
Rate for Payer: Qualcare PPO/HMO/WC	$382.20
Rate for Payer: UnitedHealthcare Community & State	$61.41
Rate for Payer: Wellpoint Medicaid Managed Care	$67.52

FIBERTAK BLUE AND STTPE WH/BLK

Facility

$2,548.00

Service Code	HCPCS C1713
Hospital Charge Code	270699200
Hospital Revenue Code	278
Min. Negotiated Rate	$382.20
Max. Negotiated Rate	$616.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$509.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$616.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$560.56
Rate for Payer: Qualcare PPO/HMO/WC	$382.20

FIBERTAK BUTTON SYST AR-3680

Facility

$3,945.00

Service Code	HCPCS C1713
Hospital Charge Code	270692481
Hospital Revenue Code	278
Min. Negotiated Rate	$591.75
Max. Negotiated Rate	$954.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$789.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$954.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$867.90
Rate for Payer: Qualcare PPO/HMO/WC	$591.75

FIBERTAK BUTTON SYST AR-3680

Facility

$3,945.00

Service Code	HCPCS C1713
Hospital Charge Code	270692481
Hospital Revenue Code	278
Min. Negotiated Rate	$95.07
Max. Negotiated Rate	$1,972.50
Rate for Payer: Aetna Commercial	$1,499.10
Rate for Payer: Aetna Medicare Advantage	$1,183.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,005.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,005.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$789.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,005.98
Rate for Payer: Cigna Commercial	$1,972.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$954.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$867.90
Rate for Payer: Qualcare PPO/HMO/WC	$591.75
Rate for Payer: UnitedHealthcare Community & State	$95.07
Rate for Payer: Wellpoint Medicaid Managed Care	$104.54

FIBERTAK CURVED KIT DISP

Facility

$975.00

Hospital Charge Code	270689680
Hospital Revenue Code	272
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$146.25
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

FIBERTAK CURVED KIT DISP

Facility

$975.00

Hospital Charge Code	270689680
Hospital Revenue Code	272
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$370.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Commercial	$195.00
Rate for Payer: UnitedHealthcare Community & State	$23.50
Rate for Payer: Wellpoint Medicaid Managed Care	$25.84

FIBER TAK KNOTLESS HIP

Facility

$2,225.00

Hospital Charge Code	270687982
Hospital Revenue Code	272
Min. Negotiated Rate	$333.75
Max. Negotiated Rate	$333.75
Rate for Payer: Qualcare PPO/HMO/WC	$333.75

FIBER TAK KNOTLESS HIP

Facility

$2,225.00

Hospital Charge Code	270687982
Hospital Revenue Code	272
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$1,112.50
Rate for Payer: Aetna Commercial	$845.50
Rate for Payer: Aetna Medicare Advantage	$667.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$567.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$567.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$567.38
Rate for Payer: Cigna Commercial	$1,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$667.50
Rate for Payer: Oxford Commercial	$445.00
Rate for Payer: Qualcare PPO/HMO/WC	$333.75
Rate for Payer: UnitedHealthcare Commercial	$445.00
Rate for Payer: UnitedHealthcare Community & State	$53.62
Rate for Payer: Wellpoint Medicaid Managed Care	$58.96

FIBERTAK KNOTLSS 2.6 BLK/BLUE

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	270699201
Hospital Revenue Code	278
Min. Negotiated Rate	$25.46
Max. Negotiated Rate	$528.12
Rate for Payer: Aetna Commercial	$401.38
Rate for Payer: Aetna Medicare Advantage	$316.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$269.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$269.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$269.34
Rate for Payer: Cigna Commercial	$528.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$232.38
Rate for Payer: Qualcare PPO/HMO/WC	$158.44
Rate for Payer: UnitedHealthcare Community & State	$25.46
Rate for Payer: Wellpoint Medicaid Managed Care	$27.99

FIBERTAK KNOTLSS 2.6 BLK/BLUE

Facility

$1,056.25

Service Code	HCPCS C1713
Hospital Charge Code	270699201
Hospital Revenue Code	278
Min. Negotiated Rate	$158.44
Max. Negotiated Rate	$255.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$211.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$232.38
Rate for Payer: Qualcare PPO/HMO/WC	$158.44

FIBERTAK RC DOUBLOAD TAPE BL/W

Facility

$1,850.00

Hospital Charge Code	270681323
Hospital Revenue Code	272
Min. Negotiated Rate	$44.59
Max. Negotiated Rate	$925.00
Rate for Payer: Aetna Commercial	$703.00
Rate for Payer: Aetna Medicare Advantage	$555.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$471.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$471.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$471.75
Rate for Payer: Cigna Commercial	$925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$555.00
Rate for Payer: Oxford Commercial	$370.00
Rate for Payer: Qualcare PPO/HMO/WC	$277.50
Rate for Payer: UnitedHealthcare Commercial	$370.00
Rate for Payer: UnitedHealthcare Community & State	$44.59
Rate for Payer: Wellpoint Medicaid Managed Care	$49.02

FIBERTAK RC DOUBLOAD TAPE BL/W

Facility

$1,850.00

Hospital Charge Code	270681323
Hospital Revenue Code	272
Min. Negotiated Rate	$277.50
Max. Negotiated Rate	$277.50
Rate for Payer: Qualcare PPO/HMO/WC	$277.50

FIBERTAK SPEEDBRIDGE IMPL 4.75

Facility

$13,364.25

Service Code	HCPCS C1713
Hospital Charge Code	270703103
Hospital Revenue Code	278
Min. Negotiated Rate	$2,004.64
Max. Negotiated Rate	$3,234.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,672.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,234.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,940.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,004.64

FIBERTAK SPEEDBRIDGE IMPL 4.75

Facility

$13,364.25

Service Code	HCPCS C1713
Hospital Charge Code	270703103
Hospital Revenue Code	278
Min. Negotiated Rate	$322.08
Max. Negotiated Rate	$6,682.12
Rate for Payer: Aetna Commercial	$5,078.41
Rate for Payer: Aetna Medicare Advantage	$4,009.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,407.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,407.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,672.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,407.88
Rate for Payer: Cigna Commercial	$6,682.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,234.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,940.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,004.64
Rate for Payer: UnitedHealthcare Community & State	$322.08
Rate for Payer: Wellpoint Medicaid Managed Care	$354.15

FIBERTAK STRAIGHT KIT DISP

Facility

$875.00

Hospital Charge Code	270689681
Hospital Revenue Code	272
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

FIBERTAK STRAIGHT KIT DISP

Facility

$875.00

Hospital Charge Code	270689681
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

Know your out-of-pocket cost for care.

All Charges