Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

KWIRE MONSTER SS SM 0.9MM

Facility

$115.50

Service Code	HCPCS C1713
Hospital Charge Code	2707002502
Hospital Revenue Code	278
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$57.75
Rate for Payer: Aetna Commercial	$43.89
Rate for Payer: Aetna Medicare Advantage	$34.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.45
Rate for Payer: Cigna Commercial	$57.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$25.41
Rate for Payer: Qualcare PPO/HMO/WC	$17.32
Rate for Payer: UnitedHealthcare Community & State	$2.78
Rate for Payer: Wellpoint Medicaid Managed Care	$3.06

KWIRE MONSTER SS SM 0.9MM

Facility

$115.50

Service Code	HCPCS C1713
Hospital Charge Code	270700250
Hospital Revenue Code	278
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$27.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$25.41
Rate for Payer: Qualcare PPO/HMO/WC	$17.32

KWIRE MONSTER SS SM 0.9MM

Facility

$115.50

Service Code	HCPCS C1713
Hospital Charge Code	270700250
Hospital Revenue Code	278
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$57.75
Rate for Payer: Aetna Commercial	$43.89
Rate for Payer: Aetna Medicare Advantage	$34.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.45
Rate for Payer: Cigna Commercial	$57.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$25.41
Rate for Payer: Qualcare PPO/HMO/WC	$17.32
Rate for Payer: UnitedHealthcare Community & State	$2.78
Rate for Payer: Wellpoint Medicaid Managed Care	$3.06

KWIRE NITINOL 149-646

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697676
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

KWIRE NITINOL 149-646

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270697676
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

KWIRE NITINOL 480MM

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	270695259
Hospital Revenue Code	278
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.50
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Community & State	$5.42
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

KWIRE NITINOL 480MM

Facility

$225.00

Service Code	HCPCS C1713
Hospital Charge Code	270695259
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.50
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

KWIRE NITINOL BLUNT 1.4X500MM

Facility

$600.00

Service Code	HCPCS C1713
Hospital Charge Code	270695742
Hospital Revenue Code	278
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$132.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$14.46
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

KWIRE NITINOL BLUNT 1.4X500MM

Facility

$600.00

Service Code	HCPCS C1713
Hospital Charge Code	270695742
Hospital Revenue Code	278
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$132.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

KWIRE NITINOL BLUNT 1.6X500MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695218
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

KWIRE NITINOL BLUNT 1.6X500MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270695218
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

KWIRE NITINOL LONG 0.62X21

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270696182
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

KWIRE NITINOL LONG 0.62X21

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270696182
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

KWIRE NITINOL TROCAR 1.4MM21IN

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698048
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

KWIRE NITINOL TROCAR 1.4MM21IN

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	270698048
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

KWIRE NI TROCAR BLUNT TIP

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270696977
Hospital Revenue Code	279
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$150.00
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

KWIRE NI TROCAR BLUNT TIP

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	270696977
Hospital Revenue Code	279
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

K-WIRE NON STERILE 1.4x150MM

Facility

$224.50

Hospital Charge Code	270662556
Hospital Revenue Code	271
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$112.25
Rate for Payer: Aetna Commercial	$85.31
Rate for Payer: Aetna Medicare Advantage	$67.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.25
Rate for Payer: Cigna Commercial	$112.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.35
Rate for Payer: Oxford Commercial	$44.90
Rate for Payer: Qualcare PPO/HMO/WC	$33.67
Rate for Payer: UnitedHealthcare Commercial	$44.90
Rate for Payer: UnitedHealthcare Community & State	$5.41
Rate for Payer: Wellpoint Medicaid Managed Care	$5.95

K-WIRE NON STERILE 1.4x150MM

Facility

$224.50

Hospital Charge Code	270662556
Hospital Revenue Code	271
Min. Negotiated Rate	$33.67
Max. Negotiated Rate	$33.67
Rate for Payer: Qualcare PPO/HMO/WC	$33.67

KWIRE NON THREADED 1.15MM

Facility

$267.65

Service Code	HCPCS C1713
Hospital Charge Code	270698691
Hospital Revenue Code	278
Min. Negotiated Rate	$40.15
Max. Negotiated Rate	$64.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$58.88
Rate for Payer: Qualcare PPO/HMO/WC	$40.15

KWIRE NON THREADED 1.15MM

Facility

$267.65

Service Code	HCPCS C1713
Hospital Charge Code	270698691
Hospital Revenue Code	278
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$133.82
Rate for Payer: Aetna Commercial	$101.71
Rate for Payer: Aetna Medicare Advantage	$80.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.25
Rate for Payer: Cigna Commercial	$133.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$58.88
Rate for Payer: Qualcare PPO/HMO/WC	$40.15
Rate for Payer: UnitedHealthcare Community & State	$6.45
Rate for Payer: Wellpoint Medicaid Managed Care	$7.09

K-WIRE OLIVE STOP 56-40281

Facility

$171.25

Hospital Charge Code	270640882
Hospital Revenue Code	272
Min. Negotiated Rate	$25.69
Max. Negotiated Rate	$25.69
Rate for Payer: Qualcare PPO/HMO/WC	$25.69

K-WIRE OLIVE STOP 56-40281

Facility

$171.25

Hospital Charge Code	270640882
Hospital Revenue Code	272
Min. Negotiated Rate	$4.13
Max. Negotiated Rate	$85.62
Rate for Payer: Aetna Commercial	$65.08
Rate for Payer: Aetna Medicare Advantage	$51.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.67
Rate for Payer: Cigna Commercial	$85.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.38
Rate for Payer: Oxford Commercial	$34.25
Rate for Payer: Qualcare PPO/HMO/WC	$25.69
Rate for Payer: UnitedHealthcare Commercial	$34.25
Rate for Payer: UnitedHealthcare Community & State	$4.13
Rate for Payer: Wellpoint Medicaid Managed Care	$4.54

K WIRE OLIVE TIP 1

Facility

$1,115.00

Hospital Charge Code	270703649
Hospital Revenue Code	279
Min. Negotiated Rate	$26.87
Max. Negotiated Rate	$557.50
Rate for Payer: Aetna Commercial	$423.70
Rate for Payer: Aetna Medicare Advantage	$334.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.32
Rate for Payer: Cigna Commercial	$557.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$334.50
Rate for Payer: Oxford Commercial	$223.00
Rate for Payer: Qualcare PPO/HMO/WC	$167.25
Rate for Payer: UnitedHealthcare Commercial	$223.00
Rate for Payer: UnitedHealthcare Community & State	$26.87
Rate for Payer: Wellpoint Medicaid Managed Care	$29.55

K WIRE OLIVE TIP 1

Facility

$1,115.00

Hospital Charge Code	270703649
Hospital Revenue Code	279
Min. Negotiated Rate	$167.25
Max. Negotiated Rate	$167.25
Rate for Payer: Qualcare PPO/HMO/WC	$167.25

Know your out-of-pocket cost for care.

All Charges