Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SCREW CANN LNG THD 4.0x32MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270642841
Hospital Revenue Code	278
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$417.15
Rate for Payer: Aetna Commercial	$317.03
Rate for Payer: Aetna Medicare Advantage	$250.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.75
Rate for Payer: Cigna Commercial	$417.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14
Rate for Payer: UnitedHealthcare Community & State	$20.11
Rate for Payer: Wellpoint Medicaid Managed Care	$22.11

SCREW CANN LNG THD 4.0x34MM

Facility

$859.35

Service Code	HCPCS C1713
Hospital Charge Code	270676400
Hospital Revenue Code	278
Min. Negotiated Rate	$20.71
Max. Negotiated Rate	$429.68
Rate for Payer: Aetna Commercial	$326.55
Rate for Payer: Aetna Medicare Advantage	$257.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.13
Rate for Payer: Cigna Commercial	$429.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.06
Rate for Payer: Qualcare PPO/HMO/WC	$128.90
Rate for Payer: UnitedHealthcare Community & State	$20.71
Rate for Payer: Wellpoint Medicaid Managed Care	$22.77

SCREW CANN LNG THD 4.0x34MM

Facility

$859.35

Service Code	HCPCS C1713
Hospital Charge Code	270676400
Hospital Revenue Code	278
Min. Negotiated Rate	$128.90
Max. Negotiated Rate	$207.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.06
Rate for Payer: Qualcare PPO/HMO/WC	$128.90

SCREW CANN LNG THD 4.0x36MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270642557
Hospital Revenue Code	278
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$417.15
Rate for Payer: Aetna Commercial	$317.03
Rate for Payer: Aetna Medicare Advantage	$250.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.75
Rate for Payer: Cigna Commercial	$417.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14
Rate for Payer: UnitedHealthcare Community & State	$20.11
Rate for Payer: Wellpoint Medicaid Managed Care	$22.11

SCREW CANN LNG THD 4.0x36MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270642557
Hospital Revenue Code	278
Min. Negotiated Rate	$125.14
Max. Negotiated Rate	$201.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14

SCREW CANN LNG THD 4.0x38MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270648508
Hospital Revenue Code	278
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$417.15
Rate for Payer: Aetna Commercial	$317.03
Rate for Payer: Aetna Medicare Advantage	$250.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.75
Rate for Payer: Cigna Commercial	$417.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14
Rate for Payer: UnitedHealthcare Community & State	$20.11
Rate for Payer: Wellpoint Medicaid Managed Care	$22.11

SCREW CANN LNG THD 4.0x38MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270648508
Hospital Revenue Code	278
Min. Negotiated Rate	$125.14
Max. Negotiated Rate	$201.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14

SCREW CANN LNG THD 4.0x40MM

Facility

$859.35

Service Code	HCPCS C1713
Hospital Charge Code	270648484
Hospital Revenue Code	278
Min. Negotiated Rate	$128.90
Max. Negotiated Rate	$207.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.06
Rate for Payer: Qualcare PPO/HMO/WC	$128.90

SCREW CANN LNG THD 4.0x40MM

Facility

$859.35

Service Code	HCPCS C1713
Hospital Charge Code	270648484
Hospital Revenue Code	278
Min. Negotiated Rate	$20.71
Max. Negotiated Rate	$429.68
Rate for Payer: Aetna Commercial	$326.55
Rate for Payer: Aetna Medicare Advantage	$257.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.13
Rate for Payer: Cigna Commercial	$429.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.06
Rate for Payer: Qualcare PPO/HMO/WC	$128.90
Rate for Payer: UnitedHealthcare Community & State	$20.71
Rate for Payer: Wellpoint Medicaid Managed Care	$22.77

SCREW CANN LNG THD 4.0x42MM

Facility

$859.35

Service Code	HCPCS C1713
Hospital Charge Code	270661943
Hospital Revenue Code	278
Min. Negotiated Rate	$20.71
Max. Negotiated Rate	$429.68
Rate for Payer: Aetna Commercial	$326.55
Rate for Payer: Aetna Medicare Advantage	$257.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.13
Rate for Payer: Cigna Commercial	$429.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.06
Rate for Payer: Qualcare PPO/HMO/WC	$128.90
Rate for Payer: UnitedHealthcare Community & State	$20.71
Rate for Payer: Wellpoint Medicaid Managed Care	$22.77

SCREW CANN LNG THD 4.0x42MM

Facility

$859.35

Service Code	HCPCS C1713
Hospital Charge Code	270661943
Hospital Revenue Code	278
Min. Negotiated Rate	$128.90
Max. Negotiated Rate	$207.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.06
Rate for Payer: Qualcare PPO/HMO/WC	$128.90

SCREW CANN LNG THD 4.0x44MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270646923
Hospital Revenue Code	278
Min. Negotiated Rate	$125.14
Max. Negotiated Rate	$201.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14

SCREW CANN LNG THD 4.0x44MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270646923
Hospital Revenue Code	278
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$417.15
Rate for Payer: Aetna Commercial	$317.03
Rate for Payer: Aetna Medicare Advantage	$250.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.75
Rate for Payer: Cigna Commercial	$417.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14
Rate for Payer: UnitedHealthcare Community & State	$20.11
Rate for Payer: Wellpoint Medicaid Managed Care	$22.11

SCREW CANN LNG THD 4.0x46MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270649142
Hospital Revenue Code	278
Min. Negotiated Rate	$125.14
Max. Negotiated Rate	$201.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14

SCREW CANN LNG THD 4.0x46MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270649142
Hospital Revenue Code	278
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$417.15
Rate for Payer: Aetna Commercial	$317.03
Rate for Payer: Aetna Medicare Advantage	$250.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.75
Rate for Payer: Cigna Commercial	$417.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14
Rate for Payer: UnitedHealthcare Community & State	$20.11
Rate for Payer: Wellpoint Medicaid Managed Care	$22.11

SCREW CANN LNG THD 4.0x52MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270679437
Hospital Revenue Code	278
Min. Negotiated Rate	$125.14
Max. Negotiated Rate	$201.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14

SCREW CANN LNG THD 4.0x52MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270679437
Hospital Revenue Code	278
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$417.15
Rate for Payer: Aetna Commercial	$317.03
Rate for Payer: Aetna Medicare Advantage	$250.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.75
Rate for Payer: Cigna Commercial	$417.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14
Rate for Payer: UnitedHealthcare Community & State	$20.11
Rate for Payer: Wellpoint Medicaid Managed Care	$22.11

SCREW CANN LNG THD 4.0x54MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270648937
Hospital Revenue Code	278
Min. Negotiated Rate	$125.14
Max. Negotiated Rate	$201.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14

SCREW CANN LNG THD 4.0x54MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270648937
Hospital Revenue Code	278
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$417.15
Rate for Payer: Aetna Commercial	$317.03
Rate for Payer: Aetna Medicare Advantage	$250.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.75
Rate for Payer: Cigna Commercial	$417.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14
Rate for Payer: UnitedHealthcare Community & State	$20.11
Rate for Payer: Wellpoint Medicaid Managed Care	$22.11

SCREW CANN LNG THD 4.0x56MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270648938
Hospital Revenue Code	278
Min. Negotiated Rate	$125.14
Max. Negotiated Rate	$201.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14

SCREW CANN LNG THD 4.0x56MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270648938
Hospital Revenue Code	278
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$417.15
Rate for Payer: Aetna Commercial	$317.03
Rate for Payer: Aetna Medicare Advantage	$250.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.75
Rate for Payer: Cigna Commercial	$417.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14
Rate for Payer: UnitedHealthcare Community & State	$20.11
Rate for Payer: Wellpoint Medicaid Managed Care	$22.11

SCREW CANN LNG THD 4.0x60MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270648939
Hospital Revenue Code	278
Min. Negotiated Rate	$125.14
Max. Negotiated Rate	$201.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14

SCREW CANN LNG THD 4.0x60MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270648939
Hospital Revenue Code	278
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$417.15
Rate for Payer: Aetna Commercial	$317.03
Rate for Payer: Aetna Medicare Advantage	$250.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.75
Rate for Payer: Cigna Commercial	$417.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14
Rate for Payer: UnitedHealthcare Community & State	$20.11
Rate for Payer: Wellpoint Medicaid Managed Care	$22.11

SCREW CANN LNG THD 4.0x64MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270648507
Hospital Revenue Code	278
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$417.15
Rate for Payer: Aetna Commercial	$317.03
Rate for Payer: Aetna Medicare Advantage	$250.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.75
Rate for Payer: Cigna Commercial	$417.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14
Rate for Payer: UnitedHealthcare Community & State	$20.11
Rate for Payer: Wellpoint Medicaid Managed Care	$22.11

SCREW CANN LNG THD 4.0x64MM

Facility

$834.30

Service Code	HCPCS C1713
Hospital Charge Code	270648507
Hospital Revenue Code	278
Min. Negotiated Rate	$125.14
Max. Negotiated Rate	$201.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.55
Rate for Payer: Qualcare PPO/HMO/WC	$125.14

Know your out-of-pocket cost for care.

All Charges