Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SCRW 2.7x12MM LOCK 53-27612E

Facility

$639.60

Service Code	HCPCS C1713
Hospital Charge Code	270647784
Hospital Revenue Code	278
Min. Negotiated Rate	$15.41
Max. Negotiated Rate	$319.80
Rate for Payer: Aetna Commercial	$243.05
Rate for Payer: Aetna Medicare Advantage	$191.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.10
Rate for Payer: Cigna Commercial	$319.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$140.71
Rate for Payer: Qualcare PPO/HMO/WC	$95.94
Rate for Payer: UnitedHealthcare Community & State	$15.41
Rate for Payer: Wellpoint Medicaid Managed Care	$16.95

SCRW 2.7x14 NON-LOCK 53-27214E

Facility

$780.00

Service Code	HCPCS C1713
Hospital Charge Code	270647783
Hospital Revenue Code	278
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$188.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$171.60
Rate for Payer: Qualcare PPO/HMO/WC	$117.00

SCRW 2.7x14 NON-LOCK 53-27214E

Facility

$780.00

Service Code	HCPCS C1713
Hospital Charge Code	270647783
Hospital Revenue Code	278
Min. Negotiated Rate	$18.80
Max. Negotiated Rate	$390.00
Rate for Payer: Aetna Commercial	$296.40
Rate for Payer: Aetna Medicare Advantage	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.90
Rate for Payer: Cigna Commercial	$390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$171.60
Rate for Payer: Qualcare PPO/HMO/WC	$117.00
Rate for Payer: UnitedHealthcare Community & State	$18.80
Rate for Payer: Wellpoint Medicaid Managed Care	$20.67

SCRW 2.7x16MM LOCK 53-27616E

Facility

$780.00

Service Code	HCPCS C1713
Hospital Charge Code	270647781
Hospital Revenue Code	278
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$188.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$171.60
Rate for Payer: Qualcare PPO/HMO/WC	$117.00

SCRW 2.7x16MM LOCK 53-27616E

Facility

$780.00

Service Code	HCPCS C1713
Hospital Charge Code	270647781
Hospital Revenue Code	278
Min. Negotiated Rate	$18.80
Max. Negotiated Rate	$390.00
Rate for Payer: Aetna Commercial	$296.40
Rate for Payer: Aetna Medicare Advantage	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.90
Rate for Payer: Cigna Commercial	$390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$171.60
Rate for Payer: Qualcare PPO/HMO/WC	$117.00
Rate for Payer: UnitedHealthcare Community & State	$18.80
Rate for Payer: Wellpoint Medicaid Managed Care	$20.67

SCRW 2.7x18MM LOCK 53-27618E

Facility

$780.00

Service Code	HCPCS C1713
Hospital Charge Code	270647780
Hospital Revenue Code	278
Min. Negotiated Rate	$18.80
Max. Negotiated Rate	$390.00
Rate for Payer: Aetna Commercial	$296.40
Rate for Payer: Aetna Medicare Advantage	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.90
Rate for Payer: Cigna Commercial	$390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$171.60
Rate for Payer: Qualcare PPO/HMO/WC	$117.00
Rate for Payer: UnitedHealthcare Community & State	$18.80
Rate for Payer: Wellpoint Medicaid Managed Care	$20.67

SCRW 2.7x18MM LOCK 53-27618E

Facility

$780.00

Service Code	HCPCS C1713
Hospital Charge Code	270647780
Hospital Revenue Code	278
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$188.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$171.60
Rate for Payer: Qualcare PPO/HMO/WC	$117.00

SCRW 2.7x20MM LOCK 53-27620E

Facility

$780.00

Hospital Charge Code	270647782
Hospital Revenue Code	278
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$188.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$171.60
Rate for Payer: Qualcare PPO/HMO/WC	$117.00

SCRW 2.7x20MM LOCK 53-27620E

Facility

$780.00

Hospital Charge Code	270647782
Hospital Revenue Code	278
Min. Negotiated Rate	$18.80
Max. Negotiated Rate	$390.00
Rate for Payer: Aetna Commercial	$296.40
Rate for Payer: Aetna Medicare Advantage	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.90
Rate for Payer: Cigna Commercial	$390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$171.60
Rate for Payer: Qualcare PPO/HMO/WC	$117.00
Rate for Payer: UnitedHealthcare Community & State	$18.80
Rate for Payer: Wellpoint Medicaid Managed Care	$20.67

SCRW 2.7x26 NON-LOCK 53-27226E

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	270647779
Hospital Revenue Code	278
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Community & State	$15.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.23

SCRW 2.7x26 NON-LOCK 53-27226E

Facility

$650.00

Service Code	HCPCS C1713
Hospital Charge Code	270647779
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

SCRW 3.5x14 LPNLCK 1312-18-014

Facility

$370.00

Hospital Charge Code	270661587
Hospital Revenue Code	278
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$185.00
Rate for Payer: Aetna Commercial	$140.60
Rate for Payer: Aetna Medicare Advantage	$111.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.35
Rate for Payer: Cigna Commercial	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$81.40
Rate for Payer: Qualcare PPO/HMO/WC	$55.50
Rate for Payer: UnitedHealthcare Community & State	$8.92
Rate for Payer: Wellpoint Medicaid Managed Care	$9.80

SCRW 3.5x14 LPNLCK 1312-18-014

Facility

$370.00

Hospital Charge Code	270661587
Hospital Revenue Code	278
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$89.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$81.40
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

SCRW 3.5x16 LPNLCK 1312-18-016

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	270661582
Hospital Revenue Code	278
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$185.00
Rate for Payer: Aetna Commercial	$140.60
Rate for Payer: Aetna Medicare Advantage	$111.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.35
Rate for Payer: Cigna Commercial	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$81.40
Rate for Payer: Qualcare PPO/HMO/WC	$55.50
Rate for Payer: UnitedHealthcare Community & State	$8.92
Rate for Payer: Wellpoint Medicaid Managed Care	$9.80

SCRW 3.5x16 LPNLCK 1312-18-016

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	270661582
Hospital Revenue Code	278
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$89.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$81.40
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

SCRW 3.5x18 LPNLCK 1312-18-018

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	270661583
Hospital Revenue Code	278
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$89.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$81.40
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

SCRW 3.5x18 LPNLCK 1312-18-018

Facility

$370.00

Service Code	HCPCS C1713
Hospital Charge Code	270661583
Hospital Revenue Code	278
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$185.00
Rate for Payer: Aetna Commercial	$140.60
Rate for Payer: Aetna Medicare Advantage	$111.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.35
Rate for Payer: Cigna Commercial	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$81.40
Rate for Payer: Qualcare PPO/HMO/WC	$55.50
Rate for Payer: UnitedHealthcare Community & State	$8.92
Rate for Payer: Wellpoint Medicaid Managed Care	$9.80

SCRW 3.5x24 LP NLCK1312-18-024

Facility

$350.00

Service Code	HCPCS C1713
Hospital Charge Code	270658896
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$77.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

SCRW 3.5x24 LP NLCK1312-18-024

Facility

$350.00

Service Code	HCPCS C1713
Hospital Charge Code	270658896
Hospital Revenue Code	278
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$77.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

SCRW 3.5x26 LPNLCK 1312-18-026

Facility

$350.00

Hospital Charge Code	270658890
Hospital Revenue Code	278
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$77.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

SCRW 3.5x26 LPNLCK 1312-18-026

Facility

$350.00

Hospital Charge Code	270658890
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$77.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

SCRW 3.5x28 LP NLCK1312-18-028

Facility

$350.00

Hospital Charge Code	270658898
Hospital Revenue Code	278
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$77.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

SCRW 3.5x28 LP NLCK1312-18-028

Facility

$350.00

Hospital Charge Code	270658898
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$77.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

SCRW 3.5x30 LP NLCK1312-18-030

Facility

$350.00

Hospital Charge Code	270658899
Hospital Revenue Code	278
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$77.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

SCRW 3.5x30 LP NLCK1312-18-030

Facility

$350.00

Hospital Charge Code	270658899
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$77.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

Know your out-of-pocket cost for care.

All Charges