Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SCRW ZIM COMP HX 1 47-1162-21

Facility

$183.80

Hospital Charge Code	270602003
Hospital Revenue Code	278
Min. Negotiated Rate	$27.57
Max. Negotiated Rate	$44.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$40.44
Rate for Payer: Qualcare PPO/HMO/WC	$27.57

SCRW ZIM CORT 4.5 38M 48453801

Facility

$63.75

Hospital Charge Code	270601791
Hospital Revenue Code	272
Min. Negotiated Rate	$9.56
Max. Negotiated Rate	$9.56
Rate for Payer: Qualcare PPO/HMO/WC	$9.56

SCRW ZIM CORT 4.5 38M 48453801

Facility

$63.75

Hospital Charge Code	270601791
Hospital Revenue Code	272
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$31.88
Rate for Payer: Aetna Commercial	$24.23
Rate for Payer: Aetna Medicare Advantage	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.26
Rate for Payer: Cigna Commercial	$31.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.12
Rate for Payer: Oxford Commercial	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.56
Rate for Payer: UnitedHealthcare Commercial	$12.75
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.69

SCW BO SELFTAP 6.5x20m62506520

Facility

$534.50

Service Code	HCPCS C1713
Hospital Charge Code	270638665
Hospital Revenue Code	278
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$267.25
Rate for Payer: Aetna Commercial	$203.11
Rate for Payer: Aetna Medicare Advantage	$160.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.30
Rate for Payer: Cigna Commercial	$267.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$117.59
Rate for Payer: Qualcare PPO/HMO/WC	$80.17
Rate for Payer: UnitedHealthcare Community & State	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$14.16

SCW BO SELFTAP 6.5x20m62506520

Facility

$534.50

Service Code	HCPCS C1713
Hospital Charge Code	270638665
Hospital Revenue Code	278
Min. Negotiated Rate	$80.17
Max. Negotiated Rate	$129.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$117.59
Rate for Payer: Qualcare PPO/HMO/WC	$80.17

SCW CAN SHT THD 3 X 38MM

Facility

$962.50

Service Code	HCPCS C1713
Hospital Charge Code	270701646
Hospital Revenue Code	278
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$481.25
Rate for Payer: Aetna Commercial	$365.75
Rate for Payer: Aetna Medicare Advantage	$288.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$245.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$245.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$245.44
Rate for Payer: Cigna Commercial	$481.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$144.38
Rate for Payer: UnitedHealthcare Community & State	$23.20
Rate for Payer: Wellpoint Medicaid Managed Care	$25.51

SCW CAN SHT THD 3 X 38MM

Facility

$962.50

Service Code	HCPCS C1713
Hospital Charge Code	270701646
Hospital Revenue Code	278
Min. Negotiated Rate	$144.38
Max. Negotiated Rate	$232.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$144.38

SCW CAN SHT THD 4 X 46MM

Facility

$1,086.25

Service Code	HCPCS C1713
Hospital Charge Code	270701644
Hospital Revenue Code	278
Min. Negotiated Rate	$162.94
Max. Negotiated Rate	$262.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.97
Rate for Payer: Qualcare PPO/HMO/WC	$162.94

SCW CAN SHT THD 4 X 46MM

Facility

$1,086.25

Service Code	HCPCS C1713
Hospital Charge Code	270701644
Hospital Revenue Code	278
Min. Negotiated Rate	$26.18
Max. Negotiated Rate	$543.12
Rate for Payer: Aetna Commercial	$412.77
Rate for Payer: Aetna Medicare Advantage	$325.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.99
Rate for Payer: Cigna Commercial	$543.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.97
Rate for Payer: Qualcare PPO/HMO/WC	$162.94
Rate for Payer: UnitedHealthcare Community & State	$26.18
Rate for Payer: Wellpoint Medicaid Managed Care	$28.79

SCW CAN THD HD 2.7 X 16MM

Facility

$1,086.25

Service Code	HCPCS C1713
Hospital Charge Code	270701643
Hospital Revenue Code	278
Min. Negotiated Rate	$26.18
Max. Negotiated Rate	$543.12
Rate for Payer: Aetna Commercial	$412.77
Rate for Payer: Aetna Medicare Advantage	$325.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.99
Rate for Payer: Cigna Commercial	$543.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.97
Rate for Payer: Qualcare PPO/HMO/WC	$162.94
Rate for Payer: UnitedHealthcare Community & State	$26.18
Rate for Payer: Wellpoint Medicaid Managed Care	$28.79

SCW CAN THD HD 2.7 X 16MM

Facility

$1,086.25

Service Code	HCPCS C1713
Hospital Charge Code	270701643
Hospital Revenue Code	278
Min. Negotiated Rate	$162.94
Max. Negotiated Rate	$262.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$238.97
Rate for Payer: Qualcare PPO/HMO/WC	$162.94

SCW LKNG R3CON 2.7 X 34MM

Facility

$907.50

Service Code	HCPCS C1713
Hospital Charge Code	270702045
Hospital Revenue Code	278
Min. Negotiated Rate	$21.87
Max. Negotiated Rate	$453.75
Rate for Payer: Aetna Commercial	$344.85
Rate for Payer: Aetna Medicare Advantage	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.41
Rate for Payer: Cigna Commercial	$453.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$199.65
Rate for Payer: Qualcare PPO/HMO/WC	$136.12
Rate for Payer: UnitedHealthcare Community & State	$21.87
Rate for Payer: Wellpoint Medicaid Managed Care	$24.05

SCW LKNG R3CON 2.7 X 34MM

Facility

$907.50

Service Code	HCPCS C1713
Hospital Charge Code	270702045
Hospital Revenue Code	278
Min. Negotiated Rate	$136.12
Max. Negotiated Rate	$219.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$199.65
Rate for Payer: Qualcare PPO/HMO/WC	$136.12

SCW LKNG R3CON 3.5 X 26MM

Facility

$907.50

Service Code	HCPCS C1713
Hospital Charge Code	270702047
Hospital Revenue Code	278
Min. Negotiated Rate	$136.12
Max. Negotiated Rate	$219.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$199.65
Rate for Payer: Qualcare PPO/HMO/WC	$136.12

SCW LKNG R3CON 3.5 X 26MM

Facility

$907.50

Service Code	HCPCS C1713
Hospital Charge Code	270702047
Hospital Revenue Code	278
Min. Negotiated Rate	$21.87
Max. Negotiated Rate	$453.75
Rate for Payer: Aetna Commercial	$344.85
Rate for Payer: Aetna Medicare Advantage	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.41
Rate for Payer: Cigna Commercial	$453.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$199.65
Rate for Payer: Qualcare PPO/HMO/WC	$136.12
Rate for Payer: UnitedHealthcare Community & State	$21.87
Rate for Payer: Wellpoint Medicaid Managed Care	$24.05

SCW LKNG R3CON 3.5X36MM

Facility

$660.00

Service Code	HCPCS C1716
Hospital Charge Code	270701596
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$159.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$99.00

SCW LKNG R3CON 3.5X36MM

Facility

$660.00

Service Code	HCPCS C1716
Hospital Charge Code	270701596
Hospital Revenue Code	278
Min. Negotiated Rate	$15.91
Max. Negotiated Rate	$2,155.71
Rate for Payer: Aetna Commercial	$1,624.38
Rate for Payer: Aetna Medicare Advantage	$1,934.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,155.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,155.71
Rate for Payer: Cigna Commercial	$1,197.08
Rate for Payer: Cigna Medicare Advantage	$597.20
Rate for Payer: Clover Medicare Advantage	$567.34
Rate for Payer: EmblemHealth Commercial	$1,791.60
Rate for Payer: Humana Medicare Advantage	$615.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$597.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$99.00
Rate for Payer: UnitedHealthcare Community & State	$15.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$597.20
Rate for Payer: Wellcare Medicare Advantage	$597.20
Rate for Payer: Wellpoint Medicaid Managed Care	$17.49

SCW NCB UNICORTICAL 5.0 L = 26

Facility

$962.50

Service Code	HCPCS C1713
Hospital Charge Code	270704922
Hospital Revenue Code	278
Min. Negotiated Rate	$144.38
Max. Negotiated Rate	$232.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$144.38

SCW NCB UNICORTICAL 5.0 L = 26

Facility

$962.50

Service Code	HCPCS C1713
Hospital Charge Code	270704922
Hospital Revenue Code	278
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$481.25
Rate for Payer: Aetna Commercial	$365.75
Rate for Payer: Aetna Medicare Advantage	$288.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$245.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$245.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$245.44
Rate for Payer: Cigna Commercial	$481.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$144.38
Rate for Payer: UnitedHealthcare Community & State	$23.20
Rate for Payer: Wellpoint Medicaid Managed Care	$25.51

SCW N-LKNG PIT 3.5 X 30MM R3CO

Facility

$660.00

Service Code	HCPCS C1713
Hospital Charge Code	270701495
Hospital Revenue Code	278
Min. Negotiated Rate	$15.91
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$250.80
Rate for Payer: Aetna Medicare Advantage	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.30
Rate for Payer: Cigna Commercial	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$99.00
Rate for Payer: UnitedHealthcare Community & State	$15.91
Rate for Payer: Wellpoint Medicaid Managed Care	$17.49

SCW N-LKNG PIT 3.5 X 30MM R3CO

Facility

$660.00

Service Code	HCPCS C1713
Hospital Charge Code	270701495
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$159.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$99.00

SCW N-LKNG PIT 3.5 X 40MM R3CO

Facility

$907.50

Service Code	HCPCS C1713
Hospital Charge Code	270701496
Hospital Revenue Code	278
Min. Negotiated Rate	$21.87
Max. Negotiated Rate	$453.75
Rate for Payer: Aetna Commercial	$344.85
Rate for Payer: Aetna Medicare Advantage	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.41
Rate for Payer: Cigna Commercial	$453.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$199.65
Rate for Payer: Qualcare PPO/HMO/WC	$136.12
Rate for Payer: UnitedHealthcare Community & State	$21.87
Rate for Payer: Wellpoint Medicaid Managed Care	$24.05

SCW N-LKNG PIT 3.5 X 40MM R3CO

Facility

$907.50

Service Code	HCPCS C1713
Hospital Charge Code	270701496
Hospital Revenue Code	278
Min. Negotiated Rate	$136.12
Max. Negotiated Rate	$219.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$199.65
Rate for Payer: Qualcare PPO/HMO/WC	$136.12

SCW R3CON N-LKNGPIT 3.5 X 22MM

Facility

$612.00

Hospital Charge Code	270701955
Hospital Revenue Code	278
Min. Negotiated Rate	$14.75
Max. Negotiated Rate	$306.00
Rate for Payer: Aetna Commercial	$232.56
Rate for Payer: Aetna Medicare Advantage	$183.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.06
Rate for Payer: Cigna Commercial	$306.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$134.64
Rate for Payer: Qualcare PPO/HMO/WC	$91.80
Rate for Payer: UnitedHealthcare Community & State	$14.75
Rate for Payer: Wellpoint Medicaid Managed Care	$16.22

SCW R3CON N-LKNGPIT 3.5 X 22MM

Facility

$612.00

Hospital Charge Code	270701955
Hospital Revenue Code	278
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$148.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$122.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$134.64
Rate for Payer: Qualcare PPO/HMO/WC	$91.80

Know your out-of-pocket cost for care.

All Charges