Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SWIVELOCK BIO-COMP-TENCO 6.25x

Facility

$2,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270684943
Hospital Revenue Code	278
Min. Negotiated Rate	$48.80
Max. Negotiated Rate	$1,012.50
Rate for Payer: Aetna Commercial	$769.50
Rate for Payer: Aetna Medicare Advantage	$607.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$516.38
Rate for Payer: Cigna Commercial	$1,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$445.50
Rate for Payer: Qualcare PPO/HMO/WC	$303.75
Rate for Payer: UnitedHealthcare Community & State	$48.80
Rate for Payer: Wellpoint Medicaid Managed Care	$53.66

SWIVELOCK BIO-COMP-TENCO 6.25x

Facility

$2,025.00

Service Code	HCPCS C1713
Hospital Charge Code	270684943
Hospital Revenue Code	278
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$490.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$445.50
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

SWIVELOCK DISP KIT 2.5x3.8MM

Facility

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270677961
Hospital Revenue Code	278
Min. Negotiated Rate	$206.25
Max. Negotiated Rate	$332.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$206.25

SWIVELOCK DISP KIT 2.5x3.8MM

Facility

$1,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270677961
Hospital Revenue Code	278
Min. Negotiated Rate	$33.14
Max. Negotiated Rate	$687.50
Rate for Payer: Aetna Commercial	$522.50
Rate for Payer: Aetna Medicare Advantage	$412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.62
Rate for Payer: Cigna Commercial	$687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$206.25
Rate for Payer: UnitedHealthcare Community & State	$33.14
Rate for Payer: Wellpoint Medicaid Managed Care	$36.44

SWIVELOCK DOUBLE 5.5

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680965
Hospital Revenue Code	278
Min. Negotiated Rate	$51.21
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$807.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$467.50
Rate for Payer: Qualcare PPO/HMO/WC	$318.75
Rate for Payer: UnitedHealthcare Community & State	$51.21
Rate for Payer: Wellpoint Medicaid Managed Care	$56.31

SWIVELOCK DOUBLE 5.5

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680961
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$514.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$467.50
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

SWIVELOCK DOUBLE 5.5

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680961
Hospital Revenue Code	278
Min. Negotiated Rate	$51.21
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$807.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$467.50
Rate for Payer: Qualcare PPO/HMO/WC	$318.75
Rate for Payer: UnitedHealthcare Community & State	$51.21
Rate for Payer: Wellpoint Medicaid Managed Care	$56.31

SWIVELOCK DOUBLE 5.5

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680965
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$514.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$467.50
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

SWIVELOCK DX 3.5 X13.5

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270691416
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$514.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$467.50
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

SWIVELOCK DX 3.5 X13.5

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270691416
Hospital Revenue Code	278
Min. Negotiated Rate	$51.21
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$807.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$467.50
Rate for Payer: Qualcare PPO/HMO/WC	$318.75
Rate for Payer: UnitedHealthcare Community & State	$51.21
Rate for Payer: Wellpoint Medicaid Managed Care	$56.31

SWIVELOCK IMPLANT SYSTEM

Facility

$3,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270676064
Hospital Revenue Code	278
Min. Negotiated Rate	$77.12
Max. Negotiated Rate	$1,600.00
Rate for Payer: Aetna Commercial	$1,216.00
Rate for Payer: Aetna Medicare Advantage	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$640.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$816.00
Rate for Payer: Cigna Commercial	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$774.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$704.00
Rate for Payer: Qualcare PPO/HMO/WC	$480.00
Rate for Payer: UnitedHealthcare Community & State	$77.12
Rate for Payer: Wellpoint Medicaid Managed Care	$84.80

SWIVELOCK IMPLANT SYSTEM

Facility

$3,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270676064
Hospital Revenue Code	278
Min. Negotiated Rate	$480.00
Max. Negotiated Rate	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$774.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$704.00
Rate for Payer: Qualcare PPO/HMO/WC	$480.00

SWIVELOCK KNOTLESS ANCHOR 5.5M

Facility

$2,549.25

Service Code	HCPCS C1713
Hospital Charge Code	270702941
Hospital Revenue Code	278
Min. Negotiated Rate	$61.44
Max. Negotiated Rate	$1,274.62
Rate for Payer: Aetna Commercial	$968.72
Rate for Payer: Aetna Medicare Advantage	$764.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$650.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$650.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$509.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$650.06
Rate for Payer: Cigna Commercial	$1,274.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$616.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$560.84
Rate for Payer: Qualcare PPO/HMO/WC	$382.39
Rate for Payer: UnitedHealthcare Community & State	$61.44
Rate for Payer: Wellpoint Medicaid Managed Care	$67.56

SWIVELOCK KNOTLESS ANCHOR 5.5M

Facility

$2,549.25

Service Code	HCPCS C1713
Hospital Charge Code	270702941
Hospital Revenue Code	278
Min. Negotiated Rate	$382.39
Max. Negotiated Rate	$616.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$509.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$616.92
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$560.84
Rate for Payer: Qualcare PPO/HMO/WC	$382.39

SWIVELOCK MINI 3.5x8.5MM

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270677960
Hospital Revenue Code	278
Min. Negotiated Rate	$51.21
Max. Negotiated Rate	$1,062.50
Rate for Payer: Aetna Commercial	$807.50
Rate for Payer: Aetna Medicare Advantage	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.88
Rate for Payer: Cigna Commercial	$1,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$467.50
Rate for Payer: Qualcare PPO/HMO/WC	$318.75
Rate for Payer: UnitedHealthcare Community & State	$51.21
Rate for Payer: Wellpoint Medicaid Managed Care	$56.31

SWIVELOCK MINI 3.5x8.5MM

Facility

$2,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270677960
Hospital Revenue Code	278
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$514.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$514.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$467.50
Rate for Payer: Qualcare PPO/HMO/WC	$318.75

SWIVELOCK NANO DISP KIT

Facility

$1,475.00

Hospital Charge Code	270691848
Hospital Revenue Code	272
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$221.25
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

SWIVELOCK NANO DISP KIT

Facility

$1,475.00

Hospital Charge Code	270691848
Hospital Revenue Code	272
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.50
Rate for Payer: Oxford Commercial	$295.00
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Commercial	$295.00
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$39.09

SWIVELOCK PEEK 4.75MM

Facility

$425.00

Hospital Charge Code	270678031
Hospital Revenue Code	272
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.50
Rate for Payer: Oxford Commercial	$85.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$85.00
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

SWIVELOCK PEEK 4.75MM

Facility

$425.00

Hospital Charge Code	270678031
Hospital Revenue Code	272
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

SWIVELOCK PEEK 4.75X19.1MM

Facility

$1,945.00

Service Code	HCPCS C1713
Hospital Charge Code	270674852
Hospital Revenue Code	278
Min. Negotiated Rate	$46.87
Max. Negotiated Rate	$972.50
Rate for Payer: Aetna Commercial	$739.10
Rate for Payer: Aetna Medicare Advantage	$583.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$495.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$495.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$389.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$495.98
Rate for Payer: Cigna Commercial	$972.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$470.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$427.90
Rate for Payer: Qualcare PPO/HMO/WC	$291.75
Rate for Payer: UnitedHealthcare Community & State	$46.87
Rate for Payer: Wellpoint Medicaid Managed Care	$51.54

SWIVELOCK PEEK 4.75X19.1MM

Facility

$1,945.00

Service Code	HCPCS C1713
Hospital Charge Code	270674852
Hospital Revenue Code	278
Min. Negotiated Rate	$291.75
Max. Negotiated Rate	$470.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$389.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$470.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$427.90
Rate for Payer: Qualcare PPO/HMO/WC	$291.75

SWIVELOCK PEEK KNOTLESS 4.75MM

Facility

$2,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270694729
Hospital Revenue Code	278
Min. Negotiated Rate	$326.25
Max. Negotiated Rate	$526.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$435.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$526.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$478.50
Rate for Payer: Qualcare PPO/HMO/WC	$326.25

SWIVELOCK PEEK KNOTLESS 4.75MM

Facility

$2,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270694729
Hospital Revenue Code	278
Min. Negotiated Rate	$52.42
Max. Negotiated Rate	$1,087.50
Rate for Payer: Aetna Commercial	$826.50
Rate for Payer: Aetna Medicare Advantage	$652.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$554.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$554.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$554.62
Rate for Payer: Cigna Commercial	$1,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$526.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$478.50
Rate for Payer: Qualcare PPO/HMO/WC	$326.25
Rate for Payer: UnitedHealthcare Community & State	$52.42
Rate for Payer: Wellpoint Medicaid Managed Care	$57.64

SWIVELOCK PEEK SELF PUNCH

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270677381
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$440.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

Know your out-of-pocket cost for care.

All Charges