Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SWIVELOCK PEEK SELF PUNCH

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270677381
Hospital Revenue Code	278
Min. Negotiated Rate	$48.20
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
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
Rate for Payer: UnitedHealthcare Community & State	$48.20
Rate for Payer: Wellpoint Medicaid Managed Care	$53.00

SWIVELOCK SP PEEK 4.75MM

Facility

$2,420.50

Service Code	HCPCS C1713
Hospital Charge Code	270704916
Hospital Revenue Code	278
Min. Negotiated Rate	$58.33
Max. Negotiated Rate	$1,210.25
Rate for Payer: Aetna Commercial	$919.79
Rate for Payer: Aetna Medicare Advantage	$726.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$617.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$617.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$484.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$617.23
Rate for Payer: Cigna Commercial	$1,210.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$532.51
Rate for Payer: Qualcare PPO/HMO/WC	$363.07
Rate for Payer: UnitedHealthcare Community & State	$58.33
Rate for Payer: Wellpoint Medicaid Managed Care	$64.14

SWIVELOCK SP PEEK 4.75MM

Facility

$2,420.50

Service Code	HCPCS C1713
Hospital Charge Code	270704916
Hospital Revenue Code	278
Min. Negotiated Rate	$363.07
Max. Negotiated Rate	$585.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$484.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$532.51
Rate for Payer: Qualcare PPO/HMO/WC	$363.07

SWIVELOCK TENODESIS 8x19.5MM

Facility

$2,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270664574
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 TENODESIS 8x19.5MM

Facility

$2,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270664574
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 TENODESIS SUT ANCHOR

Facility

$2,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270675047
Hospital Revenue Code	278
Min. Negotiated Rate	$49.41
Max. Negotiated Rate	$1,025.00
Rate for Payer: Aetna Commercial	$779.00
Rate for Payer: Aetna Medicare Advantage	$615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.75
Rate for Payer: Cigna Commercial	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$496.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$451.00
Rate for Payer: Qualcare PPO/HMO/WC	$307.50
Rate for Payer: UnitedHealthcare Community & State	$49.41
Rate for Payer: Wellpoint Medicaid Managed Care	$54.33

SWIVELOCK TENODESIS SUT ANCHOR

Facility

$2,050.00

Service Code	HCPCS C1713
Hospital Charge Code	270675047
Hospital Revenue Code	278
Min. Negotiated Rate	$307.50
Max. Negotiated Rate	$496.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$496.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$451.00
Rate for Payer: Qualcare PPO/HMO/WC	$307.50

SWIVLK BIO-COMP DBL 4.75x22MM

Facility

$2,085.00

Service Code	HCPCS C1713
Hospital Charge Code	270679322
Hospital Revenue Code	278
Min. Negotiated Rate	$50.25
Max. Negotiated Rate	$1,042.50
Rate for Payer: Aetna Commercial	$792.30
Rate for Payer: Aetna Medicare Advantage	$625.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$531.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$531.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$417.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$531.67
Rate for Payer: Cigna Commercial	$1,042.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$504.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$458.70
Rate for Payer: Qualcare PPO/HMO/WC	$312.75
Rate for Payer: UnitedHealthcare Community & State	$50.25
Rate for Payer: Wellpoint Medicaid Managed Care	$55.25

SWIVLK BIO-COMP DBL 4.75x22MM

Facility

$2,085.00

Service Code	HCPCS C1713
Hospital Charge Code	270679322
Hospital Revenue Code	278
Min. Negotiated Rate	$312.75
Max. Negotiated Rate	$504.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$417.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$504.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$458.70
Rate for Payer: Qualcare PPO/HMO/WC	$312.75

SWVLCK PEK SLF PNCH 5.5x24.5MM

Facility

$2,540.00

Hospital Charge Code	270679783
Hospital Revenue Code	272
Min. Negotiated Rate	$381.00
Max. Negotiated Rate	$381.00
Rate for Payer: Qualcare PPO/HMO/WC	$381.00

SWVLCK PEK SLF PNCH 5.5x24.5MM

Facility

$2,540.00

Hospital Charge Code	270679783
Hospital Revenue Code	272
Min. Negotiated Rate	$61.21
Max. Negotiated Rate	$1,270.00
Rate for Payer: Aetna Commercial	$965.20
Rate for Payer: Aetna Medicare Advantage	$762.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$647.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$647.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$647.70
Rate for Payer: Cigna Commercial	$1,270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.00
Rate for Payer: Oxford Commercial	$508.00
Rate for Payer: Qualcare PPO/HMO/WC	$381.00
Rate for Payer: UnitedHealthcare Commercial	$508.00
Rate for Payer: UnitedHealthcare Community & State	$61.21
Rate for Payer: Wellpoint Medicaid Managed Care	$67.31

SWVLK TENO BIO-COMP 7x19.5MM

Facility

$2,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270675046
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

SWVLK TENO BIO-COMP 7x19.5MM

Facility

$2,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270675046
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

SWWLK SP 5.5X 24.5MM

Facility

$420.00

Hospital Charge Code	270687031
Hospital Revenue Code	272
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$159.60
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.00
Rate for Payer: Oxford Commercial	$84.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.00
Rate for Payer: UnitedHealthcare Commercial	$84.00
Rate for Payer: UnitedHealthcare Community & State	$10.12
Rate for Payer: Wellpoint Medicaid Managed Care	$11.13

SWWLK SP 5.5X 24.5MM

Facility

$420.00

Hospital Charge Code	270687031
Hospital Revenue Code	272
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$63.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.00

SYMBOTEX

Facility

$2,113.55

Hospital Charge Code	270665437
Hospital Revenue Code	278
Min. Negotiated Rate	$50.94
Max. Negotiated Rate	$1,056.78
Rate for Payer: Aetna Commercial	$803.15
Rate for Payer: Aetna Medicare Advantage	$634.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$538.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$538.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$422.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$538.96
Rate for Payer: Cigna Commercial	$1,056.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$511.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$464.98
Rate for Payer: Qualcare PPO/HMO/WC	$317.03
Rate for Payer: UnitedHealthcare Community & State	$50.94
Rate for Payer: Wellpoint Medicaid Managed Care	$56.01

SYMBOTEX

Facility

$2,113.55

Hospital Charge Code	270665437
Hospital Revenue Code	278
Min. Negotiated Rate	$317.03
Max. Negotiated Rate	$511.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$422.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$511.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$464.98
Rate for Payer: Qualcare PPO/HMO/WC	$317.03

SYMBOTEX COMPOSIT MESH 30 X 20

Facility

$9,144.05

Service Code	HCPCS C1781
Hospital Charge Code	270678857
Hospital Revenue Code	278
Min. Negotiated Rate	$220.37
Max. Negotiated Rate	$4,572.02
Rate for Payer: Aetna Commercial	$3,474.74
Rate for Payer: Aetna Medicare Advantage	$2,743.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,331.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,331.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,828.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,331.73
Rate for Payer: Cigna Commercial	$4,572.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,212.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,011.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,371.61
Rate for Payer: UnitedHealthcare Community & State	$220.37
Rate for Payer: Wellpoint Medicaid Managed Care	$242.32

SYMBOTEX COMPOSIT MESH 30 X 20

Facility

$9,144.05

Service Code	HCPCS C1781
Hospital Charge Code	270678857
Hospital Revenue Code	278
Min. Negotiated Rate	$1,371.61
Max. Negotiated Rate	$2,212.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,828.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,212.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,011.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,371.61

SYMBOTEX COMPOSIT MESH 37 BY 2

Facility

$10,701.90

Service Code	HCPCS C1781
Hospital Charge Code	270678858
Hospital Revenue Code	278
Min. Negotiated Rate	$257.92
Max. Negotiated Rate	$5,350.95
Rate for Payer: Aetna Commercial	$4,066.72
Rate for Payer: Aetna Medicare Advantage	$3,210.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,728.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,728.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,140.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,728.98
Rate for Payer: Cigna Commercial	$5,350.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,589.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,354.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,605.29
Rate for Payer: UnitedHealthcare Community & State	$257.92
Rate for Payer: Wellpoint Medicaid Managed Care	$283.60

SYMBOTEX COMPOSIT MESH 37 BY 2

Facility

$10,701.90

Service Code	HCPCS C1781
Hospital Charge Code	270678858
Hospital Revenue Code	278
Min. Negotiated Rate	$1,605.29
Max. Negotiated Rate	$2,589.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,140.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,589.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,354.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,605.29

SYMBOTEX COMPOSIT MESH 42 X 32

Facility

$12,844.10

Service Code	HCPCS C1781
Hospital Charge Code	270678859
Hospital Revenue Code	278
Min. Negotiated Rate	$309.54
Max. Negotiated Rate	$6,422.05
Rate for Payer: Aetna Commercial	$4,880.76
Rate for Payer: Aetna Medicare Advantage	$3,853.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,275.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,275.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,568.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,275.25
Rate for Payer: Cigna Commercial	$6,422.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,108.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,825.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,926.62
Rate for Payer: UnitedHealthcare Community & State	$309.54
Rate for Payer: Wellpoint Medicaid Managed Care	$340.37

SYMBOTEX COMPOSIT MESH 42 X 32

Facility

$12,844.10

Service Code	HCPCS C1781
Hospital Charge Code	270678859
Hospital Revenue Code	278
Min. Negotiated Rate	$1,926.62
Max. Negotiated Rate	$3,108.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,568.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,108.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,825.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,926.62

SYMMETREL/100MG/CAP

Facility

$3.00

Hospital Charge Code	60633942
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

SYMMETREL/100MG/CAP

Facility

$3.00

Hospital Charge Code	60633942
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

Know your out-of-pocket cost for care.

All Charges