Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WEDGE SCREW UNIVERSAL 9x25MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270675671
Hospital Revenue Code	278
Min. Negotiated Rate	$143.25
Max. Negotiated Rate	$231.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$210.10
Rate for Payer: Qualcare PPO/HMO/WC	$143.25

WEDGE SCREW UNIVERSAL 9x25MM

Facility

$955.00

Service Code	HCPCS C1713
Hospital Charge Code	270675671
Hospital Revenue Code	278
Min. Negotiated Rate	$23.02
Max. Negotiated Rate	$477.50
Rate for Payer: Aetna Commercial	$362.90
Rate for Payer: Aetna Medicare Advantage	$286.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.53
Rate for Payer: Cigna Commercial	$477.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$210.10
Rate for Payer: Qualcare PPO/HMO/WC	$143.25
Rate for Payer: UnitedHealthcare Community & State	$23.02
Rate for Payer: Wellpoint Medicaid Managed Care	$25.31

WEDGET EVANS TI /PEEK 18X8MM

Facility

$13,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270686481
Hospital Revenue Code	278
Min. Negotiated Rate	$321.74
Max. Negotiated Rate	$6,675.00
Rate for Payer: Aetna Commercial	$5,073.00
Rate for Payer: Aetna Medicare Advantage	$4,005.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,404.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,404.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,404.25
Rate for Payer: Cigna Commercial	$6,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,230.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,937.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,002.50
Rate for Payer: UnitedHealthcare Community & State	$321.74
Rate for Payer: Wellpoint Medicaid Managed Care	$353.77

WEDGET EVANS TI /PEEK 18X8MM

Facility

$13,350.00

Service Code	HCPCS C1713
Hospital Charge Code	270686481
Hospital Revenue Code	278
Min. Negotiated Rate	$2,002.50
Max. Negotiated Rate	$3,230.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,670.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,230.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,937.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,002.50

WEDGE TIBIAL THIRD 22-DEGREE

Facility

$2,549.65

Hospital Charge Code	270626695
Hospital Revenue Code	278
Min. Negotiated Rate	$382.45
Max. Negotiated Rate	$617.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$509.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$560.92
Rate for Payer: Qualcare PPO/HMO/WC	$382.45

WEDGE TIBIAL THIRD 22-DEGREE

Facility

$2,549.65

Hospital Charge Code	270626695
Hospital Revenue Code	278
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$1,274.83
Rate for Payer: Aetna Commercial	$968.87
Rate for Payer: Aetna Medicare Advantage	$764.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$650.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$650.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$509.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$650.16
Rate for Payer: Cigna Commercial	$1,274.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$560.92
Rate for Payer: Qualcare PPO/HMO/WC	$382.45
Rate for Payer: UnitedHealthcare Community & State	$61.45
Rate for Payer: Wellpoint Medicaid Managed Care	$67.57

WEDGE TRIAL SUBTULAR 10MM

Facility

$18,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270698254
Hospital Revenue Code	278
Min. Negotiated Rate	$448.86
Max. Negotiated Rate	$9,312.50
Rate for Payer: Aetna Commercial	$7,077.50
Rate for Payer: Aetna Medicare Advantage	$5,587.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,749.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,749.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,749.38
Rate for Payer: Cigna Commercial	$9,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,507.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,097.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,793.75
Rate for Payer: UnitedHealthcare Community & State	$448.86
Rate for Payer: Wellpoint Medicaid Managed Care	$493.56

WEDGE TRIAL SUBTULAR 10MM

Facility

$18,625.00

Service Code	HCPCS C1776
Hospital Charge Code	270698254
Hospital Revenue Code	278
Min. Negotiated Rate	$2,793.75
Max. Negotiated Rate	$4,507.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,507.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,097.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,793.75

WEDGE TRI-CORT ILIAC LRG LIWLM

Facility

$3,224.00

Hospital Charge Code	270615746
Hospital Revenue Code	278
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$1,612.00
Rate for Payer: Aetna Commercial	$1,225.12
Rate for Payer: Aetna Medicare Advantage	$967.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$822.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$822.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$644.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$822.12
Rate for Payer: Cigna Commercial	$1,612.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$780.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$709.28
Rate for Payer: Qualcare PPO/HMO/WC	$483.60
Rate for Payer: UnitedHealthcare Community & State	$77.70
Rate for Payer: Wellpoint Medicaid Managed Care	$85.44

WEDGE TRI-CORT ILIAC LRG LIWLM

Facility

$3,224.00

Hospital Charge Code	270615746
Hospital Revenue Code	278
Min. Negotiated Rate	$483.60
Max. Negotiated Rate	$780.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$644.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$780.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$709.28
Rate for Payer: Qualcare PPO/HMO/WC	$483.60

WEDGE ZIM TIB 7 16DEG 59880720

Facility

$4,437.65

Hospital Charge Code	270619816
Hospital Revenue Code	274
Min. Negotiated Rate	$665.65
Max. Negotiated Rate	$1,073.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$887.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,073.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$976.28
Rate for Payer: Qualcare PPO/HMO/WC	$665.65

WEDGE ZIM TIB 7 16DEG 59880720

Facility

$4,437.65

Hospital Charge Code	270619816
Hospital Revenue Code	274
Min. Negotiated Rate	$106.95
Max. Negotiated Rate	$2,218.82
Rate for Payer: Aetna Commercial	$1,686.31
Rate for Payer: Aetna Medicare Advantage	$1,331.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,131.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,131.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$887.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,131.60
Rate for Payer: Cigna Commercial	$2,218.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,073.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$976.28
Rate for Payer: Qualcare PPO/HMO/WC	$665.65
Rate for Payer: UnitedHealthcare Community & State	$106.95
Rate for Payer: Wellpoint Medicaid Managed Care	$117.60

WEDGE ZIM TIB SZ6 5988-06-22

Facility

$4,306.45

Hospital Charge Code	270616163
Hospital Revenue Code	278
Min. Negotiated Rate	$103.79
Max. Negotiated Rate	$2,153.22
Rate for Payer: Aetna Commercial	$1,636.45
Rate for Payer: Aetna Medicare Advantage	$1,291.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,098.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,098.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$861.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,098.14
Rate for Payer: Cigna Commercial	$2,153.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,042.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$947.42
Rate for Payer: Qualcare PPO/HMO/WC	$645.97
Rate for Payer: UnitedHealthcare Community & State	$103.79
Rate for Payer: Wellpoint Medicaid Managed Care	$114.12

WEDGE ZIM TIB SZ6 5988-06-22

Facility

$4,306.45

Hospital Charge Code	270616163
Hospital Revenue Code	278
Min. Negotiated Rate	$645.97
Max. Negotiated Rate	$1,042.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$861.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,042.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$947.42
Rate for Payer: Qualcare PPO/HMO/WC	$645.97

WELLBUTRIN/100MG/TAB

Facility

$5.00

Hospital Charge Code	60634169
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

WELLBUTRIN/100MG/TAB

Facility

$5.00

Hospital Charge Code	60634169
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

WELLBUTRIN/75MG/TAB

Facility

$3.00

Hospital Charge Code	60634236
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

WELLBUTRIN/75MG/TAB

Facility

$3.00

Hospital Charge Code	60634236
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

WELLBUTRIN XL 150MG TABLT

Facility

$21.00

Hospital Charge Code	60635646
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

WELLBUTRIN XL 150MG TABLT

Facility

$21.00

Hospital Charge Code	60635646
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

WELLBUTRIN XL TAB 150MG

Facility

$207.77

Service Code	NDC 187073030
Hospital Charge Code	60629368
Hospital Revenue Code	250
Min. Negotiated Rate	$31.17
Max. Negotiated Rate	$31.17
Rate for Payer: Qualcare PPO/HMO/WC	$31.17

WELLBUTRIN XL TAB 150MG

Facility

$207.77

Service Code	NDC 187073030
Hospital Charge Code	60629368
Hospital Revenue Code	250
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$103.89
Rate for Payer: Aetna Commercial	$78.95
Rate for Payer: Aetna Medicare Advantage	$62.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.98
Rate for Payer: Cigna Commercial	$103.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.33
Rate for Payer: Oxford Commercial	$41.55
Rate for Payer: Qualcare PPO/HMO/WC	$31.17
Rate for Payer: UnitedHealthcare Commercial	$41.55
Rate for Payer: UnitedHealthcare Community & State	$5.01
Rate for Payer: Wellpoint Medicaid Managed Care	$5.51

WESTCORT 0.2%/15GM

Facility

$56.00

Hospital Charge Code	60634171
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

WESTCORT 0.2%/15GM

Facility

$56.00

Hospital Charge Code	60634171
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial	$21.28
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.28
Rate for Payer: Cigna Commercial	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.80
Rate for Payer: Oxford Commercial	$11.20
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Commercial	$11.20
Rate for Payer: UnitedHealthcare Community & State	$1.35
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

WESTCORT 0.2%/45GM

Facility

$107.00

Hospital Charge Code	60634170
Hospital Revenue Code	250
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

Know your out-of-pocket cost for care.

All Charges