Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

WIRE CERCLAGE COILS 1.25MM

Facility

$283.50

Service Code	HCPCS C1713
Hospital Charge Code	270676854
Hospital Revenue Code	278
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$141.75
Rate for Payer: Aetna Commercial	$107.73
Rate for Payer: Aetna Medicare Advantage	$85.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.29
Rate for Payer: Cigna Commercial	$141.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$62.37
Rate for Payer: Qualcare PPO/HMO/WC	$42.52
Rate for Payer: UnitedHealthcare Community & State	$6.83
Rate for Payer: Wellpoint Medicaid Managed Care	$7.51

WIRE CERCLAGE COILS 1.25MM

Facility

$283.50

Service Code	HCPCS C1713
Hospital Charge Code	270676854
Hospital Revenue Code	278
Min. Negotiated Rate	$42.52
Max. Negotiated Rate	$68.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$62.37
Rate for Payer: Qualcare PPO/HMO/WC	$42.52

WIRE CERCLAGE W/EYE 1.25x280MM

Facility

$346.10

Hospital Charge Code	270653107
Hospital Revenue Code	278
Min. Negotiated Rate	$8.34
Max. Negotiated Rate	$173.05
Rate for Payer: Aetna Commercial	$131.52
Rate for Payer: Aetna Medicare Advantage	$103.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.26
Rate for Payer: Cigna Commercial	$173.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$76.14
Rate for Payer: Qualcare PPO/HMO/WC	$51.91
Rate for Payer: UnitedHealthcare Community & State	$8.34
Rate for Payer: Wellpoint Medicaid Managed Care	$9.17

WIRE CERCLAGE W/EYE 1.25x280MM

Facility

$346.10

Hospital Charge Code	270653107
Hospital Revenue Code	278
Min. Negotiated Rate	$51.91
Max. Negotiated Rate	$83.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$76.14
Rate for Payer: Qualcare PPO/HMO/WC	$51.91

WIRE CERCLAGE W EYE 1.25X600MM

Facility

$1,620.00

Service Code	HCPCS C1713
Hospital Charge Code	270700110
Hospital Revenue Code	278
Min. Negotiated Rate	$39.04
Max. Negotiated Rate	$810.00
Rate for Payer: Aetna Commercial	$615.60
Rate for Payer: Aetna Medicare Advantage	$486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$413.10
Rate for Payer: Cigna Commercial	$810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$356.40
Rate for Payer: Qualcare PPO/HMO/WC	$243.00
Rate for Payer: UnitedHealthcare Community & State	$39.04
Rate for Payer: Wellpoint Medicaid Managed Care	$42.93

WIRE CERCLAGE W EYE 1.25X600MM

Facility

$1,620.00

Service Code	HCPCS C1713
Hospital Charge Code	270700110
Hospital Revenue Code	278
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$392.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$356.40
Rate for Payer: Qualcare PPO/HMO/WC	$243.00

WIRE CK GUIDE .035 TFLN 635413

Facility

$72.85

Hospital Charge Code	270614881
Hospital Revenue Code	272
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$10.93
Rate for Payer: Qualcare PPO/HMO/WC	$10.93

WIRE CK GUIDE .035 TFLN 635413

Facility

$72.85

Hospital Charge Code	270614881
Hospital Revenue Code	272
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.42
Rate for Payer: Aetna Commercial	$27.68
Rate for Payer: Aetna Medicare Advantage	$21.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.58
Rate for Payer: Cigna Commercial	$36.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.86
Rate for Payer: Oxford Commercial	$14.57
Rate for Payer: Qualcare PPO/HMO/WC	$10.93
Rate for Payer: UnitedHealthcare Commercial	$14.57
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

WIRE CK GUIDE .035 TSCM35125-3

Facility

$60.85

Hospital Charge Code	270606106
Hospital Revenue Code	272
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.43
Rate for Payer: Aetna Commercial	$23.12
Rate for Payer: Aetna Medicare Advantage	$18.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.52
Rate for Payer: Cigna Commercial	$30.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.25
Rate for Payer: Oxford Commercial	$12.17
Rate for Payer: Qualcare PPO/HMO/WC	$9.13
Rate for Payer: UnitedHealthcare Commercial	$12.17
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.61

WIRE CK GUIDE .035 TSCM35125-3

Facility

$60.85

Hospital Charge Code	270606106
Hospital Revenue Code	272
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$9.13
Rate for Payer: Qualcare PPO/HMO/WC	$9.13

WIRE CK GUIDE STIFF LQT 256889

Facility

$333.65

Hospital Charge Code	270629601
Hospital Revenue Code	272
Min. Negotiated Rate	$50.05
Max. Negotiated Rate	$50.05
Rate for Payer: Qualcare PPO/HMO/WC	$50.05

WIRE CK GUIDE STIFF LQT 256889

Facility

$333.65

Hospital Charge Code	270629601
Hospital Revenue Code	272
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$166.82
Rate for Payer: Aetna Commercial	$126.79
Rate for Payer: Aetna Medicare Advantage	$100.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.08
Rate for Payer: Cigna Commercial	$166.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.09
Rate for Payer: Oxford Commercial	$66.73
Rate for Payer: Qualcare PPO/HMO/WC	$50.05
Rate for Payer: UnitedHealthcare Commercial	$66.73
Rate for Payer: UnitedHealthcare Community & State	$8.04
Rate for Payer: Wellpoint Medicaid Managed Care	$8.84

WIRE CK GUIDE TSCM-35-145-3

Facility

$106.45

Hospital Charge Code	270601489
Hospital Revenue Code	272
Min. Negotiated Rate	$15.97
Max. Negotiated Rate	$15.97
Rate for Payer: Qualcare PPO/HMO/WC	$15.97

WIRE CK GUIDE TSCM-35-145-3

Facility

$106.45

Hospital Charge Code	270601489
Hospital Revenue Code	272
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$53.23
Rate for Payer: Aetna Commercial	$40.45
Rate for Payer: Aetna Medicare Advantage	$31.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.14
Rate for Payer: Cigna Commercial	$53.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.93
Rate for Payer: Oxford Commercial	$21.29
Rate for Payer: Qualcare PPO/HMO/WC	$15.97
Rate for Payer: UnitedHealthcare Commercial	$21.29
Rate for Payer: UnitedHealthcare Community & State	$2.57
Rate for Payer: Wellpoint Medicaid Managed Care	$2.82

WIRE CK GUIDE TSCM-38-145-3

Facility

$145.65

Hospital Charge Code	270601255
Hospital Revenue Code	272
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$72.83
Rate for Payer: Aetna Commercial	$55.35
Rate for Payer: Aetna Medicare Advantage	$43.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.14
Rate for Payer: Cigna Commercial	$72.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.70
Rate for Payer: Oxford Commercial	$29.13
Rate for Payer: Qualcare PPO/HMO/WC	$21.85
Rate for Payer: UnitedHealthcare Commercial	$29.13
Rate for Payer: UnitedHealthcare Community & State	$3.51
Rate for Payer: Wellpoint Medicaid Managed Care	$3.86

WIRE CK GUIDE TSCM-38-145-3

Facility

$145.65

Hospital Charge Code	270601255
Hospital Revenue Code	272
Min. Negotiated Rate	$21.85
Max. Negotiated Rate	$21.85
Rate for Payer: Qualcare PPO/HMO/WC	$21.85

WIRE CK GUIDE TSFB-35-145

Facility

$87.25

Hospital Charge Code	270601468
Hospital Revenue Code	272
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$13.09
Rate for Payer: Qualcare PPO/HMO/WC	$13.09

WIRE CK GUIDE TSFB-35-145

Facility

$87.25

Hospital Charge Code	270601468
Hospital Revenue Code	272
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$43.62
Rate for Payer: Aetna Commercial	$33.16
Rate for Payer: Aetna Medicare Advantage	$26.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.25
Rate for Payer: Cigna Commercial	$43.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.18
Rate for Payer: Oxford Commercial	$17.45
Rate for Payer: Qualcare PPO/HMO/WC	$13.09
Rate for Payer: UnitedHealthcare Commercial	$17.45
Rate for Payer: UnitedHealthcare Community & State	$2.10
Rate for Payer: Wellpoint Medicaid Managed Care	$2.31

WIRE CLAMP

Facility

$1,145.00

Hospital Charge Code	270657015
Hospital Revenue Code	270
Min. Negotiated Rate	$27.59
Max. Negotiated Rate	$572.50
Rate for Payer: Aetna Commercial	$435.10
Rate for Payer: Aetna Medicare Advantage	$343.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$291.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$291.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$291.98
Rate for Payer: Cigna Commercial	$572.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$343.50
Rate for Payer: Oxford Commercial	$229.00
Rate for Payer: Qualcare PPO/HMO/WC	$171.75
Rate for Payer: UnitedHealthcare Commercial	$229.00
Rate for Payer: UnitedHealthcare Community & State	$27.59
Rate for Payer: Wellpoint Medicaid Managed Care	$30.34

WIRE CLAMP

Facility

$1,145.00

Hospital Charge Code	270657015
Hospital Revenue Code	270
Min. Negotiated Rate	$171.75
Max. Negotiated Rate	$171.75
Rate for Payer: Qualcare PPO/HMO/WC	$171.75

WIRE COMP 2.8x20MM/200MM

Facility

$253.00

Service Code	HCPCS C1713
Hospital Charge Code	270683073
Hospital Revenue Code	278
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$61.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.66
Rate for Payer: Qualcare PPO/HMO/WC	$37.95

WIRE COMP 2.8x20MM/200MM

Facility

$253.00

Service Code	HCPCS C1713
Hospital Charge Code	270683073
Hospital Revenue Code	278
Min. Negotiated Rate	$6.10
Max. Negotiated Rate	$126.50
Rate for Payer: Aetna Commercial	$96.14
Rate for Payer: Aetna Medicare Advantage	$75.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.52
Rate for Payer: Cigna Commercial	$126.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.66
Rate for Payer: Qualcare PPO/HMO/WC	$37.95
Rate for Payer: UnitedHealthcare Community & State	$6.10
Rate for Payer: Wellpoint Medicaid Managed Care	$6.70

WIRE COMPR 10MM THD 1.6x150MM

Facility

$189.00

Hospital Charge Code	270677233
Hospital Revenue Code	272
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$28.35
Rate for Payer: Qualcare PPO/HMO/WC	$28.35

WIRE COMPR 10MM THD 1.6x150MM

Facility

$189.00

Hospital Charge Code	270677233
Hospital Revenue Code	272
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna Commercial	$71.82
Rate for Payer: Aetna Medicare Advantage	$56.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.20
Rate for Payer: Cigna Commercial	$94.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.70
Rate for Payer: Oxford Commercial	$37.80
Rate for Payer: Qualcare PPO/HMO/WC	$28.35
Rate for Payer: UnitedHealthcare Commercial	$37.80
Rate for Payer: UnitedHealthcare Community & State	$4.55
Rate for Payer: Wellpoint Medicaid Managed Care	$5.01

WIRE COMPR 15MM THD 150MM

Facility

$200.50

Hospital Charge Code	270675951
Hospital Revenue Code	272
Min. Negotiated Rate	$30.07
Max. Negotiated Rate	$30.07
Rate for Payer: Qualcare PPO/HMO/WC	$30.07

Know your out-of-pocket cost for care.

All Charges