Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CANN SCREW FULL THD 6.5 X 85MM

Facility

$1,527.50

Service Code	HCPCS C1713
Hospital Charge Code	270688068
Hospital Revenue Code	278
Min. Negotiated Rate	$36.81
Max. Negotiated Rate	$763.75
Rate for Payer: Aetna Commercial	$580.45
Rate for Payer: Aetna Medicare Advantage	$458.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$389.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$389.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$389.51
Rate for Payer: Cigna Commercial	$763.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$336.05
Rate for Payer: Qualcare PPO/HMO/WC	$229.12
Rate for Payer: UnitedHealthcare Community & State	$36.81
Rate for Payer: Wellpoint Medicaid Managed Care	$40.48

CANN SCREW FULL THD 6.5 X 85MM

Facility

$1,527.50

Service Code	HCPCS C1713
Hospital Charge Code	270688068
Hospital Revenue Code	278
Min. Negotiated Rate	$229.12
Max. Negotiated Rate	$369.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$336.05
Rate for Payer: Qualcare PPO/HMO/WC	$229.12

CANN SCRW FULL THD 6.5MM X 80M

Facility

$1,527.50

Service Code	HCPCS C1713
Hospital Charge Code	270680496
Hospital Revenue Code	278
Min. Negotiated Rate	$36.81
Max. Negotiated Rate	$763.75
Rate for Payer: Aetna Commercial	$580.45
Rate for Payer: Aetna Medicare Advantage	$458.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$389.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$389.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$389.51
Rate for Payer: Cigna Commercial	$763.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$336.05
Rate for Payer: Qualcare PPO/HMO/WC	$229.12
Rate for Payer: UnitedHealthcare Community & State	$36.81
Rate for Payer: Wellpoint Medicaid Managed Care	$40.48

CANN SCRW FULL THD 6.5MM X 80M

Facility

$1,527.50

Service Code	HCPCS C1713
Hospital Charge Code	270680496
Hospital Revenue Code	278
Min. Negotiated Rate	$229.12
Max. Negotiated Rate	$369.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$336.05
Rate for Payer: Qualcare PPO/HMO/WC	$229.12

CANN TFNA 11x360MM 130DEG RT

Facility

$9,942.75

Service Code	HCPCS C1713
Hospital Charge Code	270681181
Hospital Revenue Code	278
Min. Negotiated Rate	$239.62
Max. Negotiated Rate	$4,971.38
Rate for Payer: Aetna Commercial	$3,778.24
Rate for Payer: Aetna Medicare Advantage	$2,982.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,535.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,535.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,988.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,535.40
Rate for Payer: Cigna Commercial	$4,971.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,406.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,187.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.41
Rate for Payer: UnitedHealthcare Community & State	$239.62
Rate for Payer: Wellpoint Medicaid Managed Care	$263.48

CANN TFNA 11x360MM 130DEG RT

Facility

$9,942.75

Service Code	HCPCS C1713
Hospital Charge Code	270681181
Hospital Revenue Code	278
Min. Negotiated Rate	$1,491.41
Max. Negotiated Rate	$2,406.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,988.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,406.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,187.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.41

CANN TRIPPLEDAM TWIST W/VALVE

Facility

$800.00

Hospital Charge Code	270682242
Hospital Revenue Code	272
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

CANN TRIPPLEDAM TWIST W/VALVE

Facility

$800.00

Hospital Charge Code	270682242
Hospital Revenue Code	272
Min. Negotiated Rate	$19.28
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$304.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.00
Rate for Payer: Oxford Commercial	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Commercial	$160.00
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$21.20

CANNULA 100x22GAX4.0 40562040

Facility

$125.00

Hospital Charge Code	270641686
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

CANNULA 100x22GAX4.0 40562040

Facility

$125.00

Hospital Charge Code	270641686
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

CANNULA 100X22GAX5.0 406620115

Facility

$125.00

Hospital Charge Code	270641687
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

CANNULA 100X22GAX5.0 406620115

Facility

$125.00

Hospital Charge Code	270641687
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

CANNULA 150 CURVED 5MM 20G

Facility

$174.00

Hospital Charge Code	270654840
Hospital Revenue Code	272
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

CANNULA 150 CURVED 5MM 20G

Facility

$174.00

Hospital Charge Code	270654840
Hospital Revenue Code	272
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$66.12
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.20
Rate for Payer: Oxford Commercial	$34.80
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Commercial	$34.80
Rate for Payer: UnitedHealthcare Community & State	$4.19
Rate for Payer: Wellpoint Medicaid Managed Care	$4.61

CANNULA 5.0MM DISP 275905075

Facility

$123.10

Hospital Charge Code	270622642
Hospital Revenue Code	272
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$18.46
Rate for Payer: Qualcare PPO/HMO/WC	$18.46

CANNULA 5.0MM DISP 275905075

Facility

$123.10

Hospital Charge Code	270622642
Hospital Revenue Code	272
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$61.55
Rate for Payer: Aetna Commercial	$46.78
Rate for Payer: Aetna Medicare Advantage	$36.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.39
Rate for Payer: Cigna Commercial	$61.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.93
Rate for Payer: Oxford Commercial	$24.62
Rate for Payer: Qualcare PPO/HMO/WC	$18.46
Rate for Payer: UnitedHealthcare Commercial	$24.62
Rate for Payer: UnitedHealthcare Community & State	$2.97
Rate for Payer: Wellpoint Medicaid Managed Care	$3.26

CANNULA 5.75mm X 7cm AR-6564

Facility

$125.00

Hospital Charge Code	270636059
Hospital Revenue Code	270
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

CANNULA 5.75mm X 7cm AR-6564

Facility

$125.00

Hospital Charge Code	270636059
Hospital Revenue Code	270
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

CANNULA 5.8 MM TROCAR

Facility

$605.85

Hospital Charge Code	270688257
Hospital Revenue Code	272
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$302.93
Rate for Payer: Aetna Commercial	$230.22
Rate for Payer: Aetna Medicare Advantage	$181.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.49
Rate for Payer: Cigna Commercial	$302.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.75
Rate for Payer: Oxford Commercial	$121.17
Rate for Payer: Qualcare PPO/HMO/WC	$90.88
Rate for Payer: UnitedHealthcare Commercial	$121.17
Rate for Payer: UnitedHealthcare Community & State	$14.60
Rate for Payer: Wellpoint Medicaid Managed Care	$16.06

CANNULA 5.8 MM TROCAR

Facility

$605.85

Hospital Charge Code	270688257
Hospital Revenue Code	272
Min. Negotiated Rate	$90.88
Max. Negotiated Rate	$90.88
Rate for Payer: Qualcare PPO/HMO/WC	$90.88

CANNULA 5MM

Facility

$4,500.00

Hospital Charge Code	270664002
Hospital Revenue Code	270
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

CANNULA 5MM

Facility

$4,500.00

Hospital Charge Code	270664002
Hospital Revenue Code	270
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,350.00
Rate for Payer: Oxford Commercial	$900.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$900.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

CANNULA 6 X 55m 214660

Facility

$525.00

Hospital Charge Code	270635850
Hospital Revenue Code	272
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$78.75
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

CANNULA 6 X 55m 214660

Facility

$525.00

Hospital Charge Code	270635850
Hospital Revenue Code	272
Min. Negotiated Rate	$12.65
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.50
Rate for Payer: Oxford Commercial	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Commercial	$105.00
Rate for Payer: UnitedHealthcare Community & State	$12.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.91

CANNULA 7.0 X 72 MM

Facility

$163.80

Hospital Charge Code	270682201
Hospital Revenue Code	272
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$81.90
Rate for Payer: Aetna Commercial	$62.24
Rate for Payer: Aetna Medicare Advantage	$49.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.77
Rate for Payer: Cigna Commercial	$81.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.14
Rate for Payer: Oxford Commercial	$32.76
Rate for Payer: Qualcare PPO/HMO/WC	$24.57
Rate for Payer: UnitedHealthcare Commercial	$32.76
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$4.34

Know your out-of-pocket cost for care.

All Charges