Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

COVER LITE SHIELD UNIVERSAL

Facility

$4.06

Hospital Charge Code	270649599
Hospital Revenue Code	270
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Qualcare PPO/HMO/WC	$0.61

COVER LOCKING BACK UP 5-12 MM

Facility

$500.00

Service Code	HCPCS C1889
Hospital Charge Code	270694460
Hospital Revenue Code	278
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

COVER LOCKING BACK UP 5-12 MM

Facility

$500.00

Service Code	HCPCS C1889
Hospital Charge Code	270694460
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

COVERLOC LATERAL TALUS TORNIER

Facility

$800.00

Hospital Charge Code	270339516
Hospital Revenue Code	278
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) NJ Health	$160.00
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	$193.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$176.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$21.20

COVERLOC LATERAL TALUS TORNIER

Facility

$800.00

Hospital Charge Code	270339516
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$193.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$176.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

COVERLOC - TIBIA TORNIER

Facility

$800.00

Hospital Charge Code	270339515
Hospital Revenue Code	278
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$193.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$176.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

COVERLOC - TIBIA TORNIER

Facility

$800.00

Hospital Charge Code	270339515
Hospital Revenue Code	278
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) NJ Health	$160.00
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	$193.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$176.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$21.20

COVER MAYO TRAY STER

Facility

$18.45

Hospital Charge Code	270600165
Hospital Revenue Code	272
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

COVER MAYO TRAY STER

Facility

$18.45

Hospital Charge Code	270600165
Hospital Revenue Code	272
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$9.22
Rate for Payer: Aetna Commercial	$7.01
Rate for Payer: Aetna Medicare Advantage	$5.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.70
Rate for Payer: Cigna Commercial	$9.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.54
Rate for Payer: Oxford Commercial	$3.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.77
Rate for Payer: UnitedHealthcare Commercial	$3.69
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

COVER NAVIG PROBE 5X9 3787

Facility

$47.27

Hospital Charge Code	270614504
Hospital Revenue Code	272
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.64
Rate for Payer: Aetna Commercial	$17.96
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.05
Rate for Payer: Cigna Commercial	$23.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.18
Rate for Payer: Oxford Commercial	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$9.45
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

COVER NAVIG PROBE 5X9 3787

Facility

$47.27

Hospital Charge Code	270614504
Hospital Revenue Code	272
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

COVER PLATE 12MM

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703636
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

COVER PLATE 12MM

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703636
Hospital Revenue Code	278
Min. Negotiated Rate	$289.20
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

COVER PLATE 14MM

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703634
Hospital Revenue Code	278
Min. Negotiated Rate	$289.20
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$289.20
Rate for Payer: Wellpoint Medicaid Managed Care	$318.00

COVER PLATE 14MM

Facility

$12,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703634
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,640.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

COVER PROBE GENERAL PURPOSE

Facility

$29.08

Hospital Charge Code	270648023
Hospital Revenue Code	270
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$4.36
Rate for Payer: Qualcare PPO/HMO/WC	$4.36

COVER PROBE GENERAL PURPOSE

Facility

$29.08

Hospital Charge Code	270648023
Hospital Revenue Code	270
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$14.54
Rate for Payer: Aetna Commercial	$11.05
Rate for Payer: Aetna Medicare Advantage	$8.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.42
Rate for Payer: Cigna Commercial	$14.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.72
Rate for Payer: Oxford Commercial	$5.82
Rate for Payer: Qualcare PPO/HMO/WC	$4.36
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: UnitedHealthcare Community & State	$0.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

COVER PROBE THERMOSCAN PRO-LT

Facility

$474.20

Hospital Charge Code	270609108
Hospital Revenue Code	271
Min. Negotiated Rate	$11.43
Max. Negotiated Rate	$237.10
Rate for Payer: Aetna Commercial	$180.20
Rate for Payer: Aetna Medicare Advantage	$142.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.92
Rate for Payer: Cigna Commercial	$237.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.26
Rate for Payer: Oxford Commercial	$94.84
Rate for Payer: Qualcare PPO/HMO/WC	$71.13
Rate for Payer: UnitedHealthcare Commercial	$94.84
Rate for Payer: UnitedHealthcare Community & State	$11.43
Rate for Payer: Wellpoint Medicaid Managed Care	$12.57

COVER PROBE THERMOSCAN PRO-LT

Facility

$474.20

Hospital Charge Code	270609108
Hospital Revenue Code	271
Min. Negotiated Rate	$71.13
Max. Negotiated Rate	$71.13
Rate for Payer: Qualcare PPO/HMO/WC	$71.13

COVER SHOE DISPOSABLE

Facility

$94.80

Hospital Charge Code	270649136
Hospital Revenue Code	270
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$47.40
Rate for Payer: Aetna Commercial	$36.02
Rate for Payer: Aetna Medicare Advantage	$28.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.17
Rate for Payer: Cigna Commercial	$47.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.44
Rate for Payer: Oxford Commercial	$18.96
Rate for Payer: Qualcare PPO/HMO/WC	$14.22
Rate for Payer: UnitedHealthcare Commercial	$18.96
Rate for Payer: UnitedHealthcare Community & State	$2.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.51

COVER SHOE DISPOSABLE

Facility

$94.80

Hospital Charge Code	270649136
Hospital Revenue Code	270
Min. Negotiated Rate	$14.22
Max. Negotiated Rate	$14.22
Rate for Payer: Qualcare PPO/HMO/WC	$14.22

COVER SHOE NONCNDTVE XLG 77727

Facility

$46.30

Hospital Charge Code	270060675C
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.15
Rate for Payer: Aetna Commercial	$17.59
Rate for Payer: Aetna Medicare Advantage	$13.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.81
Rate for Payer: Cigna Commercial	$23.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.89
Rate for Payer: Oxford Commercial	$9.26
Rate for Payer: Qualcare PPO/HMO/WC	$6.95
Rate for Payer: UnitedHealthcare Commercial	$9.26
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

COVER SHOE NONCNDTVE XLG 77727

Facility

$46.30

Hospital Charge Code	270060675C
Hospital Revenue Code	272
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$6.95
Rate for Payer: Qualcare PPO/HMO/WC	$6.95

COVER SITERITE

Facility

$47.50

Hospital Charge Code	270658265
Hospital Revenue Code	270
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.12

COVER SITERITE

Facility

$47.50

Hospital Charge Code	270658265
Hospital Revenue Code	270
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.75
Rate for Payer: Aetna Commercial	$18.05
Rate for Payer: Aetna Medicare Advantage	$14.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.11
Rate for Payer: Cigna Commercial	$23.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.25
Rate for Payer: Oxford Commercial	$9.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.12
Rate for Payer: UnitedHealthcare Commercial	$9.50
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.26

Know your out-of-pocket cost for care.

All Charges