Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FINGER-RT HAND, THUMB

Facility

$5,100.00

Service Code	HCPCS 73140F5
Hospital Charge Code	94061337
Hospital Revenue Code	320
Min. Negotiated Rate	$122.91
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,530.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$122.91
Rate for Payer: Wellpoint Medicaid Managed Care	$135.15

FINGER-RT HAND, THUMB

Facility

$5,100.00

Service Code	HCPCS 73140F5
Hospital Charge Code	94061337
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

FINGERS-BILAT

Facility

$250.00

Service Code	HCPCS 73140
Hospital Charge Code	94061105
Hospital Revenue Code	320
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

FINGERS-BILAT

Facility

$250.00

Service Code	HCPCS 73140
Hospital Charge Code	94061105
Hospital Revenue Code	320
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$373.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$373.21
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

FINGER SPLINT DYNAMIC

Facility

$322.82

Service Code	HCPCS 29131
Hospital Charge Code	412329131
Hospital Revenue Code	361
Min. Negotiated Rate	$48.42
Max. Negotiated Rate	$48.42
Rate for Payer: Qualcare PPO/HMO/WC	$48.42

FINGER SPLINT DYNAMIC

Facility

$322.82

Service Code	HCPCS 29131
Hospital Charge Code	412329131
Hospital Revenue Code	361
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.97
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.85
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.42
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$7.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$8.55

FINGER SPLINT-STATIC

Facility

$288.00

Service Code	HCPCS 29130
Hospital Charge Code	94186045
Hospital Revenue Code	361
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$43.20
Rate for Payer: Qualcare PPO/HMO/WC	$43.20

FINGER SPLINT-STATIC

Facility

$288.00

Service Code	HCPCS 29130
Hospital Charge Code	94186045
Hospital Revenue Code	361
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.55
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.40
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.20
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$6.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.63

FINGER TRAP LARGE

Facility

$91.57

Hospital Charge Code	270677425
Hospital Revenue Code	272
Min. Negotiated Rate	$13.74
Max. Negotiated Rate	$13.74
Rate for Payer: Qualcare PPO/HMO/WC	$13.74

FINGER TRAP LARGE

Facility

$91.57

Hospital Charge Code	270677425
Hospital Revenue Code	272
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$45.78
Rate for Payer: Aetna Commercial	$34.80
Rate for Payer: Aetna Medicare Advantage	$27.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.35
Rate for Payer: Cigna Commercial	$45.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.47
Rate for Payer: Oxford Commercial	$18.31
Rate for Payer: Qualcare PPO/HMO/WC	$13.74
Rate for Payer: UnitedHealthcare Commercial	$18.31
Rate for Payer: UnitedHealthcare Community & State	$2.21
Rate for Payer: Wellpoint Medicaid Managed Care	$2.43

FINGER TRAP MEDIUM

Facility

$91.57

Hospital Charge Code	270677424
Hospital Revenue Code	272
Min. Negotiated Rate	$13.74
Max. Negotiated Rate	$13.74
Rate for Payer: Qualcare PPO/HMO/WC	$13.74

FINGER TRAP MEDIUM

Facility

$91.57

Hospital Charge Code	270677424
Hospital Revenue Code	272
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$45.78
Rate for Payer: Aetna Commercial	$34.80
Rate for Payer: Aetna Medicare Advantage	$27.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.35
Rate for Payer: Cigna Commercial	$45.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.47
Rate for Payer: Oxford Commercial	$18.31
Rate for Payer: Qualcare PPO/HMO/WC	$13.74
Rate for Payer: UnitedHealthcare Commercial	$18.31
Rate for Payer: UnitedHealthcare Community & State	$2.21
Rate for Payer: Wellpoint Medicaid Managed Care	$2.43

FINGER TRAP SMALL

Facility

$91.57

Hospital Charge Code	270677423
Hospital Revenue Code	272
Min. Negotiated Rate	$13.74
Max. Negotiated Rate	$13.74
Rate for Payer: Qualcare PPO/HMO/WC	$13.74

FINGER TRAP SMALL

Facility

$91.57

Hospital Charge Code	270677423
Hospital Revenue Code	272
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$45.78
Rate for Payer: Aetna Commercial	$34.80
Rate for Payer: Aetna Medicare Advantage	$27.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.35
Rate for Payer: Cigna Commercial	$45.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.47
Rate for Payer: Oxford Commercial	$18.31
Rate for Payer: Qualcare PPO/HMO/WC	$13.74
Rate for Payer: UnitedHealthcare Commercial	$18.31
Rate for Payer: UnitedHealthcare Community & State	$2.21
Rate for Payer: Wellpoint Medicaid Managed Care	$2.43

FINGER TRAP X-LARGE

Facility

$91.57

Hospital Charge Code	270677426
Hospital Revenue Code	272
Min. Negotiated Rate	$13.74
Max. Negotiated Rate	$13.74
Rate for Payer: Qualcare PPO/HMO/WC	$13.74

FINGER TRAP X-LARGE

Facility

$91.57

Hospital Charge Code	270677426
Hospital Revenue Code	272
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$45.78
Rate for Payer: Aetna Commercial	$34.80
Rate for Payer: Aetna Medicare Advantage	$27.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.35
Rate for Payer: Cigna Commercial	$45.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.47
Rate for Payer: Oxford Commercial	$18.31
Rate for Payer: Qualcare PPO/HMO/WC	$13.74
Rate for Payer: UnitedHealthcare Commercial	$18.31
Rate for Payer: UnitedHealthcare Community & State	$2.21
Rate for Payer: Wellpoint Medicaid Managed Care	$2.43

FINGER TRAP X-SMALL

Facility

$91.57

Hospital Charge Code	270677422
Hospital Revenue Code	272
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$45.78
Rate for Payer: Aetna Commercial	$34.80
Rate for Payer: Aetna Medicare Advantage	$27.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.35
Rate for Payer: Cigna Commercial	$45.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.47
Rate for Payer: Oxford Commercial	$18.31
Rate for Payer: Qualcare PPO/HMO/WC	$13.74
Rate for Payer: UnitedHealthcare Commercial	$18.31
Rate for Payer: UnitedHealthcare Community & State	$2.21
Rate for Payer: Wellpoint Medicaid Managed Care	$2.43

FINGER TRAP X-SMALL

Facility

$91.57

Hospital Charge Code	270677422
Hospital Revenue Code	272
Min. Negotiated Rate	$13.74
Max. Negotiated Rate	$13.74
Rate for Payer: Qualcare PPO/HMO/WC	$13.74

FIORICET 300-50-40MG CAPSULE

Facility

$32.23

Service Code	NDC 70010004401
Hospital Charge Code	606390541
Hospital Revenue Code	250
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$4.83
Rate for Payer: Qualcare PPO/HMO/WC	$4.83

FIORICET 300-50-40MG CAPSULE

Facility

$32.23

Service Code	NDC 70010004401
Hospital Charge Code	606390541
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$16.11
Rate for Payer: Aetna Commercial	$12.25
Rate for Payer: Aetna Medicare Advantage	$9.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.22
Rate for Payer: Cigna Commercial	$16.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.67
Rate for Payer: Oxford Commercial	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.83
Rate for Payer: UnitedHealthcare Commercial	$6.45
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

FIORICET/TAB

Facility

$4.00

Hospital Charge Code	60632989
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

FIORICET/TAB

Facility

$4.00

Hospital Charge Code	60632989
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

FIORICET/TAB

Facility

$3.00

Hospital Charge Code	60632991
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

FIORICET/TAB

Facility

$4.00

Hospital Charge Code	60632990
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

FIORICET/TAB

Facility

$4.00

Hospital Charge Code	60632990
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

Know your out-of-pocket cost for care.

All Charges