Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IMMOBILIZER KNEE 16 UNIVERSAL

Facility

$51.90

Service Code	HCPCS L1830
Hospital Charge Code	270650067
Hospital Revenue Code	274
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$25.95
Rate for Payer: Aetna Commercial	$19.72
Rate for Payer: Aetna Medicare Advantage	$15.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.23
Rate for Payer: Cigna Commercial	$25.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.42
Rate for Payer: Qualcare PPO/HMO/WC	$7.79
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

IMMOBILIZER KNEE LG

Facility

$92.35

Hospital Charge Code	270302810
Hospital Revenue Code	270
Min. Negotiated Rate	$13.85
Max. Negotiated Rate	$13.85
Rate for Payer: Qualcare PPO/HMO/WC	$13.85

IMMOBILIZER KNEE LG

Facility

$92.35

Hospital Charge Code	270302810
Hospital Revenue Code	270
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$46.17
Rate for Payer: Aetna Commercial	$35.09
Rate for Payer: Aetna Medicare Advantage	$27.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.55
Rate for Payer: Cigna Commercial	$46.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.70
Rate for Payer: Oxford Commercial	$18.47
Rate for Payer: Qualcare PPO/HMO/WC	$13.85
Rate for Payer: UnitedHealthcare Commercial	$18.47
Rate for Payer: UnitedHealthcare Community & State	$2.23
Rate for Payer: Wellpoint Medicaid Managed Care	$2.45

IMMOBILIZER KNEE MED

Facility

$127.25

Hospital Charge Code	270302820
Hospital Revenue Code	270
Min. Negotiated Rate	$19.09
Max. Negotiated Rate	$19.09
Rate for Payer: Qualcare PPO/HMO/WC	$19.09

IMMOBILIZER KNEE MED

Facility

$127.25

Hospital Charge Code	270302820
Hospital Revenue Code	270
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$63.62
Rate for Payer: Aetna Commercial	$48.35
Rate for Payer: Aetna Medicare Advantage	$38.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.45
Rate for Payer: Cigna Commercial	$63.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.17
Rate for Payer: Oxford Commercial	$25.45
Rate for Payer: Qualcare PPO/HMO/WC	$19.09
Rate for Payer: UnitedHealthcare Commercial	$25.45
Rate for Payer: UnitedHealthcare Community & State	$3.07
Rate for Payer: Wellpoint Medicaid Managed Care	$3.37

IMMOBILIZER KNEE ONE SIZE 16

Facility

$80.55

Hospital Charge Code	270302805
Hospital Revenue Code	271
Min. Negotiated Rate	$12.08
Max. Negotiated Rate	$12.08
Rate for Payer: Qualcare PPO/HMO/WC	$12.08

IMMOBILIZER KNEE ONE SIZE 16

Facility

$80.55

Hospital Charge Code	270302805
Hospital Revenue Code	271
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$40.27
Rate for Payer: Aetna Commercial	$30.61
Rate for Payer: Aetna Medicare Advantage	$24.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.54
Rate for Payer: Cigna Commercial	$40.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.16
Rate for Payer: Oxford Commercial	$16.11
Rate for Payer: Qualcare PPO/HMO/WC	$12.08
Rate for Payer: UnitedHealthcare Commercial	$16.11
Rate for Payer: UnitedHealthcare Community & State	$1.94
Rate for Payer: Wellpoint Medicaid Managed Care	$2.13

IMMOBILIZER KNEE ONE SIZE 20

Facility

$89.75

Hospital Charge Code	270302815
Hospital Revenue Code	272
Min. Negotiated Rate	$13.46
Max. Negotiated Rate	$13.46
Rate for Payer: Qualcare PPO/HMO/WC	$13.46

IMMOBILIZER KNEE ONE SIZE 20

Facility

$89.75

Hospital Charge Code	270302815
Hospital Revenue Code	272
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$44.88
Rate for Payer: Aetna Commercial	$34.10
Rate for Payer: Aetna Medicare Advantage	$26.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.89
Rate for Payer: Cigna Commercial	$44.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.93
Rate for Payer: Oxford Commercial	$17.95
Rate for Payer: Qualcare PPO/HMO/WC	$13.46
Rate for Payer: UnitedHealthcare Commercial	$17.95
Rate for Payer: UnitedHealthcare Community & State	$2.16
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

IMMOBILIZER KNEE SM

Facility

$127.25

Hospital Charge Code	270302795
Hospital Revenue Code	270
Min. Negotiated Rate	$19.09
Max. Negotiated Rate	$19.09
Rate for Payer: Qualcare PPO/HMO/WC	$19.09

IMMOBILIZER KNEE SM

Facility

$127.25

Hospital Charge Code	270302795
Hospital Revenue Code	270
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$63.62
Rate for Payer: Aetna Commercial	$48.35
Rate for Payer: Aetna Medicare Advantage	$38.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.45
Rate for Payer: Cigna Commercial	$63.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.17
Rate for Payer: Oxford Commercial	$25.45
Rate for Payer: Qualcare PPO/HMO/WC	$19.09
Rate for Payer: UnitedHealthcare Commercial	$25.45
Rate for Payer: UnitedHealthcare Community & State	$3.07
Rate for Payer: Wellpoint Medicaid Managed Care	$3.37

IMMOBILIZER KNEE XLG

Facility

$127.25

Hospital Charge Code	270302825
Hospital Revenue Code	270
Min. Negotiated Rate	$19.09
Max. Negotiated Rate	$19.09
Rate for Payer: Qualcare PPO/HMO/WC	$19.09

IMMOBILIZER KNEE XLG

Facility

$127.25

Hospital Charge Code	270302825
Hospital Revenue Code	270
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$63.62
Rate for Payer: Aetna Commercial	$48.35
Rate for Payer: Aetna Medicare Advantage	$38.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.45
Rate for Payer: Cigna Commercial	$63.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.17
Rate for Payer: Oxford Commercial	$25.45
Rate for Payer: Qualcare PPO/HMO/WC	$19.09
Rate for Payer: UnitedHealthcare Commercial	$25.45
Rate for Payer: UnitedHealthcare Community & State	$3.07
Rate for Payer: Wellpoint Medicaid Managed Care	$3.37

IMMOBILIZER KNEE XLG 187650324

Facility

$152.55

Hospital Charge Code	270635372
Hospital Revenue Code	270
Min. Negotiated Rate	$22.88
Max. Negotiated Rate	$22.88
Rate for Payer: Qualcare PPO/HMO/WC	$22.88

IMMOBILIZER KNEE XLG 187650324

Facility

$152.55

Hospital Charge Code	270635372
Hospital Revenue Code	270
Min. Negotiated Rate	$3.68
Max. Negotiated Rate	$76.28
Rate for Payer: Aetna Commercial	$57.97
Rate for Payer: Aetna Medicare Advantage	$45.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.90
Rate for Payer: Cigna Commercial	$76.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.77
Rate for Payer: Oxford Commercial	$30.51
Rate for Payer: Qualcare PPO/HMO/WC	$22.88
Rate for Payer: UnitedHealthcare Commercial	$30.51
Rate for Payer: UnitedHealthcare Community & State	$3.68
Rate for Payer: Wellpoint Medicaid Managed Care	$4.04

IMMOBILIZER KNEE XLG 187650622

Facility

$149.05

Hospital Charge Code	270635371
Hospital Revenue Code	270
Min. Negotiated Rate	$22.36
Max. Negotiated Rate	$22.36
Rate for Payer: Qualcare PPO/HMO/WC	$22.36

IMMOBILIZER KNEE XLG 187650622

Facility

$149.05

Hospital Charge Code	270635371
Hospital Revenue Code	270
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$74.53
Rate for Payer: Aetna Commercial	$56.64
Rate for Payer: Aetna Medicare Advantage	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.01
Rate for Payer: Cigna Commercial	$74.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.72
Rate for Payer: Oxford Commercial	$29.81
Rate for Payer: Qualcare PPO/HMO/WC	$22.36
Rate for Payer: UnitedHealthcare Commercial	$29.81
Rate for Payer: UnitedHealthcare Community & State	$3.59
Rate for Payer: Wellpoint Medicaid Managed Care	$3.95

IMMOBILIZER KNEE XXL

Facility

$124.85

Hospital Charge Code	270302800
Hospital Revenue Code	270
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$18.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.73

IMMOBILIZER KNEE XXL

Facility

$124.85

Hospital Charge Code	270302800
Hospital Revenue Code	270
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$47.44
Rate for Payer: Aetna Medicare Advantage	$37.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.84
Rate for Payer: Cigna Commercial	$62.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.45
Rate for Payer: Oxford Commercial	$24.97
Rate for Payer: Qualcare PPO/HMO/WC	$18.73
Rate for Payer: UnitedHealthcare Commercial	$24.97
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

IMMOBILIZER SHOULDER

Facility

$39.75

Hospital Charge Code	270665592
Hospital Revenue Code	270
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$5.96
Rate for Payer: Qualcare PPO/HMO/WC	$5.96

IMMOBILIZER SHOULDER

Facility

$39.75

Hospital Charge Code	270665592
Hospital Revenue Code	270
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$19.88
Rate for Payer: Aetna Commercial	$15.11
Rate for Payer: Aetna Medicare Advantage	$11.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.14
Rate for Payer: Cigna Commercial	$19.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.93
Rate for Payer: Oxford Commercial	$7.95
Rate for Payer: Qualcare PPO/HMO/WC	$5.96
Rate for Payer: UnitedHealthcare Commercial	$7.95
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.05

IMMOBILIZER SHOULDER ******

Facility

$49.00

Hospital Charge Code	8002065
Hospital Revenue Code	279
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

IMMOBILIZER SHOULDER ******

Facility

$49.00

Hospital Charge Code	8002065
Hospital Revenue Code	279
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.70
Rate for Payer: Oxford Commercial	$9.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$9.80
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

IMMOBILIZER SHOULDER LG

Facility

$30.00

Hospital Charge Code	270677150
Hospital Revenue Code	270
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

IMMOBILIZER SHOULDER LG

Facility

$30.00

Hospital Charge Code	270677150
Hospital Revenue Code	270
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.00
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

Know your out-of-pocket cost for care.

All Charges