Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

KIT OPTIVAC 80G CEMENT 417800

Facility

$755.25

Hospital Charge Code	270621912
Hospital Revenue Code	272
Min. Negotiated Rate	$113.29
Max. Negotiated Rate	$113.29
Rate for Payer: Qualcare PPO/HMO/WC	$113.29

KIT OPTIVAC 80G DBL MIX 417200

Facility

$1,104.85

Hospital Charge Code	270618648
Hospital Revenue Code	272
Min. Negotiated Rate	$165.73
Max. Negotiated Rate	$165.73
Rate for Payer: Qualcare PPO/HMO/WC	$165.73

KIT OPTIVAC 80G DBL MIX 417200

Facility

$1,104.85

Hospital Charge Code	270618648
Hospital Revenue Code	272
Min. Negotiated Rate	$26.63
Max. Negotiated Rate	$552.42
Rate for Payer: Aetna Commercial	$419.84
Rate for Payer: Aetna Medicare Advantage	$331.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.74
Rate for Payer: Cigna Commercial	$552.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$331.45
Rate for Payer: Oxford Commercial	$220.97
Rate for Payer: Qualcare PPO/HMO/WC	$165.73
Rate for Payer: UnitedHealthcare Commercial	$220.97
Rate for Payer: UnitedHealthcare Community & State	$26.63
Rate for Payer: Wellpoint Medicaid Managed Care	$29.28

KIT OPTIVAC MIX HIP

Facility

$850.00

Hospital Charge Code	270621291
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

KIT OPTIVAC MIX HIP

Facility

$850.00

Hospital Charge Code	270621291
Hospital Revenue Code	272
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.00
Rate for Payer: Oxford Commercial	$170.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$170.00
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

KIT ORISE GEL SYRINGE

Facility

$975.00

Hospital Charge Code	270687104E
Hospital Revenue Code	272
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$146.25
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

KIT ORISE GEL SYRINGE

Facility

$975.00

Hospital Charge Code	270687104
Hospital Revenue Code	272
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$370.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Commercial	$195.00
Rate for Payer: UnitedHealthcare Community & State	$23.50
Rate for Payer: Wellpoint Medicaid Managed Care	$25.84

KIT ORISE GEL SYRINGE

Facility

$975.00

Hospital Charge Code	270687104
Hospital Revenue Code	272
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$146.25
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

KIT ORISE GEL SYRINGE

Facility

$975.00

Hospital Charge Code	270687104E
Hospital Revenue Code	272
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$370.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Commercial	$195.00
Rate for Payer: UnitedHealthcare Community & State	$23.50
Rate for Payer: Wellpoint Medicaid Managed Care	$25.84

KIT ORTHOSORB PIN *******

Facility

$473.00

Hospital Charge Code	1604735
Hospital Revenue Code	274
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$236.50
Rate for Payer: Aetna Commercial	$179.74
Rate for Payer: Aetna Medicare Advantage	$141.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.61
Rate for Payer: Cigna Commercial	$236.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.06
Rate for Payer: Qualcare PPO/HMO/WC	$70.95
Rate for Payer: UnitedHealthcare Community & State	$11.40
Rate for Payer: Wellpoint Medicaid Managed Care	$12.53

KIT ORTHOSORB PIN *******

Facility

$473.00

Hospital Charge Code	1604735
Hospital Revenue Code	274
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$114.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$94.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.06
Rate for Payer: Qualcare PPO/HMO/WC	$70.95

KIT ORTHOSORB PIN 84-1070

Facility

$1,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270601198
Hospital Revenue Code	278
Min. Negotiated Rate	$27.35
Max. Negotiated Rate	$567.50
Rate for Payer: Aetna Commercial	$431.30
Rate for Payer: Aetna Medicare Advantage	$340.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$289.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$289.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$289.43
Rate for Payer: Cigna Commercial	$567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$249.70
Rate for Payer: Qualcare PPO/HMO/WC	$170.25
Rate for Payer: UnitedHealthcare Community & State	$27.35
Rate for Payer: Wellpoint Medicaid Managed Care	$30.08

KIT ORTHOSORB PIN 84-1070

Facility

$1,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270601198
Hospital Revenue Code	278
Min. Negotiated Rate	$170.25
Max. Negotiated Rate	$274.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$227.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$274.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$249.70
Rate for Payer: Qualcare PPO/HMO/WC	$170.25

KIT ORTHOSORB PIN 84-2052

Facility

$1,385.00

Service Code	HCPCS C1713
Hospital Charge Code	270601204
Hospital Revenue Code	278
Min. Negotiated Rate	$207.75
Max. Negotiated Rate	$335.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$277.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$304.70
Rate for Payer: Qualcare PPO/HMO/WC	$207.75

KIT ORTHOSORB PIN 84-2052

Facility

$1,385.00

Service Code	HCPCS C1713
Hospital Charge Code	270601204
Hospital Revenue Code	278
Min. Negotiated Rate	$33.38
Max. Negotiated Rate	$692.50
Rate for Payer: Aetna Commercial	$526.30
Rate for Payer: Aetna Medicare Advantage	$415.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$353.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$353.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$277.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$353.18
Rate for Payer: Cigna Commercial	$692.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.17
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$304.70
Rate for Payer: Qualcare PPO/HMO/WC	$207.75
Rate for Payer: UnitedHealthcare Community & State	$33.38
Rate for Payer: Wellpoint Medicaid Managed Care	$36.70

KIT OS WILSON FRAME 5322

Facility

$958.45

Hospital Charge Code	270627625
Hospital Revenue Code	270
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$479.23
Rate for Payer: Aetna Commercial	$364.21
Rate for Payer: Aetna Medicare Advantage	$287.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$244.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$244.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$244.40
Rate for Payer: Cigna Commercial	$479.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$287.54
Rate for Payer: Oxford Commercial	$191.69
Rate for Payer: Qualcare PPO/HMO/WC	$143.77
Rate for Payer: UnitedHealthcare Commercial	$191.69
Rate for Payer: UnitedHealthcare Community & State	$23.10
Rate for Payer: Wellpoint Medicaid Managed Care	$25.40

KIT OS WILSON FRAME 5322

Facility

$958.45

Hospital Charge Code	270627625
Hospital Revenue Code	270
Min. Negotiated Rate	$143.77
Max. Negotiated Rate	$143.77
Rate for Payer: Qualcare PPO/HMO/WC	$143.77

KIT PAD POSITIONING

Facility

$265.00

Hospital Charge Code	270677848
Hospital Revenue Code	272
Min. Negotiated Rate	$39.75
Max. Negotiated Rate	$39.75
Rate for Payer: Qualcare PPO/HMO/WC	$39.75

KIT PAD POSITIONING

Facility

$265.00

Hospital Charge Code	270677848
Hospital Revenue Code	272
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$132.50
Rate for Payer: Aetna Commercial	$100.70
Rate for Payer: Aetna Medicare Advantage	$79.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.58
Rate for Payer: Cigna Commercial	$132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.50
Rate for Payer: Oxford Commercial	$53.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.75
Rate for Payer: UnitedHealthcare Commercial	$53.00
Rate for Payer: UnitedHealthcare Community & State	$6.39
Rate for Payer: Wellpoint Medicaid Managed Care	$7.02

KIT PAT CARE ANDREW FRAME 946S

Facility

$295.25

Hospital Charge Code	270606434
Hospital Revenue Code	272
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$147.62
Rate for Payer: Aetna Commercial	$112.19
Rate for Payer: Aetna Medicare Advantage	$88.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.29
Rate for Payer: Cigna Commercial	$147.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.58
Rate for Payer: Oxford Commercial	$59.05
Rate for Payer: Qualcare PPO/HMO/WC	$44.29
Rate for Payer: UnitedHealthcare Commercial	$59.05
Rate for Payer: UnitedHealthcare Community & State	$7.12
Rate for Payer: Wellpoint Medicaid Managed Care	$7.82

KIT PAT CARE ANDREW FRAME 946S

Facility

$295.25

Hospital Charge Code	270606434
Hospital Revenue Code	272
Min. Negotiated Rate	$44.29
Max. Negotiated Rate	$44.29
Rate for Payer: Qualcare PPO/HMO/WC	$44.29

KIT PATELLA TEMPLATE ANTERIOR

Facility

$965.25

Hospital Charge Code	270694963
Hospital Revenue Code	272
Min. Negotiated Rate	$144.79
Max. Negotiated Rate	$144.79
Rate for Payer: Qualcare PPO/HMO/WC	$144.79

KIT PATELLA TEMPLATE ANTERIOR

Facility

$965.25

Hospital Charge Code	270694963
Hospital Revenue Code	272
Min. Negotiated Rate	$23.26
Max. Negotiated Rate	$482.62
Rate for Payer: Aetna Commercial	$366.80
Rate for Payer: Aetna Medicare Advantage	$289.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$246.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$246.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$246.14
Rate for Payer: Cigna Commercial	$482.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$289.57
Rate for Payer: Oxford Commercial	$193.05
Rate for Payer: Qualcare PPO/HMO/WC	$144.79
Rate for Payer: UnitedHealthcare Commercial	$193.05
Rate for Payer: UnitedHealthcare Community & State	$23.26
Rate for Payer: Wellpoint Medicaid Managed Care	$25.58

KIT PATIENT PROGRAMMER SC55002

Facility

$5,975.00

Hospital Charge Code	270641626
Hospital Revenue Code	278
Min. Negotiated Rate	$896.25
Max. Negotiated Rate	$1,445.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,445.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,314.50
Rate for Payer: Qualcare PPO/HMO/WC	$896.25

KIT PATIENT PROGRAMMER SC55002

Facility

$5,975.00

Hospital Charge Code	270641626
Hospital Revenue Code	278
Min. Negotiated Rate	$144.00
Max. Negotiated Rate	$2,987.50
Rate for Payer: Aetna Commercial	$2,270.50
Rate for Payer: Aetna Medicare Advantage	$1,792.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,523.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,523.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,523.62
Rate for Payer: Cigna Commercial	$2,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,445.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,314.50
Rate for Payer: Qualcare PPO/HMO/WC	$896.25
Rate for Payer: UnitedHealthcare Community & State	$144.00
Rate for Payer: Wellpoint Medicaid Managed Care	$158.34

Know your out-of-pocket cost for care.

All Charges