Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

MAXEPINE 1GM IN D5W

Facility

$61.00

Hospital Charge Code	60635524
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$23.18
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.30
Rate for Payer: Oxford Commercial	$12.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$12.20
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

MAXEPINE 1GM IN NS

Facility

$61.00

Hospital Charge Code	60635525
Hospital Revenue Code	250
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

MAXEPINE 1GM IN NS

Facility

$61.00

Hospital Charge Code	60635525
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.50
Rate for Payer: Aetna Commercial	$23.18
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.30
Rate for Payer: Oxford Commercial	$12.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Commercial	$12.20
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

MAXFORCE PLATE LEFT

Facility

$10,274.25

Service Code	HCPCS C1713
Hospital Charge Code	270705523
Hospital Revenue Code	278
Min. Negotiated Rate	$247.61
Max. Negotiated Rate	$5,137.12
Rate for Payer: Aetna Commercial	$3,904.22
Rate for Payer: Aetna Medicare Advantage	$3,082.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,619.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,619.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,054.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,619.93
Rate for Payer: Cigna Commercial	$5,137.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,486.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,260.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,541.14
Rate for Payer: UnitedHealthcare Community & State	$247.61
Rate for Payer: Wellpoint Medicaid Managed Care	$272.27

MAXFORCE PLATE LEFT

Facility

$10,274.25

Service Code	HCPCS C1713
Hospital Charge Code	270705523
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.14
Max. Negotiated Rate	$2,486.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,054.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,486.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,260.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,541.14

MAXFORCE PLATE PETITE RIGHT

Facility

$10,274.25

Service Code	HCPCS C1713
Hospital Charge Code	270693500
Hospital Revenue Code	278
Min. Negotiated Rate	$247.61
Max. Negotiated Rate	$5,137.12
Rate for Payer: Aetna Commercial	$3,904.22
Rate for Payer: Aetna Medicare Advantage	$3,082.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,619.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,619.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,054.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,619.93
Rate for Payer: Cigna Commercial	$5,137.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,486.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,260.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,541.14
Rate for Payer: UnitedHealthcare Community & State	$247.61
Rate for Payer: Wellpoint Medicaid Managed Care	$272.27

MAXFORCE PLATE PETITE RIGHT

Facility

$10,274.25

Service Code	HCPCS C1713
Hospital Charge Code	270693500
Hospital Revenue Code	278
Min. Negotiated Rate	$1,541.14
Max. Negotiated Rate	$2,486.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,054.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,486.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,260.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,541.14

MAXFRAME FULL RING 180MM ALUM

Facility

$6,930.00

Hospital Charge Code	270681262
Hospital Revenue Code	272
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,039.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50

MAXFRAME FULL RING 180MM ALUM

Facility

$6,930.00

Hospital Charge Code	270681262
Hospital Revenue Code	272
Min. Negotiated Rate	$167.01
Max. Negotiated Rate	$3,465.00
Rate for Payer: Aetna Commercial	$2,633.40
Rate for Payer: Aetna Medicare Advantage	$2,079.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,767.15
Rate for Payer: Cigna Commercial	$3,465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,079.00
Rate for Payer: Oxford Commercial	$1,386.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50
Rate for Payer: UnitedHealthcare Commercial	$1,386.00
Rate for Payer: UnitedHealthcare Community & State	$167.01
Rate for Payer: Wellpoint Medicaid Managed Care	$183.65

MAXFRAME SHOULDR BOLT 8MM RNG

Facility

$450.00

Hospital Charge Code	270681316
Hospital Revenue Code	272
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.00
Rate for Payer: Oxford Commercial	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$90.00
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

MAXFRAME SHOULDR BOLT 8MM RNG

Facility

$450.00

Hospital Charge Code	270681316
Hospital Revenue Code	272
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

MAXFUSE DBM CRUNCH

Facility

$6,250.00

Service Code	HCPCS C1765
Hospital Charge Code	270705464
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

MAXFUSE DBM CRUNCH

Facility

$6,250.00

Service Code	HCPCS C1765
Hospital Charge Code	270705464
Hospital Revenue Code	278
Min. Negotiated Rate	$150.62
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$150.62
Rate for Payer: Wellpoint Medicaid Managed Care	$165.62

MAXIDE 75

Facility

$3.00

Hospital Charge Code	60634887
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

MAXIDE 75

Facility

$3.00

Hospital Charge Code	60634887
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

MAXIDEX 0.1% OPHTH/5ML

Facility

$75.00

Hospital Charge Code	60633357
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

MAXIDEX 0.1% OPHTH/5ML

Facility

$75.00

Hospital Charge Code	60633357
Hospital Revenue Code	250
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

MAXIFRAME X SHORT

Facility

$6,657.00

Hospital Charge Code	270683977
Hospital Revenue Code	272
Min. Negotiated Rate	$160.43
Max. Negotiated Rate	$3,328.50
Rate for Payer: Aetna Commercial	$2,529.66
Rate for Payer: Aetna Medicare Advantage	$1,997.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,697.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,697.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,697.54
Rate for Payer: Cigna Commercial	$3,328.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,997.10
Rate for Payer: Oxford Commercial	$1,331.40
Rate for Payer: Qualcare PPO/HMO/WC	$998.55
Rate for Payer: UnitedHealthcare Commercial	$1,331.40
Rate for Payer: UnitedHealthcare Community & State	$160.43
Rate for Payer: Wellpoint Medicaid Managed Care	$176.41

MAXIFRAME X SHORT

Facility

$6,657.00

Hospital Charge Code	270683977
Hospital Revenue Code	272
Min. Negotiated Rate	$998.55
Max. Negotiated Rate	$998.55
Rate for Payer: Qualcare PPO/HMO/WC	$998.55

MAXIPIME 1GM

Facility

$67.00

Hospital Charge Code	60635133
Hospital Revenue Code	636
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.21
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

MAXIPIME 1GM

Facility

$67.00

Hospital Charge Code	60635133
Hospital Revenue Code	636
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$16.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.21
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

MAXIPIME 1GM ADD/D5W

Facility

$101.00

Hospital Charge Code	60635120
Hospital Revenue Code	636
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$50.50
Rate for Payer: Aetna Commercial	$38.38
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.44
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

MAXIPIME 1GM ADD/D5W

Facility

$101.00

Hospital Charge Code	60635120
Hospital Revenue Code	636
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$24.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.44
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

MAXIPIME 1GM ADD/NS

Facility

$67.00

Hospital Charge Code	60635121
Hospital Revenue Code	636
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.21
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

MAXIPIME 1GM ADD/NS

Facility

$67.00

Hospital Charge Code	60635121
Hospital Revenue Code	636
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$16.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.21
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

Know your out-of-pocket cost for care.

All Charges