Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ORTHOGLASS 5X15 FOR ARM SPLINT

Facility

$246.45

Hospital Charge Code	8004145
Hospital Revenue Code	272
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$123.22
Rate for Payer: Aetna Commercial	$93.65
Rate for Payer: Aetna Medicare Advantage	$73.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.84
Rate for Payer: Cigna Commercial	$123.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.94
Rate for Payer: Oxford Commercial	$49.29
Rate for Payer: Qualcare PPO/HMO/WC	$36.97
Rate for Payer: UnitedHealthcare Commercial	$49.29
Rate for Payer: UnitedHealthcare Community & State	$5.94
Rate for Payer: Wellpoint Medicaid Managed Care	$6.53

ORTHOGLASS 5X15 FOR LEG SPLINT

Facility

$328.85

Hospital Charge Code	8004111
Hospital Revenue Code	272
Min. Negotiated Rate	$49.33
Max. Negotiated Rate	$49.33
Rate for Payer: Qualcare PPO/HMO/WC	$49.33

ORTHOGLASS 5X15 FOR LEG SPLINT

Facility

$328.85

Hospital Charge Code	8004111
Hospital Revenue Code	272
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$164.43
Rate for Payer: Aetna Commercial	$124.96
Rate for Payer: Aetna Medicare Advantage	$98.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.86
Rate for Payer: Cigna Commercial	$164.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.66
Rate for Payer: Oxford Commercial	$65.77
Rate for Payer: Qualcare PPO/HMO/WC	$49.33
Rate for Payer: UnitedHealthcare Commercial	$65.77
Rate for Payer: UnitedHealthcare Community & State	$7.93
Rate for Payer: Wellpoint Medicaid Managed Care	$8.71

ORTHO GLASS SPLINTING SYSTEM

Facility

$471.25

Hospital Charge Code	270654391
Hospital Revenue Code	272
Min. Negotiated Rate	$70.69
Max. Negotiated Rate	$70.69
Rate for Payer: Qualcare PPO/HMO/WC	$70.69

ORTHO GLASS SPLINTING SYSTEM

Facility

$471.25

Hospital Charge Code	270654391
Hospital Revenue Code	272
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$235.62
Rate for Payer: Aetna Commercial	$179.07
Rate for Payer: Aetna Medicare Advantage	$141.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.17
Rate for Payer: Cigna Commercial	$235.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.38
Rate for Payer: Oxford Commercial	$94.25
Rate for Payer: Qualcare PPO/HMO/WC	$70.69
Rate for Payer: UnitedHealthcare Commercial	$94.25
Rate for Payer: UnitedHealthcare Community & State	$11.36
Rate for Payer: Wellpoint Medicaid Managed Care	$12.49

ORTHO-PACK

Facility

$219.00

Hospital Charge Code	270330631
Hospital Revenue Code	272
Min. Negotiated Rate	$32.85
Max. Negotiated Rate	$32.85
Rate for Payer: Qualcare PPO/HMO/WC	$32.85

ORTHO-PACK

Facility

$219.00

Hospital Charge Code	270330631
Hospital Revenue Code	272
Min. Negotiated Rate	$5.28
Max. Negotiated Rate	$109.50
Rate for Payer: Aetna Commercial	$83.22
Rate for Payer: Aetna Medicare Advantage	$65.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.84
Rate for Payer: Cigna Commercial	$109.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.70
Rate for Payer: Oxford Commercial	$43.80
Rate for Payer: Qualcare PPO/HMO/WC	$32.85
Rate for Payer: UnitedHealthcare Commercial	$43.80
Rate for Payer: UnitedHealthcare Community & State	$5.28
Rate for Payer: Wellpoint Medicaid Managed Care	$5.80

ORTHOSIS MOLD ANKLE CUSTOM

Facility

$3,157.65

Hospital Charge Code	270613508
Hospital Revenue Code	274
Min. Negotiated Rate	$76.10
Max. Negotiated Rate	$1,578.83
Rate for Payer: Aetna Commercial	$1,199.91
Rate for Payer: Aetna Medicare Advantage	$947.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$805.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$805.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$631.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$805.20
Rate for Payer: Cigna Commercial	$1,578.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$764.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$694.68
Rate for Payer: Qualcare PPO/HMO/WC	$473.65
Rate for Payer: UnitedHealthcare Community & State	$76.10
Rate for Payer: Wellpoint Medicaid Managed Care	$83.68

ORTHOSIS MOLD ANKLE CUSTOM

Facility

$3,157.65

Hospital Charge Code	270613508
Hospital Revenue Code	274
Min. Negotiated Rate	$473.65
Max. Negotiated Rate	$764.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$631.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$764.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$694.68
Rate for Payer: Qualcare PPO/HMO/WC	$473.65

ORTHOSIS TOWERS LONG TALL

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270694371
Hospital Revenue Code	278
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$617.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$561.00
Rate for Payer: Qualcare PPO/HMO/WC	$382.50

ORTHOSIS TOWERS LONG TALL

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270694371
Hospital Revenue Code	278
Min. Negotiated Rate	$61.45
Max. Negotiated Rate	$1,275.00
Rate for Payer: Aetna Commercial	$969.00
Rate for Payer: Aetna Medicare Advantage	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$650.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$650.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$650.25
Rate for Payer: Cigna Commercial	$1,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$561.00
Rate for Payer: Qualcare PPO/HMO/WC	$382.50
Rate for Payer: UnitedHealthcare Community & State	$61.45
Rate for Payer: Wellpoint Medicaid Managed Care	$67.58

ORTHOSORB PIN LS 1.3MM KIT

Facility

$1,365.00

Service Code	HCPCS C1713
Hospital Charge Code	270601205
Hospital Revenue Code	278
Min. Negotiated Rate	$204.75
Max. Negotiated Rate	$330.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$273.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$330.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$300.30
Rate for Payer: Qualcare PPO/HMO/WC	$204.75

ORTHOSORB PIN LS 1.3MM KIT

Facility

$1,365.00

Service Code	HCPCS C1713
Hospital Charge Code	270601205
Hospital Revenue Code	278
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$682.50
Rate for Payer: Aetna Commercial	$518.70
Rate for Payer: Aetna Medicare Advantage	$409.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$348.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$348.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$273.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$348.07
Rate for Payer: Cigna Commercial	$682.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$330.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$300.30
Rate for Payer: Qualcare PPO/HMO/WC	$204.75
Rate for Payer: UnitedHealthcare Community & State	$32.90
Rate for Payer: Wellpoint Medicaid Managed Care	$36.17

ORTHO TAPE SCOTCH CAST 2- 4IN

Facility

$16.15

Hospital Charge Code	270652013
Hospital Revenue Code	270
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$2.42

ORTHO TAPE SCOTCH CAST 2- 4IN

Facility

$16.15

Hospital Charge Code	270652013
Hospital Revenue Code	270
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$8.07
Rate for Payer: Aetna Commercial	$6.14
Rate for Payer: Aetna Medicare Advantage	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.12
Rate for Payer: Cigna Commercial	$8.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.84
Rate for Payer: Oxford Commercial	$3.23
Rate for Payer: Qualcare PPO/HMO/WC	$2.42
Rate for Payer: UnitedHealthcare Commercial	$3.23
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

ORTHOTIC CHECKOUT EA 15 MINS

Facility

$299.00

Service Code	HCPCS 97763GP
Hospital Charge Code	1008370
Hospital Revenue Code	420
Min. Negotiated Rate	$7.21
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$113.62
Rate for Payer: Aetna Medicare Advantage	$89.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.25
Rate for Payer: Cigna Commercial	$149.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.70
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.85
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.21
Rate for Payer: Wellpoint Medicaid Managed Care	$7.92

ORTHOTIC CHECKOUT EA 15 MINS

Facility

$299.00

Service Code	HCPCS 97763GP
Hospital Charge Code	1008370
Hospital Revenue Code	420
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$44.85
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

ORTHOTIC FIT/TRAINING 15MIN

Facility

$135.00

Service Code	HCPCS 97760GO
Hospital Charge Code	1008350
Hospital Revenue Code	430
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.50
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

ORTHOTIC FIT/TRAINING 15MIN

Facility

$135.00

Service Code	HCPCS 97760GO
Hospital Charge Code	1008350
Hospital Revenue Code	430
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$20.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

ORTHOTIC MNG/TRAIN/15 MIN 1ST

Facility

$137.00

Service Code	HCPCS 97760
Hospital Charge Code	9808175
Hospital Revenue Code	420
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$20.55
Rate for Payer: Qualcare PPO/HMO/WC	$20.55

ORTHOTIC MNG/TRAIN/15 MIN 1ST

Facility

$137.00

Service Code	HCPCS 97760
Hospital Charge Code	9808175
Hospital Revenue Code	420
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$52.06
Rate for Payer: Aetna Medicare Advantage	$41.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.94
Rate for Payer: Cigna Commercial	$68.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.10
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.55
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.30
Rate for Payer: Wellpoint Medicaid Managed Care	$3.63

ORTHOTIC TRNG EA 15 MIN CQ

Facility

$137.00

Service Code	HCPCS 97760GP
Hospital Charge Code	409197760Q
Hospital Revenue Code	420
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$52.06
Rate for Payer: Aetna Medicare Advantage	$41.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.94
Rate for Payer: Cigna Commercial	$68.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.10
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.55
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.30
Rate for Payer: Wellpoint Medicaid Managed Care	$3.63

ORTHOTIC TRNG EA 15 MIN CQ

Facility

$137.00

Service Code	HCPCS 97760GP
Hospital Charge Code	409197760Q
Hospital Revenue Code	420
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$20.55
Rate for Payer: Qualcare PPO/HMO/WC	$20.55

ORTH/PROS MNG SUBSEQ/15 MIN

Facility

$86.40

Service Code	HCPCS 97763GO
Hospital Charge Code	74203140
Hospital Revenue Code	430
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$12.96
Rate for Payer: Qualcare PPO/HMO/WC	$12.96

ORTH/PROS MNG SUBSEQ/15 MIN

Facility

$86.40

Service Code	HCPCS 97763GO
Hospital Charge Code	74203140
Hospital Revenue Code	430
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$32.83
Rate for Payer: Aetna Medicare Advantage	$25.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.03
Rate for Payer: Cigna Commercial	$43.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.92
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.96
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.08
Rate for Payer: Wellpoint Medicaid Managed Care	$2.29

Know your out-of-pocket cost for care.

All Charges