Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RESTRAINT TIEBACK VEST LG

Facility

$82.50

Hospital Charge Code	270301050
Hospital Revenue Code	270
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

RESTRAINT TIEBACK VEST MED

Facility

$88.00

Hospital Charge Code	270301045
Hospital Revenue Code	270
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

RESTRAINT TIEBACK VEST MED

Facility

$88.00

Hospital Charge Code	270301045
Hospital Revenue Code	270
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$44.00
Rate for Payer: Aetna Commercial	$33.44
Rate for Payer: Aetna Medicare Advantage	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.44
Rate for Payer: Cigna Commercial	$44.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.40
Rate for Payer: Oxford Commercial	$17.60
Rate for Payer: Qualcare PPO/HMO/WC	$13.20
Rate for Payer: UnitedHealthcare Commercial	$17.60
Rate for Payer: UnitedHealthcare Community & State	$2.12
Rate for Payer: Wellpoint Medicaid Managed Care	$2.33

RESTRAINT TIEBACK VEST SM

Facility

$30.45

Hospital Charge Code	270301040
Hospital Revenue Code	270
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$4.57
Rate for Payer: Qualcare PPO/HMO/WC	$4.57

RESTRAINT TIEBACK VEST SM

Facility

$30.45

Hospital Charge Code	270301040
Hospital Revenue Code	270
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.22
Rate for Payer: Aetna Commercial	$11.57
Rate for Payer: Aetna Medicare Advantage	$9.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.76
Rate for Payer: Cigna Commercial	$15.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.13
Rate for Payer: Oxford Commercial	$6.09
Rate for Payer: Qualcare PPO/HMO/WC	$4.57
Rate for Payer: UnitedHealthcare Commercial	$6.09
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.81

RESTRAINT TIEBACK VEST XLG

Facility

$88.00

Hospital Charge Code	270301055
Hospital Revenue Code	270
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

RESTRAINT TIEBACK VEST XLG

Facility

$88.00

Hospital Charge Code	270301055
Hospital Revenue Code	270
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$44.00
Rate for Payer: Aetna Commercial	$33.44
Rate for Payer: Aetna Medicare Advantage	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.44
Rate for Payer: Cigna Commercial	$44.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.40
Rate for Payer: Oxford Commercial	$17.60
Rate for Payer: Qualcare PPO/HMO/WC	$13.20
Rate for Payer: UnitedHealthcare Commercial	$17.60
Rate for Payer: UnitedHealthcare Community & State	$2.12
Rate for Payer: Wellpoint Medicaid Managed Care	$2.33

RESTRAINT TORSO BELT LG

Facility

$97.65

Hospital Charge Code	270301078
Hospital Revenue Code	270
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$48.83
Rate for Payer: Aetna Commercial	$37.11
Rate for Payer: Aetna Medicare Advantage	$29.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.90
Rate for Payer: Cigna Commercial	$48.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.30
Rate for Payer: Oxford Commercial	$19.53
Rate for Payer: Qualcare PPO/HMO/WC	$14.65
Rate for Payer: UnitedHealthcare Commercial	$19.53
Rate for Payer: UnitedHealthcare Community & State	$2.35
Rate for Payer: Wellpoint Medicaid Managed Care	$2.59

RESTRAINT TORSO BELT LG

Facility

$97.65

Hospital Charge Code	270301078
Hospital Revenue Code	270
Min. Negotiated Rate	$14.65
Max. Negotiated Rate	$14.65
Rate for Payer: Qualcare PPO/HMO/WC	$14.65

RESTRAINT TORSO BELT MED

Facility

$100.00

Hospital Charge Code	270301077
Hospital Revenue Code	270
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$20.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

RESTRAINT TORSO BELT MED

Facility

$100.00

Hospital Charge Code	270301077
Hospital Revenue Code	270
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

RESTRAINT TORSO BELT SM

Facility

$100.00

Hospital Charge Code	270301076
Hospital Revenue Code	270
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

RESTRAINT TORSO BELT SM

Facility

$100.00

Hospital Charge Code	270301076
Hospital Revenue Code	270
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$20.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

RESTRAINT TORSO BELT XLG

Facility

$110.45

Hospital Charge Code	270301079
Hospital Revenue Code	270
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$55.23
Rate for Payer: Aetna Commercial	$41.97
Rate for Payer: Aetna Medicare Advantage	$33.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.16
Rate for Payer: Cigna Commercial	$55.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.13
Rate for Payer: Oxford Commercial	$22.09
Rate for Payer: Qualcare PPO/HMO/WC	$16.57
Rate for Payer: UnitedHealthcare Commercial	$22.09
Rate for Payer: UnitedHealthcare Community & State	$2.66
Rate for Payer: Wellpoint Medicaid Managed Care	$2.93

RESTRAINT TORSO BELT XLG

Facility

$110.45

Hospital Charge Code	270301079
Hospital Revenue Code	270
Min. Negotiated Rate	$16.57
Max. Negotiated Rate	$16.57
Rate for Payer: Qualcare PPO/HMO/WC	$16.57

RESTRATA MESHED 5CMX5CM

Facility

$13,750.00

Service Code	HCPCS C1781
Hospital Charge Code	270704823
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

RESTRATA MESHED 5CMX5CM

Facility

$13,750.00

Service Code	HCPCS C1781
Hospital Charge Code	270704823
Hospital Revenue Code	278
Min. Negotiated Rate	$331.38
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$5,225.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50
Rate for Payer: UnitedHealthcare Community & State	$331.38
Rate for Payer: Wellpoint Medicaid Managed Care	$364.38

RESTRATA MESHED 7.5CMX 7.5CM

Facility

$18,750.00

Service Code	HCPCS C1781
Hospital Charge Code	270704824
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

RESTRATA MESHED 7.5CMX 7.5CM

Facility

$18,750.00

Service Code	HCPCS C1781
Hospital Charge Code	270704824
Hospital Revenue Code	278
Min. Negotiated Rate	$451.88
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$7,125.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,125.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50
Rate for Payer: UnitedHealthcare Community & State	$451.88
Rate for Payer: Wellpoint Medicaid Managed Care	$496.88

RESTRATA MINIMATRIX 1000MG

Facility

$23,450.00

Service Code	HCPCS C1781
Hospital Charge Code	270704827
Hospital Revenue Code	278
Min. Negotiated Rate	$565.14
Max. Negotiated Rate	$11,725.00
Rate for Payer: Aetna Commercial	$8,911.00
Rate for Payer: Aetna Medicare Advantage	$7,035.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,979.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,979.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,979.75
Rate for Payer: Cigna Commercial	$11,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,674.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,159.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,517.50
Rate for Payer: UnitedHealthcare Community & State	$565.14
Rate for Payer: Wellpoint Medicaid Managed Care	$621.42

RESTRATA MINIMATRIX 1000MG

Facility

$23,450.00

Service Code	HCPCS C1781
Hospital Charge Code	270704827
Hospital Revenue Code	278
Min. Negotiated Rate	$3,517.50
Max. Negotiated Rate	$5,674.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,674.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$5,159.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,517.50

RESTRATA MINIMATRIX 500MG

Facility

$12,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270704826
Hospital Revenue Code	278
Min. Negotiated Rate	$300.05
Max. Negotiated Rate	$6,225.00
Rate for Payer: Aetna Commercial	$4,731.00
Rate for Payer: Aetna Medicare Advantage	$3,735.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,174.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,174.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,174.75
Rate for Payer: Cigna Commercial	$6,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,012.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,739.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,867.50
Rate for Payer: UnitedHealthcare Community & State	$300.05
Rate for Payer: Wellpoint Medicaid Managed Care	$329.93

RESTRATA MINIMATRIX 500MG

Facility

$12,450.00

Service Code	HCPCS C1889
Hospital Charge Code	270704826
Hospital Revenue Code	278
Min. Negotiated Rate	$1,867.50
Max. Negotiated Rate	$3,012.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,012.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,739.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,867.50

RESTRICTOR BUCK CEMENT PLUG***

Facility

$50.00

Hospital Charge Code	1606359
Hospital Revenue Code	279
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

RESTRICTOR BUCK CEMENT PLUG***

Facility

$50.00

Hospital Charge Code	1606359
Hospital Revenue Code	279
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.00
Rate for Payer: Oxford Commercial	$10.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$10.00
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

Know your out-of-pocket cost for care.

All Charges