Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

RIMXR WRIST RT COMPL 2 VIEWS**

Facility

$101.00

Service Code	HCPCS 73110RT
Hospital Charge Code	2011014
Hospital Revenue Code	320
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

RIMXR WRIST RT COMPL 2 VIEWS**

Facility

$101.00

Service Code	HCPCS 73110RT
Hospital Charge Code	2011014
Hospital Revenue Code	320
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$1,975.00
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	$30.30
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

RING 1/3 COMPSTE SM 6D FC10028

Facility

$1,190.45

Hospital Charge Code	270632629
Hospital Revenue Code	272
Min. Negotiated Rate	$178.57
Max. Negotiated Rate	$178.57
Rate for Payer: Qualcare PPO/HMO/WC	$178.57

RING 1/3 COMPSTE SM 6D FC10028

Facility

$1,190.45

Hospital Charge Code	270632629
Hospital Revenue Code	272
Min. Negotiated Rate	$28.69
Max. Negotiated Rate	$595.23
Rate for Payer: Aetna Commercial	$452.37
Rate for Payer: Aetna Medicare Advantage	$357.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$303.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$303.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$303.56
Rate for Payer: Cigna Commercial	$595.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$357.13
Rate for Payer: Oxford Commercial	$238.09
Rate for Payer: Qualcare PPO/HMO/WC	$178.57
Rate for Payer: UnitedHealthcare Commercial	$238.09
Rate for Payer: UnitedHealthcare Community & State	$28.69
Rate for Payer: Wellpoint Medicaid Managed Care	$31.55

RING 2/3 ALUMM MED 8IN FA10029

Facility

$2,480.00

Hospital Charge Code	270612445
Hospital Revenue Code	272
Min. Negotiated Rate	$59.77
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$942.40
Rate for Payer: Aetna Medicare Advantage	$744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$632.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$632.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$632.40
Rate for Payer: Cigna Commercial	$1,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$744.00
Rate for Payer: Oxford Commercial	$496.00
Rate for Payer: Qualcare PPO/HMO/WC	$372.00
Rate for Payer: UnitedHealthcare Commercial	$496.00
Rate for Payer: UnitedHealthcare Community & State	$59.77
Rate for Payer: Wellpoint Medicaid Managed Care	$65.72

RING 2/3 ALUMM MED 8IN FA10029

Facility

$2,480.00

Hospital Charge Code	270612445
Hospital Revenue Code	272
Min. Negotiated Rate	$372.00
Max. Negotiated Rate	$372.00
Rate for Payer: Qualcare PPO/HMO/WC	$372.00

RING 2/3 COMPSTE SM 6D FC10028

Facility

$2,281.65

Hospital Charge Code	270632630
Hospital Revenue Code	272
Min. Negotiated Rate	$342.25
Max. Negotiated Rate	$342.25
Rate for Payer: Qualcare PPO/HMO/WC	$342.25

RING 2/3 COMPSTE SM 6D FC10028

Facility

$2,281.65

Hospital Charge Code	270632630
Hospital Revenue Code	272
Min. Negotiated Rate	$54.99
Max. Negotiated Rate	$1,140.83
Rate for Payer: Aetna Commercial	$867.03
Rate for Payer: Aetna Medicare Advantage	$684.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$581.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$581.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$581.82
Rate for Payer: Cigna Commercial	$1,140.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$684.50
Rate for Payer: Oxford Commercial	$456.33
Rate for Payer: Qualcare PPO/HMO/WC	$342.25
Rate for Payer: UnitedHealthcare Commercial	$456.33
Rate for Payer: UnitedHealthcare Community & State	$54.99
Rate for Payer: Wellpoint Medicaid Managed Care	$60.46

RING 3/4 140mm ID 393734

Facility

$1,580.95

Hospital Charge Code	270633840
Hospital Revenue Code	272
Min. Negotiated Rate	$237.14
Max. Negotiated Rate	$237.14
Rate for Payer: Qualcare PPO/HMO/WC	$237.14

RING 3/4 140mm ID 393734

Facility

$1,580.95

Hospital Charge Code	270633840
Hospital Revenue Code	272
Min. Negotiated Rate	$38.10
Max. Negotiated Rate	$790.48
Rate for Payer: Aetna Commercial	$600.76
Rate for Payer: Aetna Medicare Advantage	$474.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$403.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$403.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$403.14
Rate for Payer: Cigna Commercial	$790.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$474.29
Rate for Payer: Oxford Commercial	$316.19
Rate for Payer: Qualcare PPO/HMO/WC	$237.14
Rate for Payer: UnitedHealthcare Commercial	$316.19
Rate for Payer: UnitedHealthcare Community & State	$38.10
Rate for Payer: Wellpoint Medicaid Managed Care	$41.90

RING 3/4 165mm ID

Facility

$2,159.90

Hospital Charge Code	270632997
Hospital Revenue Code	278
Min. Negotiated Rate	$52.05
Max. Negotiated Rate	$1,079.95
Rate for Payer: Aetna Commercial	$820.76
Rate for Payer: Aetna Medicare Advantage	$647.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$550.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$550.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$431.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$550.77
Rate for Payer: Cigna Commercial	$1,079.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$522.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$475.18
Rate for Payer: Qualcare PPO/HMO/WC	$323.99
Rate for Payer: UnitedHealthcare Community & State	$52.05
Rate for Payer: Wellpoint Medicaid Managed Care	$57.24

RING 3/4 165mm ID

Facility

$2,159.90

Hospital Charge Code	270632997
Hospital Revenue Code	278
Min. Negotiated Rate	$323.99
Max. Negotiated Rate	$522.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$431.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$522.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$475.18
Rate for Payer: Qualcare PPO/HMO/WC	$323.99

RING BASIN GUIDEWIRE BOWL

Facility

$32.55

Hospital Charge Code	270694935S
Hospital Revenue Code	272
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$16.27
Rate for Payer: Aetna Commercial	$12.37
Rate for Payer: Aetna Medicare Advantage	$9.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.30
Rate for Payer: Cigna Commercial	$16.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.77
Rate for Payer: Oxford Commercial	$6.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.88
Rate for Payer: UnitedHealthcare Commercial	$6.51
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

RING BASIN GUIDEWIRE BOWL

Facility

$32.55

Hospital Charge Code	270694935S
Hospital Revenue Code	272
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$4.88
Rate for Payer: Qualcare PPO/HMO/WC	$4.88

RING CAPSULAR TENSION 12MM

Facility

$1,000.00

Hospital Charge Code	270660024
Hospital Revenue Code	270
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

RING CAPSULAR TENSION 12MM

Facility

$1,000.00

Hospital Charge Code	270660024
Hospital Revenue Code	270
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

RING CAPSULAR TENSION 13MM

Facility

$5.00

Hospital Charge Code	270660015
Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

RING CAPSULAR TENSION 13MM

Facility

$5.00

Hospital Charge Code	270660015
Hospital Revenue Code	270
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

RING CK TRANSJUG HEPAT 179780

Facility

$2,025.65

Hospital Charge Code	270626432
Hospital Revenue Code	272
Min. Negotiated Rate	$48.82
Max. Negotiated Rate	$1,012.83
Rate for Payer: Aetna Commercial	$769.75
Rate for Payer: Aetna Medicare Advantage	$607.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$516.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$516.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$516.54
Rate for Payer: Cigna Commercial	$1,012.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$607.70
Rate for Payer: Oxford Commercial	$405.13
Rate for Payer: Qualcare PPO/HMO/WC	$303.85
Rate for Payer: UnitedHealthcare Commercial	$405.13
Rate for Payer: UnitedHealthcare Community & State	$48.82
Rate for Payer: Wellpoint Medicaid Managed Care	$53.68

RING CK TRANSJUG HEPAT 179780

Facility

$2,025.65

Hospital Charge Code	270626432
Hospital Revenue Code	272
Min. Negotiated Rate	$303.85
Max. Negotiated Rate	$303.85
Rate for Payer: Qualcare PPO/HMO/WC	$303.85

RING CONNECTION BOLT LRF

Facility

$198.25

Service Code	HCPCS A4649
Hospital Charge Code	270699596
Hospital Revenue Code	272
Min. Negotiated Rate	$29.74
Max. Negotiated Rate	$29.74
Rate for Payer: Qualcare PPO/HMO/WC	$29.74

RING CONNECTION BOLT LRF

Facility

$198.25

Service Code	HCPCS A4649
Hospital Charge Code	270699596
Hospital Revenue Code	272
Min. Negotiated Rate	$4.78
Max. Negotiated Rate	$99.12
Rate for Payer: Aetna Commercial	$75.33
Rate for Payer: Aetna Medicare Advantage	$59.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.55
Rate for Payer: Cigna Commercial	$99.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.48
Rate for Payer: Oxford Commercial	$39.65
Rate for Payer: Qualcare PPO/HMO/WC	$29.74
Rate for Payer: UnitedHealthcare Commercial	$39.65
Rate for Payer: UnitedHealthcare Community & State	$4.78
Rate for Payer: Wellpoint Medicaid Managed Care	$5.25

RING CONSTRAINNG GROUP 3

Facility

$4,398.75

Hospital Charge Code	270670932
Hospital Revenue Code	278
Min. Negotiated Rate	$106.01
Max. Negotiated Rate	$2,199.38
Rate for Payer: Aetna Commercial	$1,671.53
Rate for Payer: Aetna Medicare Advantage	$1,319.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,121.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,121.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,121.68
Rate for Payer: Cigna Commercial	$2,199.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,064.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$967.73
Rate for Payer: Qualcare PPO/HMO/WC	$659.81
Rate for Payer: UnitedHealthcare Community & State	$106.01
Rate for Payer: Wellpoint Medicaid Managed Care	$116.57

RING CONSTRAINNG GROUP 3

Facility

$4,398.75

Hospital Charge Code	270670932
Hospital Revenue Code	278
Min. Negotiated Rate	$659.81
Max. Negotiated Rate	$1,064.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$879.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,064.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$967.73
Rate for Payer: Qualcare PPO/HMO/WC	$659.81

RING DPY COMP MED 8 FC10029

Facility

$3,035.25

Hospital Charge Code	270612488
Hospital Revenue Code	272
Min. Negotiated Rate	$455.29
Max. Negotiated Rate	$455.29
Rate for Payer: Qualcare PPO/HMO/WC	$455.29

Know your out-of-pocket cost for care.

All Charges