Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHIELD NIPPLE

Facility

$24.85

Hospital Charge Code	200600466
Hospital Revenue Code	272
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$9.44
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.46
Rate for Payer: Oxford Commercial	$4.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$4.97
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

SHIELD OPTI

Facility

$24.85

Hospital Charge Code	270606060
Hospital Revenue Code	270
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$9.44
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.46
Rate for Payer: Oxford Commercial	$4.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$4.97
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

SHIELD OPTI

Facility

$24.85

Hospital Charge Code	270606060
Hospital Revenue Code	270
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

SHIELD SIMPULSE SPLASH 6.5

Facility

$104.85

Hospital Charge Code	270600331
Hospital Revenue Code	272
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$52.42
Rate for Payer: Aetna Commercial	$39.84
Rate for Payer: Aetna Medicare Advantage	$31.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.74
Rate for Payer: Cigna Commercial	$52.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.45
Rate for Payer: Oxford Commercial	$20.97
Rate for Payer: Qualcare PPO/HMO/WC	$15.73
Rate for Payer: UnitedHealthcare Commercial	$20.97
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

SHIELD SIMPULSE SPLASH 6.5

Facility

$104.85

Hospital Charge Code	270600331
Hospital Revenue Code	272
Min. Negotiated Rate	$15.73
Max. Negotiated Rate	$15.73
Rate for Payer: Qualcare PPO/HMO/WC	$15.73

SHIELD SOFT SPLASH WOUND TIP

Facility

$187.25

Hospital Charge Code	270600335
Hospital Revenue Code	272
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$93.62
Rate for Payer: Aetna Commercial	$71.16
Rate for Payer: Aetna Medicare Advantage	$56.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.75
Rate for Payer: Cigna Commercial	$93.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.17
Rate for Payer: Oxford Commercial	$37.45
Rate for Payer: Qualcare PPO/HMO/WC	$28.09
Rate for Payer: UnitedHealthcare Commercial	$37.45
Rate for Payer: UnitedHealthcare Community & State	$4.51
Rate for Payer: Wellpoint Medicaid Managed Care	$4.96

SHIELD SOFT SPLASH WOUND TIP

Facility

$187.25

Hospital Charge Code	270600335
Hospital Revenue Code	272
Min. Negotiated Rate	$28.09
Max. Negotiated Rate	$28.09
Rate for Payer: Qualcare PPO/HMO/WC	$28.09

SHIELD STRY BURR GRD 2296-301

Facility

$239.25

Hospital Charge Code	270610812
Hospital Revenue Code	272
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$119.62
Rate for Payer: Aetna Commercial	$90.92
Rate for Payer: Aetna Medicare Advantage	$71.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.01
Rate for Payer: Cigna Commercial	$119.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.78
Rate for Payer: Oxford Commercial	$47.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.89
Rate for Payer: UnitedHealthcare Commercial	$47.85
Rate for Payer: UnitedHealthcare Community & State	$5.77
Rate for Payer: Wellpoint Medicaid Managed Care	$6.34

SHIELD STRY BURR GRD 2296-301

Facility

$239.25

Hospital Charge Code	270610812
Hospital Revenue Code	272
Min. Negotiated Rate	$35.89
Max. Negotiated Rate	$35.89
Rate for Payer: Qualcare PPO/HMO/WC	$35.89

SHIELD STRY BURR GRD 2296-302

Facility

$239.25

Hospital Charge Code	270610813
Hospital Revenue Code	272
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$119.62
Rate for Payer: Aetna Commercial	$90.92
Rate for Payer: Aetna Medicare Advantage	$71.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.01
Rate for Payer: Cigna Commercial	$119.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.78
Rate for Payer: Oxford Commercial	$47.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.89
Rate for Payer: UnitedHealthcare Commercial	$47.85
Rate for Payer: UnitedHealthcare Community & State	$5.77
Rate for Payer: Wellpoint Medicaid Managed Care	$6.34

SHIELD STRY BURR GRD 2296-302

Facility

$239.25

Hospital Charge Code	270610813
Hospital Revenue Code	272
Min. Negotiated Rate	$35.89
Max. Negotiated Rate	$35.89
Rate for Payer: Qualcare PPO/HMO/WC	$35.89

SHIGA TOXIN EIA W REFLX E COLI

Facility

$390.00

Service Code	HCPCS 87427
Hospital Charge Code	401187427
Hospital Revenue Code	306
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SHIGA TOXIN EIA W REFLX E COLI

Facility

$390.00

Service Code	HCPCS 87427
Hospital Charge Code	401187427
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SHILEY SG LUMAN SUB CAN UDAL**

Facility

$168.00

Hospital Charge Code	8002479
Hospital Revenue Code	279
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$25.20

SHILEY SG LUMAN SUB CAN UDAL**

Facility

$168.00

Hospital Charge Code	8002479
Hospital Revenue Code	279
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$84.00
Rate for Payer: Aetna Commercial	$63.84
Rate for Payer: Aetna Medicare Advantage	$50.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.84
Rate for Payer: Cigna Commercial	$84.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.40
Rate for Payer: Oxford Commercial	$33.60
Rate for Payer: Qualcare PPO/HMO/WC	$25.20
Rate for Payer: UnitedHealthcare Commercial	$33.60
Rate for Payer: UnitedHealthcare Community & State	$4.05
Rate for Payer: Wellpoint Medicaid Managed Care	$4.45

SHIM 10/12MMX29MM 6 DEGREE

Facility

$10,000.00

Hospital Charge Code	270702409
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

SHIM 10/12MMX29MM 6 DEGREE

Facility

$10,000.00

Hospital Charge Code	270702409
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

SHIM 10/13X29MM

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703703
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

SHIM 10/13X29MM

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270703703
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

SHIM 10MM X 30MM 0 DEGREE

Facility

$18,975.00

Service Code	HCPCS L8699
Hospital Charge Code	270693058
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

SHIM 10MM X 30MM 0 DEGREE

Facility

$18,975.00

Service Code	HCPCS L8699
Hospital Charge Code	270693058
Hospital Revenue Code	278
Min. Negotiated Rate	$457.30
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$7,210.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25
Rate for Payer: UnitedHealthcare Community & State	$457.30
Rate for Payer: Wellpoint Medicaid Managed Care	$502.84

SHIM 11/13 X 25 MM

Facility

$10,000.00

Hospital Charge Code	270703302
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

SHIM 11/13 X 25 MM

Facility

$10,000.00

Hospital Charge Code	270703302
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$241.00
Rate for Payer: Wellpoint Medicaid Managed Care	$265.00

SHIM 12 OR 14X29MM FH11 6D

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270695889
Hospital Revenue Code	278
Min. Negotiated Rate	$457.30
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$7,210.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25
Rate for Payer: UnitedHealthcare Community & State	$457.30
Rate for Payer: Wellpoint Medicaid Managed Care	$502.84

SHIM 12 OR 14X29MM FH11 6D

Facility

$18,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270695889
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

Know your out-of-pocket cost for care.

All Charges