Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SLEEVE LAP FIXATION 5X100MM

Facility

$30.58

Service Code	HCPCS A4649
Hospital Charge Code	270642087
Hospital Revenue Code	272
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$4.59
Rate for Payer: Qualcare PPO/HMO/WC	$4.59

SLEEVE NECK ADJSMT C-TPR 0+

Facility

$926.25

Service Code	HCPCS C1776
Hospital Charge Code	270678037
Hospital Revenue Code	278
Min. Negotiated Rate	$138.94
Max. Negotiated Rate	$224.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$203.78
Rate for Payer: Qualcare PPO/HMO/WC	$138.94

SLEEVE NECK ADJSMT C-TPR 0+

Facility

$926.25

Service Code	HCPCS C1776
Hospital Charge Code	270678037
Hospital Revenue Code	278
Min. Negotiated Rate	$22.32
Max. Negotiated Rate	$463.12
Rate for Payer: Aetna Commercial	$351.98
Rate for Payer: Aetna Medicare Advantage	$277.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$236.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$236.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$236.19
Rate for Payer: Cigna Commercial	$463.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$203.78
Rate for Payer: Qualcare PPO/HMO/WC	$138.94
Rate for Payer: UnitedHealthcare Community & State	$22.32
Rate for Payer: Wellpoint Medicaid Managed Care	$24.55

SLEEVE PNEUMO W/PROTRC 100500

Facility

$3,793.65

Hospital Charge Code	270609480
Hospital Revenue Code	272
Min. Negotiated Rate	$569.05
Max. Negotiated Rate	$569.05
Rate for Payer: Qualcare PPO/HMO/WC	$569.05

SLEEVE PNEUMO W/PROTRC 100500

Facility

$3,793.65

Hospital Charge Code	270609480
Hospital Revenue Code	272
Min. Negotiated Rate	$91.43
Max. Negotiated Rate	$1,896.83
Rate for Payer: Aetna Commercial	$1,441.59
Rate for Payer: Aetna Medicare Advantage	$1,138.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$967.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$967.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$967.38
Rate for Payer: Cigna Commercial	$1,896.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,138.10
Rate for Payer: Oxford Commercial	$758.73
Rate for Payer: Qualcare PPO/HMO/WC	$569.05
Rate for Payer: UnitedHealthcare Commercial	$758.73
Rate for Payer: UnitedHealthcare Community & State	$91.43
Rate for Payer: Wellpoint Medicaid Managed Care	$100.53

SLEEVE POSITIONING 10mm 113578

Facility

$985.00

Hospital Charge Code	270639969
Hospital Revenue Code	278
Min. Negotiated Rate	$147.75
Max. Negotiated Rate	$238.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$216.70
Rate for Payer: Qualcare PPO/HMO/WC	$147.75

SLEEVE POSITIONING 10mm 113578

Facility

$985.00

Hospital Charge Code	270639969
Hospital Revenue Code	278
Min. Negotiated Rate	$23.74
Max. Negotiated Rate	$492.50
Rate for Payer: Aetna Commercial	$374.30
Rate for Payer: Aetna Medicare Advantage	$295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.18
Rate for Payer: Cigna Commercial	$492.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$216.70
Rate for Payer: Qualcare PPO/HMO/WC	$147.75
Rate for Payer: UnitedHealthcare Community & State	$23.74
Rate for Payer: Wellpoint Medicaid Managed Care	$26.10

SLEEVE PROTECTIVE

Facility

$422.50

Hospital Charge Code	270677297
Hospital Revenue Code	272
Min. Negotiated Rate	$10.18
Max. Negotiated Rate	$211.25
Rate for Payer: Aetna Commercial	$160.55
Rate for Payer: Aetna Medicare Advantage	$126.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.74
Rate for Payer: Cigna Commercial	$211.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.75
Rate for Payer: Oxford Commercial	$84.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.38
Rate for Payer: UnitedHealthcare Commercial	$84.50
Rate for Payer: UnitedHealthcare Community & State	$10.18
Rate for Payer: Wellpoint Medicaid Managed Care	$11.20

SLEEVE PROTECTIVE

Facility

$422.50

Hospital Charge Code	270677297
Hospital Revenue Code	272
Min. Negotiated Rate	$63.38
Max. Negotiated Rate	$63.38
Rate for Payer: Qualcare PPO/HMO/WC	$63.38

SLEEVE PROTECTIVE TM ANKLE

Facility

$390.00

Hospital Charge Code	270695538
Hospital Revenue Code	272
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SLEEVE PROTECTIVE TM ANKLE

Facility

$390.00

Hospital Charge Code	270695538
Hospital Revenue Code	272
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$78.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$78.00
Rate for Payer: UnitedHealthcare Community & State	$9.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

SLEEVE RESORB F/4.0mm SCREW

Facility

$816.00

Hospital Charge Code	270662828
Hospital Revenue Code	278
Min. Negotiated Rate	$19.67
Max. Negotiated Rate	$408.00
Rate for Payer: Aetna Commercial	$310.08
Rate for Payer: Aetna Medicare Advantage	$244.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.08
Rate for Payer: Cigna Commercial	$408.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$179.52
Rate for Payer: Qualcare PPO/HMO/WC	$122.40
Rate for Payer: UnitedHealthcare Community & State	$19.67
Rate for Payer: Wellpoint Medicaid Managed Care	$21.62

SLEEVE RESORB F/4.0mm SCREW

Facility

$816.00

Hospital Charge Code	270662828
Hospital Revenue Code	278
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$197.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$179.52
Rate for Payer: Qualcare PPO/HMO/WC	$122.40

SLEEVE SCD CALF LG 14IN BULK

Facility

$165.61

Hospital Charge Code	270654148
Hospital Revenue Code	270
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$82.81
Rate for Payer: Aetna Commercial	$62.93
Rate for Payer: Aetna Medicare Advantage	$49.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.23
Rate for Payer: Cigna Commercial	$82.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.68
Rate for Payer: Oxford Commercial	$33.12
Rate for Payer: Qualcare PPO/HMO/WC	$24.84
Rate for Payer: UnitedHealthcare Commercial	$33.12
Rate for Payer: UnitedHealthcare Community & State	$3.99
Rate for Payer: Wellpoint Medicaid Managed Care	$4.39

SLEEVE SCD CALF LG 14IN BULK

Facility

$165.61

Hospital Charge Code	270654148
Hospital Revenue Code	270
Min. Negotiated Rate	$24.84
Max. Negotiated Rate	$24.84
Rate for Payer: Qualcare PPO/HMO/WC	$24.84

SLEEVE SEQUEN COMP LG 5480

Facility

$502.45

Hospital Charge Code	270604156
Hospital Revenue Code	270
Min. Negotiated Rate	$75.37
Max. Negotiated Rate	$75.37
Rate for Payer: Qualcare PPO/HMO/WC	$75.37

SLEEVE SEQUEN COMP LG 5480

Facility

$502.45

Hospital Charge Code	270604156
Hospital Revenue Code	270
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$251.22
Rate for Payer: Aetna Commercial	$190.93
Rate for Payer: Aetna Medicare Advantage	$150.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.12
Rate for Payer: Cigna Commercial	$251.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.74
Rate for Payer: Oxford Commercial	$100.49
Rate for Payer: Qualcare PPO/HMO/WC	$75.37
Rate for Payer: UnitedHealthcare Commercial	$100.49
Rate for Payer: UnitedHealthcare Community & State	$12.11
Rate for Payer: Wellpoint Medicaid Managed Care	$13.31

SLEEVE SEQUEN COMP LG/XL

Facility

$629.65

Hospital Charge Code	270600083
Hospital Revenue Code	270
Min. Negotiated Rate	$94.45
Max. Negotiated Rate	$94.45
Rate for Payer: Qualcare PPO/HMO/WC	$94.45

SLEEVE SEQUEN COMP LG/XL

Facility

$629.65

Hospital Charge Code	270600083
Hospital Revenue Code	270
Min. Negotiated Rate	$15.17
Max. Negotiated Rate	$314.82
Rate for Payer: Aetna Commercial	$239.27
Rate for Payer: Aetna Medicare Advantage	$188.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.56
Rate for Payer: Cigna Commercial	$314.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.90
Rate for Payer: Oxford Commercial	$125.93
Rate for Payer: Qualcare PPO/HMO/WC	$94.45
Rate for Payer: UnitedHealthcare Commercial	$125.93
Rate for Payer: UnitedHealthcare Community & State	$15.17
Rate for Payer: Wellpoint Medicaid Managed Care	$16.69

SLEEVE SEQUEN COMP MED

Facility

$414.45

Hospital Charge Code	270604157
Hospital Revenue Code	270
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

SLEEVE SEQUEN COMP MED

Facility

$414.45

Hospital Charge Code	270604157
Hospital Revenue Code	270
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$207.22
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$82.89
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$82.89
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

SLEEVE SEQUEN COMP SM

Facility

$537.65

Hospital Charge Code	270600094
Hospital Revenue Code	270
Min. Negotiated Rate	$80.65
Max. Negotiated Rate	$80.65
Rate for Payer: Qualcare PPO/HMO/WC	$80.65

SLEEVE SEQUEN COMP SM

Facility

$537.65

Hospital Charge Code	270600094
Hospital Revenue Code	270
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$268.82
Rate for Payer: Aetna Commercial	$204.31
Rate for Payer: Aetna Medicare Advantage	$161.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$137.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$137.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$137.10
Rate for Payer: Cigna Commercial	$268.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.29
Rate for Payer: Oxford Commercial	$107.53
Rate for Payer: Qualcare PPO/HMO/WC	$80.65
Rate for Payer: UnitedHealthcare Commercial	$107.53
Rate for Payer: UnitedHealthcare Community & State	$12.96
Rate for Payer: Wellpoint Medicaid Managed Care	$14.25

SLEEVE SMIT 40MM 084.093

Facility

$183.25

Hospital Charge Code	270624020
Hospital Revenue Code	272
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$91.62
Rate for Payer: Aetna Commercial	$69.64
Rate for Payer: Aetna Medicare Advantage	$54.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.73
Rate for Payer: Cigna Commercial	$91.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.98
Rate for Payer: Oxford Commercial	$36.65
Rate for Payer: Qualcare PPO/HMO/WC	$27.49
Rate for Payer: UnitedHealthcare Commercial	$36.65
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: Wellpoint Medicaid Managed Care	$4.86

SLEEVE SMIT 40MM 084.093

Facility

$183.25

Hospital Charge Code	270624020
Hospital Revenue Code	272
Min. Negotiated Rate	$27.49
Max. Negotiated Rate	$27.49
Rate for Payer: Qualcare PPO/HMO/WC	$27.49

Know your out-of-pocket cost for care.

All Charges