Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SLIN OBTR TRANSOBT M0068505000

Facility

$6,025.00

Service Code	HCPCS C1771
Hospital Charge Code	270639751
Hospital Revenue Code	278
Min. Negotiated Rate	$145.20
Max. Negotiated Rate	$3,012.50
Rate for Payer: Aetna Commercial	$2,289.50
Rate for Payer: Aetna Medicare Advantage	$1,807.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,536.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,536.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,536.38
Rate for Payer: Cigna Commercial	$3,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,458.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,325.50
Rate for Payer: Qualcare PPO/HMO/WC	$903.75
Rate for Payer: UnitedHealthcare Community & State	$145.20
Rate for Payer: Wellpoint Medicaid Managed Care	$159.66

SLIP ON SLEEVE LARGE

Facility

$800.00

Hospital Charge Code	270666776
Hospital Revenue Code	270
Min. Negotiated Rate	$19.28
Max. Negotiated Rate	$400.00
Rate for Payer: Aetna Commercial	$304.00
Rate for Payer: Aetna Medicare Advantage	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.00
Rate for Payer: Cigna Commercial	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.00
Rate for Payer: Oxford Commercial	$160.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00
Rate for Payer: UnitedHealthcare Commercial	$160.00
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$21.20

SLIP ON SLEEVE LARGE

Facility

$800.00

Hospital Charge Code	270666776
Hospital Revenue Code	270
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$120.00

SLIPPER GRAY XL

Facility

$2.89

Hospital Charge Code	270649361
Hospital Revenue Code	270
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.43
Rate for Payer: Qualcare PPO/HMO/WC	$0.43

SLIPPER GRAY XL

Facility

$2.89

Hospital Charge Code	270649361
Hospital Revenue Code	270
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.45
Rate for Payer: Aetna Commercial	$1.10
Rate for Payer: Aetna Medicare Advantage	$0.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.74
Rate for Payer: Cigna Commercial	$1.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.87
Rate for Payer: Oxford Commercial	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.43
Rate for Payer: UnitedHealthcare Commercial	$0.58
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

SLIPPER LG 10-12 BEIGE

Facility

$5.65

Hospital Charge Code	270301993
Hospital Revenue Code	270
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

SLIPPER LG 10-12 BEIGE

Facility

$5.65

Hospital Charge Code	270301993
Hospital Revenue Code	270
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

SLIPPER MED LT BLUE

Facility

$5.65

Hospital Charge Code	270301992
Hospital Revenue Code	270
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

SLIPPER MED LT BLUE

Facility

$5.65

Hospital Charge Code	270301992
Hospital Revenue Code	270
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

SLIPPERS BARIATRIC DBL TRD SSO

Facility

$4.13

Hospital Charge Code	270662689
Hospital Revenue Code	270
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.62
Rate for Payer: Qualcare PPO/HMO/WC	$0.62

SLIPPERS BARIATRIC DBL TRD SSO

Facility

$4.13

Hospital Charge Code	270662689
Hospital Revenue Code	270
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.06
Rate for Payer: Aetna Commercial	$1.57
Rate for Payer: Aetna Medicare Advantage	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.05
Rate for Payer: Cigna Commercial	$2.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.24
Rate for Payer: Oxford Commercial	$0.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.62
Rate for Payer: UnitedHealthcare Commercial	$0.83
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

SLIPPER SM RED

Facility

$5.65

Hospital Charge Code	270301991
Hospital Revenue Code	270
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

SLIPPER SM RED

Facility

$5.65

Hospital Charge Code	270301991
Hospital Revenue Code	270
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

SLIPPER XLG 12 TO 13-1/2 *****

Facility

$11.00

Hospital Charge Code	8003915
Hospital Revenue Code	270
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.50
Rate for Payer: Aetna Commercial	$4.18
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.81
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.30
Rate for Payer: Oxford Commercial	$2.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.65
Rate for Payer: UnitedHealthcare Commercial	$2.20
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

SLIPPER XLG 12 TO 13-1/2 *****

Facility

$11.00

Hospital Charge Code	8003915
Hospital Revenue Code	270
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.65

SLIPPER XLG BEIGE

Facility

$5.65

Hospital Charge Code	270301995
Hospital Revenue Code	270
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

SLIPPER XLG BEIGE

Facility

$5.65

Hospital Charge Code	270301995
Hospital Revenue Code	270
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

SLIT KNIFE 2.4 MM BEVEL UP

Facility

$248.08

Hospital Charge Code	270685046
Hospital Revenue Code	272
Min. Negotiated Rate	$37.21
Max. Negotiated Rate	$37.21
Rate for Payer: Qualcare PPO/HMO/WC	$37.21

SLIT KNIFE 2.4 MM BEVEL UP

Facility

$248.08

Hospital Charge Code	270685046
Hospital Revenue Code	272
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$124.04
Rate for Payer: Aetna Commercial	$94.27
Rate for Payer: Aetna Medicare Advantage	$74.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.26
Rate for Payer: Cigna Commercial	$124.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.42
Rate for Payer: Oxford Commercial	$49.62
Rate for Payer: Qualcare PPO/HMO/WC	$37.21
Rate for Payer: UnitedHealthcare Commercial	$49.62
Rate for Payer: UnitedHealthcare Community & State	$5.98
Rate for Payer: Wellpoint Medicaid Managed Care	$6.57

SLIT KNIFE 2.75MM ANGLED

Facility

$29.00

Hospital Charge Code	270338750
Hospital Revenue Code	272
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$4.35
Rate for Payer: Qualcare PPO/HMO/WC	$4.35

SLIT KNIFE 2.75MM ANGLED

Facility

$29.00

Hospital Charge Code	270338750
Hospital Revenue Code	272
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$14.50
Rate for Payer: Aetna Commercial	$11.02
Rate for Payer: Aetna Medicare Advantage	$8.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.39
Rate for Payer: Cigna Commercial	$14.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.70
Rate for Payer: Oxford Commercial	$5.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.35
Rate for Payer: UnitedHealthcare Commercial	$5.80
Rate for Payer: UnitedHealthcare Community & State	$0.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

SLO-BID 100/100MG/CAP

Facility

$3.00

Hospital Charge Code	60633890
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

SLO-BID 100/100MG/CAP

Facility

$3.00

Hospital Charge Code	60633891
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SLO-BID 100/100MG/CAP

Facility

$3.00

Hospital Charge Code	60633890
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

SLO-BID 100/100MG/CAP

Facility

$3.00

Hospital Charge Code	60633891
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

Know your out-of-pocket cost for care.

All Charges