Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPLINT COCK-UP WRIST MED RT

Facility

$32.60

Hospital Charge Code	270649000
Hospital Revenue Code	272
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$16.30
Rate for Payer: Aetna Commercial	$12.39
Rate for Payer: Aetna Medicare Advantage	$9.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.31
Rate for Payer: Cigna Commercial	$16.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.78
Rate for Payer: Oxford Commercial	$6.52
Rate for Payer: Qualcare PPO/HMO/WC	$4.89
Rate for Payer: UnitedHealthcare Commercial	$6.52
Rate for Payer: UnitedHealthcare Community & State	$0.79
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

SPLINT DOYLE AIRWAY ******

Facility

$20.49

Hospital Charge Code	1600709
Hospital Revenue Code	272
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$3.07
Rate for Payer: Qualcare PPO/HMO/WC	$3.07

SPLINT DOYLE AIRWAY ******

Facility

$20.49

Hospital Charge Code	1600709
Hospital Revenue Code	272
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$10.24
Rate for Payer: Aetna Commercial	$7.79
Rate for Payer: Aetna Medicare Advantage	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.22
Rate for Payer: Cigna Commercial	$10.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.15
Rate for Payer: Oxford Commercial	$4.10
Rate for Payer: Qualcare PPO/HMO/WC	$3.07
Rate for Payer: UnitedHealthcare Commercial	$4.10
Rate for Payer: UnitedHealthcare Community & State	$0.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.54

SPLINT DOYLE NASAL SIL 2007-11

Facility

$173.65

Hospital Charge Code	270061285
Hospital Revenue Code	278
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$86.83
Rate for Payer: Aetna Commercial	$65.99
Rate for Payer: Aetna Medicare Advantage	$52.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.28
Rate for Payer: Cigna Commercial	$86.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.20
Rate for Payer: Qualcare PPO/HMO/WC	$26.05
Rate for Payer: UnitedHealthcare Community & State	$4.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.60

SPLINT DOYLE NASAL SIL 2007-11

Facility

$173.65

Hospital Charge Code	270061285
Hospital Revenue Code	278
Min. Negotiated Rate	$26.05
Max. Negotiated Rate	$42.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.20
Rate for Payer: Qualcare PPO/HMO/WC	$26.05

SPLINT ELBOW VINYL 11

Facility

$59.75

Hospital Charge Code	270649336
Hospital Revenue Code	272
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$8.96
Rate for Payer: Qualcare PPO/HMO/WC	$8.96

SPLINT ELBOW VINYL 11

Facility

$59.75

Hospital Charge Code	270649336
Hospital Revenue Code	272
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$29.88
Rate for Payer: Aetna Commercial	$22.70
Rate for Payer: Aetna Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.24
Rate for Payer: Cigna Commercial	$29.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.93
Rate for Payer: Oxford Commercial	$11.95
Rate for Payer: Qualcare PPO/HMO/WC	$8.96
Rate for Payer: UnitedHealthcare Commercial	$11.95
Rate for Payer: UnitedHealthcare Community & State	$1.44
Rate for Payer: Wellpoint Medicaid Managed Care	$1.58

SPLINT ELBOW VINYL 13

Facility

$64.75

Hospital Charge Code	270649337
Hospital Revenue Code	272
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$9.71
Rate for Payer: Qualcare PPO/HMO/WC	$9.71

SPLINT ELBOW VINYL 13

Facility

$64.75

Hospital Charge Code	270649337
Hospital Revenue Code	272
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$32.38
Rate for Payer: Aetna Commercial	$24.61
Rate for Payer: Aetna Medicare Advantage	$19.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.51
Rate for Payer: Cigna Commercial	$32.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.43
Rate for Payer: Oxford Commercial	$12.95
Rate for Payer: Qualcare PPO/HMO/WC	$9.71
Rate for Payer: UnitedHealthcare Commercial	$12.95
Rate for Payer: UnitedHealthcare Community & State	$1.56
Rate for Payer: Wellpoint Medicaid Managed Care	$1.72

SPLINT FINGER 1-1/4 9119-01

Facility

$31.20

Hospital Charge Code	270649338
Hospital Revenue Code	270
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$4.68
Rate for Payer: Qualcare PPO/HMO/WC	$4.68

SPLINT FINGER 1-1/4 9119-01

Facility

$31.20

Hospital Charge Code	270649338
Hospital Revenue Code	270
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$15.60
Rate for Payer: Aetna Commercial	$11.86
Rate for Payer: Aetna Medicare Advantage	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.96
Rate for Payer: Cigna Commercial	$15.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$6.24
Rate for Payer: Qualcare PPO/HMO/WC	$4.68
Rate for Payer: UnitedHealthcare Commercial	$6.24
Rate for Payer: UnitedHealthcare Community & State	$0.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

SPLINT FINGER 1-5/8 11201

Facility

$48.55

Hospital Charge Code	270649339
Hospital Revenue Code	270
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$24.27
Rate for Payer: Aetna Commercial	$18.45
Rate for Payer: Aetna Medicare Advantage	$14.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.38
Rate for Payer: Cigna Commercial	$24.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.56
Rate for Payer: Oxford Commercial	$9.71
Rate for Payer: Qualcare PPO/HMO/WC	$7.28
Rate for Payer: UnitedHealthcare Commercial	$9.71
Rate for Payer: UnitedHealthcare Community & State	$1.17
Rate for Payer: Wellpoint Medicaid Managed Care	$1.29

SPLINT FINGER 1-5/8 11201

Facility

$48.55

Hospital Charge Code	270649339
Hospital Revenue Code	270
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$7.28
Rate for Payer: Qualcare PPO/HMO/WC	$7.28

SPLINT FINGER 2-1/4 11902

Facility

$45.90

Hospital Charge Code	270649340
Hospital Revenue Code	272
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$22.95
Rate for Payer: Aetna Commercial	$17.44
Rate for Payer: Aetna Medicare Advantage	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.70
Rate for Payer: Cigna Commercial	$22.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.77
Rate for Payer: Oxford Commercial	$9.18
Rate for Payer: Qualcare PPO/HMO/WC	$6.88
Rate for Payer: UnitedHealthcare Commercial	$9.18
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

SPLINT FINGER 2-1/4 11902

Facility

$45.90

Hospital Charge Code	270649340
Hospital Revenue Code	272
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$6.88
Rate for Payer: Qualcare PPO/HMO/WC	$6.88

SPLINT FINGER 3-1/4 9119-03

Facility

$39.30

Hospital Charge Code	270649343
Hospital Revenue Code	270
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$5.89
Rate for Payer: Qualcare PPO/HMO/WC	$5.89

SPLINT FINGER 3-1/4 9119-03

Facility

$39.30

Hospital Charge Code	270649343
Hospital Revenue Code	270
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$19.65
Rate for Payer: Aetna Commercial	$14.93
Rate for Payer: Aetna Medicare Advantage	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.02
Rate for Payer: Cigna Commercial	$19.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.79
Rate for Payer: Oxford Commercial	$7.86
Rate for Payer: Qualcare PPO/HMO/WC	$5.89
Rate for Payer: UnitedHealthcare Commercial	$7.86
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

SPLINT FINGER 4-1/4 9119-04

Facility

$47.30

Hospital Charge Code	270649344
Hospital Revenue Code	270
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.65
Rate for Payer: Aetna Commercial	$17.97
Rate for Payer: Aetna Medicare Advantage	$14.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.06
Rate for Payer: Cigna Commercial	$23.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.19
Rate for Payer: Oxford Commercial	$9.46
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$9.46
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

SPLINT FINGER 4-1/4 9119-04

Facility

$47.30

Hospital Charge Code	270649344
Hospital Revenue Code	270
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

SPLINT FINGER 5 1/2 11203

Facility

$48.65

Hospital Charge Code	270649345
Hospital Revenue Code	270
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$24.32
Rate for Payer: Aetna Commercial	$18.49
Rate for Payer: Aetna Medicare Advantage	$14.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.41
Rate for Payer: Cigna Commercial	$24.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.60
Rate for Payer: Oxford Commercial	$9.73
Rate for Payer: Qualcare PPO/HMO/WC	$7.30
Rate for Payer: UnitedHealthcare Commercial	$9.73
Rate for Payer: UnitedHealthcare Community & State	$1.17
Rate for Payer: Wellpoint Medicaid Managed Care	$1.29

SPLINT FINGER 5 1/2 11203

Facility

$48.65

Hospital Charge Code	270649345
Hospital Revenue Code	270
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$7.30
Rate for Payer: Qualcare PPO/HMO/WC	$7.30

SPLINT FINGER W/BLUB 3 1/4

Facility

$51.50

Hospital Charge Code	270649346
Hospital Revenue Code	270
Min. Negotiated Rate	$7.72
Max. Negotiated Rate	$7.72
Rate for Payer: Qualcare PPO/HMO/WC	$7.72

SPLINT FINGER W/BLUB 3 1/4

Facility

$51.50

Hospital Charge Code	270649346
Hospital Revenue Code	270
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$25.75
Rate for Payer: Aetna Commercial	$19.57
Rate for Payer: Aetna Medicare Advantage	$15.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.13
Rate for Payer: Cigna Commercial	$25.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.45
Rate for Payer: Oxford Commercial	$10.30
Rate for Payer: Qualcare PPO/HMO/WC	$7.72
Rate for Payer: UnitedHealthcare Commercial	$10.30
Rate for Payer: UnitedHealthcare Community & State	$1.24
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

SPLINT FINGER W/BLUB 4 1/4

Facility

$57.55

Hospital Charge Code	270649347
Hospital Revenue Code	270
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$8.63
Rate for Payer: Qualcare PPO/HMO/WC	$8.63

SPLINT FINGER W/BLUB 4 1/4

Facility

$57.55

Hospital Charge Code	270649347
Hospital Revenue Code	270
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$28.77
Rate for Payer: Aetna Commercial	$21.87
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.68
Rate for Payer: Cigna Commercial	$28.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.27
Rate for Payer: Oxford Commercial	$11.51
Rate for Payer: Qualcare PPO/HMO/WC	$8.63
Rate for Payer: UnitedHealthcare Commercial	$11.51
Rate for Payer: UnitedHealthcare Community & State	$1.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.53

Know your out-of-pocket cost for care.

All Charges