Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPLINT FINGER W/BULB 5 1/4

Facility

$64.00

Hospital Charge Code	270649348
Hospital Revenue Code	271
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$9.60

SPLINT FINGER W/BULB 5 1/4

Facility

$64.00

Hospital Charge Code	270649348
Hospital Revenue Code	271
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$32.00
Rate for Payer: Aetna Commercial	$24.32
Rate for Payer: Aetna Medicare Advantage	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.32
Rate for Payer: Cigna Commercial	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.20
Rate for Payer: Oxford Commercial	$12.80
Rate for Payer: Qualcare PPO/HMO/WC	$9.60
Rate for Payer: UnitedHealthcare Commercial	$12.80
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.70

SPLINT FOREARM CHILD (ZIM)****

Facility

$51.00

Hospital Charge Code	8004186
Hospital Revenue Code	272
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

SPLINT FOREARM CHILD (ZIM)****

Facility

$51.00

Hospital Charge Code	8004186
Hospital Revenue Code	272
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$19.38
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.30
Rate for Payer: Oxford Commercial	$10.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Commercial	$10.20
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.35

SPLINT FOREARM YOUTH/ADULT****

Facility

$54.00

Hospital Charge Code	8004178
Hospital Revenue Code	272
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

SPLINT FOREARM YOUTH/ADULT****

Facility

$54.00

Hospital Charge Code	8004178
Hospital Revenue Code	272
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$20.52
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.77
Rate for Payer: Cigna Commercial	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.20
Rate for Payer: Oxford Commercial	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$8.10
Rate for Payer: UnitedHealthcare Commercial	$10.80
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

SPLINT FREEDOM POSEY 8168M

Facility

$105.65

Hospital Charge Code	270613231
Hospital Revenue Code	270
Min. Negotiated Rate	$15.85
Max. Negotiated Rate	$15.85
Rate for Payer: Qualcare PPO/HMO/WC	$15.85

SPLINT FREEDOM POSEY 8168M

Facility

$105.65

Hospital Charge Code	270613231
Hospital Revenue Code	270
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$52.83
Rate for Payer: Aetna Commercial	$40.15
Rate for Payer: Aetna Medicare Advantage	$31.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.94
Rate for Payer: Cigna Commercial	$52.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.70
Rate for Payer: Oxford Commercial	$21.13
Rate for Payer: Qualcare PPO/HMO/WC	$15.85
Rate for Payer: UnitedHealthcare Commercial	$21.13
Rate for Payer: UnitedHealthcare Community & State	$2.55
Rate for Payer: Wellpoint Medicaid Managed Care	$2.80

SPLINT FREEDOM X-SM

Facility

$104.44

Hospital Charge Code	270650266
Hospital Revenue Code	270
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$52.22
Rate for Payer: Aetna Commercial	$39.69
Rate for Payer: Aetna Medicare Advantage	$31.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.63
Rate for Payer: Cigna Commercial	$52.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.33
Rate for Payer: Oxford Commercial	$20.89
Rate for Payer: Qualcare PPO/HMO/WC	$15.67
Rate for Payer: UnitedHealthcare Commercial	$20.89
Rate for Payer: UnitedHealthcare Community & State	$2.52
Rate for Payer: Wellpoint Medicaid Managed Care	$2.77

SPLINT FREEDOM X-SM

Facility

$104.44

Hospital Charge Code	270650266
Hospital Revenue Code	270
Min. Negotiated Rate	$15.67
Max. Negotiated Rate	$15.67
Rate for Payer: Qualcare PPO/HMO/WC	$15.67

SPLINT GLASS ROLL 3X15

Facility

$282.40

Hospital Charge Code	270600759W
Hospital Revenue Code	270
Min. Negotiated Rate	$6.81
Max. Negotiated Rate	$141.20
Rate for Payer: Aetna Commercial	$107.31
Rate for Payer: Aetna Medicare Advantage	$84.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.01
Rate for Payer: Cigna Commercial	$141.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.72
Rate for Payer: Oxford Commercial	$56.48
Rate for Payer: Qualcare PPO/HMO/WC	$42.36
Rate for Payer: UnitedHealthcare Commercial	$56.48
Rate for Payer: UnitedHealthcare Community & State	$6.81
Rate for Payer: Wellpoint Medicaid Managed Care	$7.48

SPLINT GLASS ROLL 3X15

Facility

$282.40

Hospital Charge Code	270600759
Hospital Revenue Code	270
Min. Negotiated Rate	$42.36
Max. Negotiated Rate	$42.36
Rate for Payer: Qualcare PPO/HMO/WC	$42.36

SPLINT GLASS ROLL 3X15

Facility

$282.40

Hospital Charge Code	270600759W
Hospital Revenue Code	270
Min. Negotiated Rate	$42.36
Max. Negotiated Rate	$42.36
Rate for Payer: Qualcare PPO/HMO/WC	$42.36

SPLINT GLASS ROLL 3X15

Facility

$282.40

Hospital Charge Code	270600759
Hospital Revenue Code	270
Min. Negotiated Rate	$6.81
Max. Negotiated Rate	$141.20
Rate for Payer: Aetna Commercial	$107.31
Rate for Payer: Aetna Medicare Advantage	$84.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.01
Rate for Payer: Cigna Commercial	$141.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.72
Rate for Payer: Oxford Commercial	$56.48
Rate for Payer: Qualcare PPO/HMO/WC	$42.36
Rate for Payer: UnitedHealthcare Commercial	$56.48
Rate for Payer: UnitedHealthcare Community & State	$6.81
Rate for Payer: Wellpoint Medicaid Managed Care	$7.48

SPLINT GLASS ROLL 4X15

Facility

$334.50

Hospital Charge Code	270600745
Hospital Revenue Code	270
Min. Negotiated Rate	$50.17
Max. Negotiated Rate	$50.17
Rate for Payer: Qualcare PPO/HMO/WC	$50.17

SPLINT GLASS ROLL 4X15

Facility

$334.50

Hospital Charge Code	270600745W
Hospital Revenue Code	270
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$167.25
Rate for Payer: Aetna Commercial	$127.11
Rate for Payer: Aetna Medicare Advantage	$100.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.30
Rate for Payer: Cigna Commercial	$167.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.35
Rate for Payer: Oxford Commercial	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$50.17
Rate for Payer: UnitedHealthcare Commercial	$66.90
Rate for Payer: UnitedHealthcare Community & State	$8.06
Rate for Payer: Wellpoint Medicaid Managed Care	$8.86

SPLINT GLASS ROLL 4X15

Facility

$334.50

Hospital Charge Code	270600745W
Hospital Revenue Code	270
Min. Negotiated Rate	$50.17
Max. Negotiated Rate	$50.17
Rate for Payer: Qualcare PPO/HMO/WC	$50.17

SPLINT GLASS ROLL 4X15

Facility

$334.50

Hospital Charge Code	270600745
Hospital Revenue Code	270
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$167.25
Rate for Payer: Aetna Commercial	$127.11
Rate for Payer: Aetna Medicare Advantage	$100.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.30
Rate for Payer: Cigna Commercial	$167.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.35
Rate for Payer: Oxford Commercial	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$50.17
Rate for Payer: UnitedHealthcare Commercial	$66.90
Rate for Payer: UnitedHealthcare Community & State	$8.06
Rate for Payer: Wellpoint Medicaid Managed Care	$8.86

SPLINT GLASS ROLL 5X15

Facility

$392.50

Hospital Charge Code	270600760W
Hospital Revenue Code	270
Min. Negotiated Rate	$58.88
Max. Negotiated Rate	$58.88
Rate for Payer: Qualcare PPO/HMO/WC	$58.88

SPLINT GLASS ROLL 5X15

Facility

$392.50

Hospital Charge Code	270600760W
Hospital Revenue Code	270
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$196.25
Rate for Payer: Aetna Commercial	$149.15
Rate for Payer: Aetna Medicare Advantage	$117.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.09
Rate for Payer: Cigna Commercial	$196.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.75
Rate for Payer: Oxford Commercial	$78.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.88
Rate for Payer: UnitedHealthcare Commercial	$78.50
Rate for Payer: UnitedHealthcare Community & State	$9.46
Rate for Payer: Wellpoint Medicaid Managed Care	$10.40

SPLINT GLASS ROLL 5X15

Facility

$392.50

Hospital Charge Code	270600760
Hospital Revenue Code	270
Min. Negotiated Rate	$58.88
Max. Negotiated Rate	$58.88
Rate for Payer: Qualcare PPO/HMO/WC	$58.88

SPLINT GLASS ROLL 5X15

Facility

$392.50

Hospital Charge Code	270600760
Hospital Revenue Code	270
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$196.25
Rate for Payer: Aetna Commercial	$149.15
Rate for Payer: Aetna Medicare Advantage	$117.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.09
Rate for Payer: Cigna Commercial	$196.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.75
Rate for Payer: Oxford Commercial	$78.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.88
Rate for Payer: UnitedHealthcare Commercial	$78.50
Rate for Payer: UnitedHealthcare Community & State	$9.46
Rate for Payer: Wellpoint Medicaid Managed Care	$10.40

SPLINTINGFABRICATION INI 15 MI

Facility

$446.00

Service Code	HCPCS 97760GO
Hospital Charge Code	1008355
Hospital Revenue Code	430
Min. Negotiated Rate	$10.75
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$169.48
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.80
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$10.75
Rate for Payer: Wellpoint Medicaid Managed Care	$11.82

SPLINTINGFABRICATION INI 15 MI

Facility

$446.00

Service Code	HCPCS 97760GO
Hospital Charge Code	1008355
Hospital Revenue Code	430
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

SPLINT IROM REGULAR LONG

Facility

$1,625.65

Hospital Charge Code	270610223
Hospital Revenue Code	270
Min. Negotiated Rate	$243.85
Max. Negotiated Rate	$243.85
Rate for Payer: Qualcare PPO/HMO/WC	$243.85

Know your out-of-pocket cost for care.

All Charges