Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPLINT METACARPAL RIGHT MEDIUM

Facility

$28.15

Hospital Charge Code	270653989
Hospital Revenue Code	272
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$14.07
Rate for Payer: Aetna Commercial	$10.70
Rate for Payer: Aetna Medicare Advantage	$8.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.18
Rate for Payer: Cigna Commercial	$14.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.45
Rate for Payer: Oxford Commercial	$5.63
Rate for Payer: Qualcare PPO/HMO/WC	$4.22
Rate for Payer: UnitedHealthcare Commercial	$5.63
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.75

SPLINT METACARPAL RIGHT MEDIUM

Facility

$28.15

Hospital Charge Code	270653989
Hospital Revenue Code	272
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$4.22
Rate for Payer: Qualcare PPO/HMO/WC	$4.22

SPLINT NASAL DENVER LG

Facility

$219.41

Hospital Charge Code	270649758
Hospital Revenue Code	272
Min. Negotiated Rate	$32.91
Max. Negotiated Rate	$32.91
Rate for Payer: Qualcare PPO/HMO/WC	$32.91

SPLINT NASAL DENVER LG

Facility

$219.41

Hospital Charge Code	270649758
Hospital Revenue Code	272
Min. Negotiated Rate	$5.29
Max. Negotiated Rate	$109.70
Rate for Payer: Aetna Commercial	$83.38
Rate for Payer: Aetna Medicare Advantage	$65.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.95
Rate for Payer: Cigna Commercial	$109.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.82
Rate for Payer: Oxford Commercial	$43.88
Rate for Payer: Qualcare PPO/HMO/WC	$32.91
Rate for Payer: UnitedHealthcare Commercial	$43.88
Rate for Payer: UnitedHealthcare Community & State	$5.29
Rate for Payer: Wellpoint Medicaid Managed Care	$5.81

SPLINT NASAL DOYLE

Facility

$225.00

Hospital Charge Code	270649759
Hospital Revenue Code	272
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.50
Rate for Payer: Oxford Commercial	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$45.00
Rate for Payer: UnitedHealthcare Community & State	$5.42
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

SPLINT NASAL DOYLE

Facility

$225.00

Hospital Charge Code	270649759
Hospital Revenue Code	272
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

SPLINT NASAL DOYLE II

Facility

$157.50

Hospital Charge Code	270649760
Hospital Revenue Code	272
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$23.62
Rate for Payer: Qualcare PPO/HMO/WC	$23.62

SPLINT NASAL DOYLE II

Facility

$254.45

Hospital Charge Code	270061275
Hospital Revenue Code	272
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$127.22
Rate for Payer: Aetna Commercial	$96.69
Rate for Payer: Aetna Medicare Advantage	$76.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.88
Rate for Payer: Cigna Commercial	$127.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.33
Rate for Payer: Oxford Commercial	$50.89
Rate for Payer: Qualcare PPO/HMO/WC	$38.17
Rate for Payer: UnitedHealthcare Commercial	$50.89
Rate for Payer: UnitedHealthcare Community & State	$6.13
Rate for Payer: Wellpoint Medicaid Managed Care	$6.74

SPLINT NASAL DOYLE II

Facility

$254.45

Hospital Charge Code	270061275
Hospital Revenue Code	272
Min. Negotiated Rate	$38.17
Max. Negotiated Rate	$38.17
Rate for Payer: Qualcare PPO/HMO/WC	$38.17

SPLINT NASAL DOYLE II

Facility

$157.50

Hospital Charge Code	270649760
Hospital Revenue Code	272
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna Commercial	$59.85
Rate for Payer: Aetna Medicare Advantage	$47.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.16
Rate for Payer: Cigna Commercial	$78.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.25
Rate for Payer: Oxford Commercial	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$23.62
Rate for Payer: UnitedHealthcare Commercial	$31.50
Rate for Payer: UnitedHealthcare Community & State	$3.80
Rate for Payer: Wellpoint Medicaid Managed Care	$4.17

SPLINT NASAL EXTERNAL*******

Facility

$51.00

Hospital Charge Code	1600691
Hospital Revenue Code	272
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

SPLINT NASAL EXTERNAL*******

Facility

$51.00

Hospital Charge Code	1600691
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 NASAL SILICONE DOYLE

Facility

$260.00

Hospital Charge Code	270650485
Hospital Revenue Code	272
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

SPLINT NASAL SILICONE DOYLE

Facility

$260.00

Hospital Charge Code	270650485
Hospital Revenue Code	272
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna Medicare Advantage	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.30
Rate for Payer: Cigna Commercial	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.00
Rate for Payer: Oxford Commercial	$52.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Commercial	$52.00
Rate for Payer: UnitedHealthcare Community & State	$6.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.89

SPLINT NASAL XOMED MED

Facility

$1,226.45

Hospital Charge Code	2700061285
Hospital Revenue Code	272
Min. Negotiated Rate	$183.97
Max. Negotiated Rate	$183.97
Rate for Payer: Qualcare PPO/HMO/WC	$183.97

SPLINT NASAL XOMED MED

Facility

$1,226.45

Hospital Charge Code	2700061285
Hospital Revenue Code	272
Min. Negotiated Rate	$29.56
Max. Negotiated Rate	$613.23
Rate for Payer: Aetna Commercial	$466.05
Rate for Payer: Aetna Medicare Advantage	$367.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.74
Rate for Payer: Cigna Commercial	$613.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.94
Rate for Payer: Oxford Commercial	$245.29
Rate for Payer: Qualcare PPO/HMO/WC	$183.97
Rate for Payer: UnitedHealthcare Commercial	$245.29
Rate for Payer: UnitedHealthcare Community & State	$29.56
Rate for Payer: Wellpoint Medicaid Managed Care	$32.50

SPLINT NASAL XOMED MED 1528126

Facility

$165.75

Hospital Charge Code	270628738
Hospital Revenue Code	272
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$82.88
Rate for Payer: Aetna Commercial	$62.98
Rate for Payer: Aetna Medicare Advantage	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.27
Rate for Payer: Cigna Commercial	$82.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.73
Rate for Payer: Oxford Commercial	$33.15
Rate for Payer: Qualcare PPO/HMO/WC	$24.86
Rate for Payer: UnitedHealthcare Commercial	$33.15
Rate for Payer: UnitedHealthcare Community & State	$3.99
Rate for Payer: Wellpoint Medicaid Managed Care	$4.39

SPLINT NASAL XOMED MED 1528126

Facility

$165.75

Hospital Charge Code	270628738
Hospital Revenue Code	272
Min. Negotiated Rate	$24.86
Max. Negotiated Rate	$24.86
Rate for Payer: Qualcare PPO/HMO/WC	$24.86

SPLINT ORTHOGLASS 1x15

Facility

$166.10

Hospital Charge Code	270651769
Hospital Revenue Code	271
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$83.05
Rate for Payer: Aetna Commercial	$63.12
Rate for Payer: Aetna Medicare Advantage	$49.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.36
Rate for Payer: Cigna Commercial	$83.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.83
Rate for Payer: Oxford Commercial	$33.22
Rate for Payer: Qualcare PPO/HMO/WC	$24.91
Rate for Payer: UnitedHealthcare Commercial	$33.22
Rate for Payer: UnitedHealthcare Community & State	$4.00
Rate for Payer: Wellpoint Medicaid Managed Care	$4.40

SPLINT ORTHOGLASS 1x15

Facility

$166.10

Hospital Charge Code	270651769
Hospital Revenue Code	271
Min. Negotiated Rate	$24.91
Max. Negotiated Rate	$24.91
Rate for Payer: Qualcare PPO/HMO/WC	$24.91

SPLINT ORTHOGLASS 2 X 15

Facility

$173.15

Hospital Charge Code	270651777
Hospital Revenue Code	270
Min. Negotiated Rate	$25.97
Max. Negotiated Rate	$25.97
Rate for Payer: Qualcare PPO/HMO/WC	$25.97

SPLINT ORTHOGLASS 2 X 15

Facility

$173.15

Hospital Charge Code	270651777
Hospital Revenue Code	270
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$86.58
Rate for Payer: Aetna Commercial	$65.80
Rate for Payer: Aetna Medicare Advantage	$51.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.15
Rate for Payer: Cigna Commercial	$86.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.95
Rate for Payer: Oxford Commercial	$34.63
Rate for Payer: Qualcare PPO/HMO/WC	$25.97
Rate for Payer: UnitedHealthcare Commercial	$34.63
Rate for Payer: UnitedHealthcare Community & State	$4.17
Rate for Payer: Wellpoint Medicaid Managed Care	$4.59

SPLINT ORTHOGLASS 3

Facility

$268.80

Hospital Charge Code	270651688
Hospital Revenue Code	272
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$134.40
Rate for Payer: Aetna Commercial	$102.14
Rate for Payer: Aetna Medicare Advantage	$80.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.54
Rate for Payer: Cigna Commercial	$134.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.64
Rate for Payer: Oxford Commercial	$53.76
Rate for Payer: Qualcare PPO/HMO/WC	$40.32
Rate for Payer: UnitedHealthcare Commercial	$53.76
Rate for Payer: UnitedHealthcare Community & State	$6.48
Rate for Payer: Wellpoint Medicaid Managed Care	$7.12

SPLINT ORTHOGLASS 3

Facility

$268.80

Hospital Charge Code	270651688
Hospital Revenue Code	272
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$40.32
Rate for Payer: Qualcare PPO/HMO/WC	$40.32

SPLINT ORTHO GLASS 3INX15FT

Facility

$642.45

Hospital Charge Code	270652829
Hospital Revenue Code	272
Min. Negotiated Rate	$96.37
Max. Negotiated Rate	$96.37
Rate for Payer: Qualcare PPO/HMO/WC	$96.37

Know your out-of-pocket cost for care.

All Charges