Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPLINT ORTHO GLASS 3INX15FT

Facility

$642.45

Hospital Charge Code	270652829
Hospital Revenue Code	272
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$321.23
Rate for Payer: Aetna Commercial	$244.13
Rate for Payer: Aetna Medicare Advantage	$192.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.82
Rate for Payer: Cigna Commercial	$321.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.74
Rate for Payer: Oxford Commercial	$128.49
Rate for Payer: Qualcare PPO/HMO/WC	$96.37
Rate for Payer: UnitedHealthcare Commercial	$128.49
Rate for Payer: UnitedHealthcare Community & State	$15.48
Rate for Payer: Wellpoint Medicaid Managed Care	$17.02

SPLINT ORTHOGLASS 4

Facility

$322.55

Hospital Charge Code	270651689
Hospital Revenue Code	272
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$161.28
Rate for Payer: Aetna Commercial	$122.57
Rate for Payer: Aetna Medicare Advantage	$96.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.25
Rate for Payer: Cigna Commercial	$161.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.77
Rate for Payer: Oxford Commercial	$64.51
Rate for Payer: Qualcare PPO/HMO/WC	$48.38
Rate for Payer: UnitedHealthcare Commercial	$64.51
Rate for Payer: UnitedHealthcare Community & State	$7.77
Rate for Payer: Wellpoint Medicaid Managed Care	$8.55

SPLINT ORTHOGLASS 4

Facility

$322.55

Hospital Charge Code	270651689
Hospital Revenue Code	272
Min. Negotiated Rate	$48.38
Max. Negotiated Rate	$48.38
Rate for Payer: Qualcare PPO/HMO/WC	$48.38

SPLINT ORTHOGLASS 5

Facility

$364.10

Hospital Charge Code	270651694
Hospital Revenue Code	272
Min. Negotiated Rate	$54.62
Max. Negotiated Rate	$54.62
Rate for Payer: Qualcare PPO/HMO/WC	$54.62

SPLINT ORTHOGLASS 5

Facility

$364.10

Hospital Charge Code	270651694
Hospital Revenue Code	272
Min. Negotiated Rate	$8.77
Max. Negotiated Rate	$182.05
Rate for Payer: Aetna Commercial	$138.36
Rate for Payer: Aetna Medicare Advantage	$109.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.85
Rate for Payer: Cigna Commercial	$182.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.23
Rate for Payer: Oxford Commercial	$72.82
Rate for Payer: Qualcare PPO/HMO/WC	$54.62
Rate for Payer: UnitedHealthcare Commercial	$72.82
Rate for Payer: UnitedHealthcare Community & State	$8.77
Rate for Payer: Wellpoint Medicaid Managed Care	$9.65

SPLINT ORTHO GLASS 5IN X 15FT

Facility

$962.45

Hospital Charge Code	270652831
Hospital Revenue Code	272
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$481.23
Rate for Payer: Aetna Commercial	$365.73
Rate for Payer: Aetna Medicare Advantage	$288.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$245.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$245.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$245.42
Rate for Payer: Cigna Commercial	$481.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$288.74
Rate for Payer: Oxford Commercial	$192.49
Rate for Payer: Qualcare PPO/HMO/WC	$144.37
Rate for Payer: UnitedHealthcare Commercial	$192.49
Rate for Payer: UnitedHealthcare Community & State	$23.20
Rate for Payer: Wellpoint Medicaid Managed Care	$25.50

SPLINT ORTHO GLASS 5IN X 15FT

Facility

$962.45

Hospital Charge Code	270652831
Hospital Revenue Code	272
Min. Negotiated Rate	$144.37
Max. Negotiated Rate	$144.37
Rate for Payer: Qualcare PPO/HMO/WC	$144.37

SPLINT ORTHOGLASS 6

Facility

$586.63

Hospital Charge Code	270651782
Hospital Revenue Code	272
Min. Negotiated Rate	$87.99
Max. Negotiated Rate	$87.99
Rate for Payer: Qualcare PPO/HMO/WC	$87.99

SPLINT ORTHOGLASS 6

Facility

$586.63

Hospital Charge Code	270651782
Hospital Revenue Code	272
Min. Negotiated Rate	$14.14
Max. Negotiated Rate	$293.31
Rate for Payer: Aetna Commercial	$222.92
Rate for Payer: Aetna Medicare Advantage	$175.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.59
Rate for Payer: Cigna Commercial	$293.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.99
Rate for Payer: Oxford Commercial	$117.33
Rate for Payer: Qualcare PPO/HMO/WC	$87.99
Rate for Payer: UnitedHealthcare Commercial	$117.33
Rate for Payer: UnitedHealthcare Community & State	$14.14
Rate for Payer: Wellpoint Medicaid Managed Care	$15.55

SPLINT ORTHOGLASS PRECUT 5x30

Facility

$70.66

Hospital Charge Code	270655934
Hospital Revenue Code	271
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$35.33
Rate for Payer: Aetna Commercial	$26.85
Rate for Payer: Aetna Medicare Advantage	$21.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.02
Rate for Payer: Cigna Commercial	$35.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.20
Rate for Payer: Oxford Commercial	$14.13
Rate for Payer: Qualcare PPO/HMO/WC	$10.60
Rate for Payer: UnitedHealthcare Commercial	$14.13
Rate for Payer: UnitedHealthcare Community & State	$1.70
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

SPLINT ORTHOGLASS PRECUT 5x30

Facility

$70.66

Hospital Charge Code	270655934
Hospital Revenue Code	271
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$10.60
Rate for Payer: Qualcare PPO/HMO/WC	$10.60

SPLINT PLSTC TIB/FIB HIP LGT**

Facility

$99.00

Hospital Charge Code	8003592
Hospital Revenue Code	279
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.85

SPLINT PLSTC TIB/FIB HIP LGT**

Facility

$99.00

Hospital Charge Code	8003592
Hospital Revenue Code	279
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$49.50
Rate for Payer: Aetna Commercial	$37.62
Rate for Payer: Aetna Medicare Advantage	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.25
Rate for Payer: Cigna Commercial	$49.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.70
Rate for Payer: Oxford Commercial	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$14.85
Rate for Payer: UnitedHealthcare Commercial	$19.80
Rate for Payer: UnitedHealthcare Community & State	$2.39
Rate for Payer: Wellpoint Medicaid Managed Care	$2.62

SPLINT POSITIONING WRIST ACCUM

Facility

$195.00

Hospital Charge Code	270673345N
Hospital Revenue Code	271
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare Advantage	$58.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.73
Rate for Payer: Cigna Commercial	$97.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Oxford Commercial	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$39.00
Rate for Payer: UnitedHealthcare Community & State	$4.70
Rate for Payer: Wellpoint Medicaid Managed Care	$5.17

SPLINT POSITIONING WRIST ACCUM

Facility

$195.00

Hospital Charge Code	270673345
Hospital Revenue Code	271
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

SPLINT POSITIONING WRIST ACCUM

Facility

$195.00

Hospital Charge Code	270673345
Hospital Revenue Code	271
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare Advantage	$58.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.73
Rate for Payer: Cigna Commercial	$97.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Oxford Commercial	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$39.00
Rate for Payer: UnitedHealthcare Community & State	$4.70
Rate for Payer: Wellpoint Medicaid Managed Care	$5.17

SPLINT POSITIONING WRIST ACCUM

Facility

$195.00

Hospital Charge Code	270673345N
Hospital Revenue Code	271
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

SPLINT PRECUT 3x12

Facility

$14.73

Hospital Charge Code	270655933
Hospital Revenue Code	271
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.37
Rate for Payer: Aetna Commercial	$5.60
Rate for Payer: Aetna Medicare Advantage	$4.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.76
Rate for Payer: Cigna Commercial	$7.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.42
Rate for Payer: Oxford Commercial	$2.95
Rate for Payer: Qualcare PPO/HMO/WC	$2.21
Rate for Payer: UnitedHealthcare Commercial	$2.95
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

SPLINT PRECUT 3x12

Facility

$14.73

Hospital Charge Code	270655933
Hospital Revenue Code	271
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$2.21
Rate for Payer: Qualcare PPO/HMO/WC	$2.21

SPLINT PRECUT 4x30

Facility

$142.20

Hospital Charge Code	270655927
Hospital Revenue Code	271
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$71.10
Rate for Payer: Aetna Commercial	$54.04
Rate for Payer: Aetna Medicare Advantage	$42.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.26
Rate for Payer: Cigna Commercial	$71.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.66
Rate for Payer: Oxford Commercial	$28.44
Rate for Payer: Qualcare PPO/HMO/WC	$21.33
Rate for Payer: UnitedHealthcare Commercial	$28.44
Rate for Payer: UnitedHealthcare Community & State	$3.43
Rate for Payer: Wellpoint Medicaid Managed Care	$3.77

SPLINT PRECUT 4x30

Facility

$142.20

Hospital Charge Code	270655927
Hospital Revenue Code	271
Min. Negotiated Rate	$21.33
Max. Negotiated Rate	$21.33
Rate for Payer: Qualcare PPO/HMO/WC	$21.33

SPLINT PRECUT SAFETY 4inx15

Facility

$20.87

Hospital Charge Code	270655930
Hospital Revenue Code	271
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.13
Rate for Payer: Qualcare PPO/HMO/WC	$3.13

SPLINT PRECUT SAFETY 4inx15

Facility

$20.87

Hospital Charge Code	270655930
Hospital Revenue Code	271
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$10.44
Rate for Payer: Aetna Commercial	$7.93
Rate for Payer: Aetna Medicare Advantage	$6.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.32
Rate for Payer: Cigna Commercial	$10.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.26
Rate for Payer: Oxford Commercial	$4.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.13
Rate for Payer: UnitedHealthcare Commercial	$4.17
Rate for Payer: UnitedHealthcare Community & State	$0.50
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

SPLINT RADIAL BAR WRIST A171

Facility

$228.85

Hospital Charge Code	270610296
Hospital Revenue Code	270
Min. Negotiated Rate	$5.52
Max. Negotiated Rate	$114.42
Rate for Payer: Aetna Commercial	$86.96
Rate for Payer: Aetna Medicare Advantage	$68.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.36
Rate for Payer: Cigna Commercial	$114.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.66
Rate for Payer: Oxford Commercial	$45.77
Rate for Payer: Qualcare PPO/HMO/WC	$34.33
Rate for Payer: UnitedHealthcare Commercial	$45.77
Rate for Payer: UnitedHealthcare Community & State	$5.52
Rate for Payer: Wellpoint Medicaid Managed Care	$6.06

SPLINT RADIAL BAR WRIST A171

Facility

$228.85

Hospital Charge Code	270610296
Hospital Revenue Code	270
Min. Negotiated Rate	$34.33
Max. Negotiated Rate	$34.33
Rate for Payer: Qualcare PPO/HMO/WC	$34.33

Know your out-of-pocket cost for care.

All Charges