Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPLINT WRIST R 10 1/2 MED

Facility

$100.85

Hospital Charge Code	270600807
Hospital Revenue Code	270
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$50.42
Rate for Payer: Aetna Commercial	$38.32
Rate for Payer: Aetna Medicare Advantage	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.72
Rate for Payer: Cigna Commercial	$50.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Oxford Commercial	$20.17
Rate for Payer: Qualcare PPO/HMO/WC	$15.13
Rate for Payer: UnitedHealthcare Commercial	$20.17
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.67

SPLINT WRIST R 10 1/2 MED

Facility

$100.85

Hospital Charge Code	270600807
Hospital Revenue Code	270
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$15.13
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

SPLINT WRIST R 10 1/2 SM

Facility

$100.85

Hospital Charge Code	270600809
Hospital Revenue Code	270
Min. Negotiated Rate	$15.13
Max. Negotiated Rate	$15.13
Rate for Payer: Qualcare PPO/HMO/WC	$15.13

SPLINT WRIST R 10 1/2 SM

Facility

$100.85

Hospital Charge Code	270600809
Hospital Revenue Code	270
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$50.42
Rate for Payer: Aetna Commercial	$38.32
Rate for Payer: Aetna Medicare Advantage	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.72
Rate for Payer: Cigna Commercial	$50.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Oxford Commercial	$20.17
Rate for Payer: Qualcare PPO/HMO/WC	$15.13
Rate for Payer: UnitedHealthcare Commercial	$20.17
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.67

SPLINT WRIST R 8 LG

Facility

$89.65

Hospital Charge Code	270600799
Hospital Revenue Code	270
Min. Negotiated Rate	$13.45
Max. Negotiated Rate	$13.45
Rate for Payer: Qualcare PPO/HMO/WC	$13.45

SPLINT WRIST R 8 LG

Facility

$89.65

Hospital Charge Code	270600799
Hospital Revenue Code	270
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$44.83
Rate for Payer: Aetna Commercial	$34.07
Rate for Payer: Aetna Medicare Advantage	$26.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.86
Rate for Payer: Cigna Commercial	$44.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.89
Rate for Payer: Oxford Commercial	$17.93
Rate for Payer: Qualcare PPO/HMO/WC	$13.45
Rate for Payer: UnitedHealthcare Commercial	$17.93
Rate for Payer: UnitedHealthcare Community & State	$2.16
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

SPLINT WRIST R 8 MED

Facility

$47.15

Hospital Charge Code	270600801
Hospital Revenue Code	270
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.57
Rate for Payer: Aetna Commercial	$17.92
Rate for Payer: Aetna Medicare Advantage	$14.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.02
Rate for Payer: Cigna Commercial	$23.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.14
Rate for Payer: Oxford Commercial	$9.43
Rate for Payer: Qualcare PPO/HMO/WC	$7.07
Rate for Payer: UnitedHealthcare Commercial	$9.43
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

SPLINT WRIST R 8 MED

Facility

$47.15

Hospital Charge Code	270600801
Hospital Revenue Code	270
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$7.07
Rate for Payer: Qualcare PPO/HMO/WC	$7.07

SPLINT WRIST R 8 SM

Facility

$89.65

Hospital Charge Code	270600803
Hospital Revenue Code	270
Min. Negotiated Rate	$13.45
Max. Negotiated Rate	$13.45
Rate for Payer: Qualcare PPO/HMO/WC	$13.45

SPLINT WRIST R 8 SM

Facility

$89.65

Hospital Charge Code	270600803
Hospital Revenue Code	270
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$44.83
Rate for Payer: Aetna Commercial	$34.07
Rate for Payer: Aetna Medicare Advantage	$26.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.86
Rate for Payer: Cigna Commercial	$44.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.89
Rate for Payer: Oxford Commercial	$17.93
Rate for Payer: Qualcare PPO/HMO/WC	$13.45
Rate for Payer: UnitedHealthcare Commercial	$17.93
Rate for Payer: UnitedHealthcare Community & State	$2.16
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

SPLINT WRIST R 8 XLG

Facility

$86.45

Hospital Charge Code	270606115
Hospital Revenue Code	270
Min. Negotiated Rate	$12.97
Max. Negotiated Rate	$12.97
Rate for Payer: Qualcare PPO/HMO/WC	$12.97

SPLINT WRIST R 8 XLG

Facility

$86.45

Hospital Charge Code	270606115
Hospital Revenue Code	270
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$43.23
Rate for Payer: Aetna Commercial	$32.85
Rate for Payer: Aetna Medicare Advantage	$25.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.04
Rate for Payer: Cigna Commercial	$43.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.93
Rate for Payer: Oxford Commercial	$17.29
Rate for Payer: Qualcare PPO/HMO/WC	$12.97
Rate for Payer: UnitedHealthcare Commercial	$17.29
Rate for Payer: UnitedHealthcare Community & State	$2.08
Rate for Payer: Wellpoint Medicaid Managed Care	$2.29

SPLINT WRIST RIGHT 10.5 XLG

Facility

$56.60

Hospital Charge Code	270614964
Hospital Revenue Code	270
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$8.49
Rate for Payer: Qualcare PPO/HMO/WC	$8.49

SPLINT WRIST RIGHT 10.5 XLG

Facility

$56.60

Hospital Charge Code	270614964
Hospital Revenue Code	270
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$28.30
Rate for Payer: Aetna Commercial	$21.51
Rate for Payer: Aetna Medicare Advantage	$16.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.43
Rate for Payer: Cigna Commercial	$28.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.98
Rate for Payer: Oxford Commercial	$11.32
Rate for Payer: Qualcare PPO/HMO/WC	$8.49
Rate for Payer: UnitedHealthcare Commercial	$11.32
Rate for Payer: UnitedHealthcare Community & State	$1.36
Rate for Payer: Wellpoint Medicaid Managed Care	$1.50

SPLIT BLOOD UNIT

Facility

$1,255.00

Hospital Charge Code	38471157
Hospital Revenue Code	390
Min. Negotiated Rate	$188.25
Max. Negotiated Rate	$188.25
Rate for Payer: Qualcare PPO/HMO/WC	$188.25

SPLIT BLOOD UNIT

Facility

$1,255.00

Hospital Charge Code	38471157
Hospital Revenue Code	390
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$476.90
Rate for Payer: Aetna Medicare Advantage	$376.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.02
Rate for Payer: Cigna Commercial	$627.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$376.50
Rate for Payer: Oxford Commercial	$666.00
Rate for Payer: Qualcare PPO/HMO/WC	$188.25
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$30.25
Rate for Payer: Wellpoint Medicaid Managed Care	$33.26

SPLIT SHEET TIBURON

Facility

$23.95

Hospital Charge Code	270665839
Hospital Revenue Code	270
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$3.59
Rate for Payer: Qualcare PPO/HMO/WC	$3.59

SPLIT SHEET TIBURON

Facility

$23.95

Hospital Charge Code	270665839
Hospital Revenue Code	270
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$11.97
Rate for Payer: Aetna Commercial	$9.10
Rate for Payer: Aetna Medicare Advantage	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.11
Rate for Payer: Cigna Commercial	$11.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.18
Rate for Payer: Oxford Commercial	$4.79
Rate for Payer: Qualcare PPO/HMO/WC	$3.59
Rate for Payer: UnitedHealthcare Commercial	$4.79
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.63

SPLITTING OF BLOOD

Facility

$296.00

Service Code	HCPCS 86985
Hospital Charge Code	38471153
Hospital Revenue Code	309
Min. Negotiated Rate	$44.40
Max. Negotiated Rate	$44.40
Rate for Payer: Qualcare PPO/HMO/WC	$44.40

SPLITTING OF BLOOD

Facility

$296.00

Service Code	HCPCS 86985
Hospital Charge Code	38471153
Hospital Revenue Code	309
Min. Negotiated Rate	$7.84
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.80
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.40
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$25.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$7.84

SP MODIFY VOICE PROSTHESIS***

Facility

$241.00

Service Code	HCPCS 92507
Hospital Charge Code	9100110
Hospital Revenue Code	440
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$91.58
Rate for Payer: Aetna Medicare Advantage	$72.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.45
Rate for Payer: Cigna Commercial	$120.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.30
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.15
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.81
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

SP MODIFY VOICE PROSTHESIS***

Facility

$241.00

Service Code	HCPCS 92507
Hospital Charge Code	9100110
Hospital Revenue Code	440
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$36.15
Rate for Payer: Qualcare PPO/HMO/WC	$36.15

S. PNEUMONIAE AG LA

Facility

$390.00

Service Code	HCPCS 86403
Hospital Charge Code	39900222
Hospital Revenue Code	302
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$31.39
Rate for Payer: Aetna Medicare Advantage	$37.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.66
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.54
Rate for Payer: Clover Medicare Advantage	$10.96
Rate for Payer: EmblemHealth Commercial	$34.62
Rate for Payer: Humana Medicare Advantage	$11.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.54
Rate for Payer: Wellcare Medicare Advantage	$11.54
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

S. PNEUMONIAE AG LA

Facility

$390.00

Service Code	HCPCS 86403
Hospital Charge Code	39900222
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SPN FSN WO DECMPR CERV BELW C2

Facility

$47,548.90

Service Code	HCPCS 22554
Hospital Charge Code	16000607
Hospital Revenue Code	360
Min. Negotiated Rate	$7,132.34
Max. Negotiated Rate	$7,132.34
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34

Know your out-of-pocket cost for care.

All Charges