Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TEMOVATE 0.05%/15GM

Facility

$107.00

Hospital Charge Code	60633981
Hospital Revenue Code	250
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$16.05
Rate for Payer: Qualcare PPO/HMO/WC	$16.05

TEMPERATURE SKIN SENSOR

Facility

$66.00

Hospital Charge Code	270331375
Hospital Revenue Code	272
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Oxford Commercial	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$13.20
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

TEMPERATURE SKIN SENSOR

Facility

$66.00

Hospital Charge Code	270331375
Hospital Revenue Code	272
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

TEMPLATE BENDNG 12HL 4.5DCP PL

Facility

$140.60

Service Code	HCPCS C1713
Hospital Charge Code	270651503
Hospital Revenue Code	272
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$21.09
Rate for Payer: Qualcare PPO/HMO/WC	$21.09

TEMPLATE BENDNG 12HL 4.5DCP PL

Facility

$140.60

Service Code	HCPCS C1713
Hospital Charge Code	270651503
Hospital Revenue Code	272
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$70.30
Rate for Payer: Aetna Commercial	$53.43
Rate for Payer: Aetna Medicare Advantage	$42.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.85
Rate for Payer: Cigna Commercial	$70.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.18
Rate for Payer: Oxford Commercial	$28.12
Rate for Payer: Qualcare PPO/HMO/WC	$21.09
Rate for Payer: UnitedHealthcare Commercial	$28.12
Rate for Payer: UnitedHealthcare Community & State	$3.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.73

TEMPLATE BENDNG 9 HL 4.5 DCP

Facility

$140.60

Service Code	HCPCS C1713
Hospital Charge Code	270651509
Hospital Revenue Code	272
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$21.09
Rate for Payer: Qualcare PPO/HMO/WC	$21.09

TEMPLATE BENDNG 9 HL 4.5 DCP

Facility

$140.60

Service Code	HCPCS C1713
Hospital Charge Code	270651509
Hospital Revenue Code	272
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$70.30
Rate for Payer: Aetna Commercial	$53.43
Rate for Payer: Aetna Medicare Advantage	$42.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.85
Rate for Payer: Cigna Commercial	$70.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.18
Rate for Payer: Oxford Commercial	$28.12
Rate for Payer: Qualcare PPO/HMO/WC	$21.09
Rate for Payer: UnitedHealthcare Commercial	$28.12
Rate for Payer: UnitedHealthcare Community & State	$3.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.73

TEMPLATE GRID 17GA STERILE

Facility

$234.00

Hospital Charge Code	270640971
Hospital Revenue Code	272
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Commercial	$88.92
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.67
Rate for Payer: Cigna Commercial	$117.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.20
Rate for Payer: Oxford Commercial	$46.80
Rate for Payer: Qualcare PPO/HMO/WC	$35.10
Rate for Payer: UnitedHealthcare Commercial	$46.80
Rate for Payer: UnitedHealthcare Community & State	$5.64
Rate for Payer: Wellpoint Medicaid Managed Care	$6.20

TEMPLATE GRID 17GA STERILE

Facility

$234.00

Hospital Charge Code	270640971
Hospital Revenue Code	272
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Qualcare PPO/HMO/WC	$35.10

TEMPLATE GRID 18G USE W/UA1084

Facility

$236.00

Hospital Charge Code	270662675
Hospital Revenue Code	270
Min. Negotiated Rate	$35.40
Max. Negotiated Rate	$35.40
Rate for Payer: Qualcare PPO/HMO/WC	$35.40

TEMPLATE GRID 18G USE W/UA1084

Facility

$236.00

Hospital Charge Code	270662675
Hospital Revenue Code	270
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$118.00
Rate for Payer: Aetna Commercial	$89.68
Rate for Payer: Aetna Medicare Advantage	$70.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.18
Rate for Payer: Cigna Commercial	$118.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.80
Rate for Payer: Oxford Commercial	$47.20
Rate for Payer: Qualcare PPO/HMO/WC	$35.40
Rate for Payer: UnitedHealthcare Commercial	$47.20
Rate for Payer: UnitedHealthcare Community & State	$5.69
Rate for Payer: Wellpoint Medicaid Managed Care	$6.25

TEMPLATE OCCIPITAL PLATE SMALL

Facility

$4,350.00

Service Code	HCPCS A4649
Hospital Charge Code	270697875
Hospital Revenue Code	272
Min. Negotiated Rate	$652.50
Max. Negotiated Rate	$652.50
Rate for Payer: Qualcare PPO/HMO/WC	$652.50

TEMPLATE OCCIPITAL PLATE SMALL

Facility

$4,350.00

Service Code	HCPCS A4649
Hospital Charge Code	270697875
Hospital Revenue Code	272
Min. Negotiated Rate	$104.83
Max. Negotiated Rate	$2,175.00
Rate for Payer: Aetna Commercial	$1,653.00
Rate for Payer: Aetna Medicare Advantage	$1,305.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,109.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,109.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,109.25
Rate for Payer: Cigna Commercial	$2,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,305.00
Rate for Payer: Oxford Commercial	$870.00
Rate for Payer: Qualcare PPO/HMO/WC	$652.50
Rate for Payer: UnitedHealthcare Commercial	$870.00
Rate for Payer: UnitedHealthcare Community & State	$104.83
Rate for Payer: Wellpoint Medicaid Managed Care	$115.28

TEMPLATE SDK SIZING 11MM

Facility

$323.25

Hospital Charge Code	270614969
Hospital Revenue Code	272
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$161.62
Rate for Payer: Aetna Commercial	$122.83
Rate for Payer: Aetna Medicare Advantage	$96.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.43
Rate for Payer: Cigna Commercial	$161.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.97
Rate for Payer: Oxford Commercial	$64.65
Rate for Payer: Qualcare PPO/HMO/WC	$48.49
Rate for Payer: UnitedHealthcare Commercial	$64.65
Rate for Payer: UnitedHealthcare Community & State	$7.79
Rate for Payer: Wellpoint Medicaid Managed Care	$8.57

TEMPLATE SDK SIZING 11MM

Facility

$323.25

Hospital Charge Code	270614969
Hospital Revenue Code	272
Min. Negotiated Rate	$48.49
Max. Negotiated Rate	$48.49
Rate for Payer: Qualcare PPO/HMO/WC	$48.49

TEMPLATE SDK SPIN SYS 823.320

Facility

$261.65

Hospital Charge Code	270616285
Hospital Revenue Code	272
Min. Negotiated Rate	$6.31
Max. Negotiated Rate	$130.82
Rate for Payer: Aetna Commercial	$99.43
Rate for Payer: Aetna Medicare Advantage	$78.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.72
Rate for Payer: Cigna Commercial	$130.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.50
Rate for Payer: Oxford Commercial	$52.33
Rate for Payer: Qualcare PPO/HMO/WC	$39.25
Rate for Payer: UnitedHealthcare Commercial	$52.33
Rate for Payer: UnitedHealthcare Community & State	$6.31
Rate for Payer: Wellpoint Medicaid Managed Care	$6.93

TEMPLATE SDK SPIN SYS 823.320

Facility

$261.65

Hospital Charge Code	270616285
Hospital Revenue Code	272
Min. Negotiated Rate	$39.25
Max. Negotiated Rate	$39.25
Rate for Payer: Qualcare PPO/HMO/WC	$39.25

TEMPLATE SYN 22H 3.5PLT 329.64

Facility

$396.85

Hospital Charge Code	270615259
Hospital Revenue Code	278
Min. Negotiated Rate	$59.53
Max. Negotiated Rate	$96.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$87.31
Rate for Payer: Qualcare PPO/HMO/WC	$59.53

TEMPLATE SYN 22H 3.5PLT 329.64

Facility

$396.85

Hospital Charge Code	270615259
Hospital Revenue Code	278
Min. Negotiated Rate	$9.56
Max. Negotiated Rate	$198.43
Rate for Payer: Aetna Commercial	$150.80
Rate for Payer: Aetna Medicare Advantage	$119.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101.20
Rate for Payer: Cigna Commercial	$198.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$87.31
Rate for Payer: Qualcare PPO/HMO/WC	$59.53
Rate for Payer: UnitedHealthcare Community & State	$9.56
Rate for Payer: Wellpoint Medicaid Managed Care	$10.52

TEMPLATE SYN 7H 3.5PLT 329.87

Facility

$144.00

Hospital Charge Code	270614776
Hospital Revenue Code	278
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna Commercial	$54.72
Rate for Payer: Aetna Medicare Advantage	$43.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.72
Rate for Payer: Cigna Commercial	$72.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$31.68
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Community & State	$3.47
Rate for Payer: Wellpoint Medicaid Managed Care	$3.82

TEMPLATE SYN 7H 3.5PLT 329.87

Facility

$144.00

Hospital Charge Code	270614776
Hospital Revenue Code	278
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$34.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$31.68
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

TEMPLTE GRID 18GA STRL 610-906

Facility

$234.00

Hospital Charge Code	270640970
Hospital Revenue Code	272
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Commercial	$88.92
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.67
Rate for Payer: Cigna Commercial	$117.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.20
Rate for Payer: Oxford Commercial	$46.80
Rate for Payer: Qualcare PPO/HMO/WC	$35.10
Rate for Payer: UnitedHealthcare Commercial	$46.80
Rate for Payer: UnitedHealthcare Community & State	$5.64
Rate for Payer: Wellpoint Medicaid Managed Care	$6.20

TEMPLTE GRID 18GA STRL 610-906

Facility

$234.00

Hospital Charge Code	270640970
Hospital Revenue Code	272
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Qualcare PPO/HMO/WC	$35.10

TEMPORARY FIXATION PIN

Facility

$1,240.00

Hospital Charge Code	270704213
Hospital Revenue Code	279
Min. Negotiated Rate	$29.88
Max. Negotiated Rate	$620.00
Rate for Payer: Aetna Commercial	$471.20
Rate for Payer: Aetna Medicare Advantage	$372.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$316.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$316.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$316.20
Rate for Payer: Cigna Commercial	$620.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.00
Rate for Payer: Oxford Commercial	$248.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.00
Rate for Payer: UnitedHealthcare Commercial	$248.00
Rate for Payer: UnitedHealthcare Community & State	$29.88
Rate for Payer: Wellpoint Medicaid Managed Care	$32.86

TEMPORARY FIXATION PIN

Facility

$1,240.00

Hospital Charge Code	270704213
Hospital Revenue Code	279
Min. Negotiated Rate	$186.00
Max. Negotiated Rate	$186.00
Rate for Payer: Qualcare PPO/HMO/WC	$186.00

Know your out-of-pocket cost for care.

All Charges