Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BOOT CAMWALKER

Facility

$5.00

Hospital Charge Code	270633897
Hospital Revenue Code	271
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

BOOT CAMWALKER

Facility

$5.00

Hospital Charge Code	270633897
Hospital Revenue Code	271
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

BOOT HEEL LIFT SUSPENSION 9949

Facility

$229.90

Hospital Charge Code	270302935
Hospital Revenue Code	272
Min. Negotiated Rate	$34.48
Max. Negotiated Rate	$34.48
Rate for Payer: Qualcare PPO/HMO/WC	$34.48

BOOT HEEL LIFT SUSPENSION 9949

Facility

$229.90

Hospital Charge Code	270302935
Hospital Revenue Code	272
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$114.95
Rate for Payer: Aetna Commercial	$87.36
Rate for Payer: Aetna Medicare Advantage	$68.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.62
Rate for Payer: Cigna Commercial	$114.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.97
Rate for Payer: Oxford Commercial	$45.98
Rate for Payer: Qualcare PPO/HMO/WC	$34.48
Rate for Payer: UnitedHealthcare Commercial	$45.98
Rate for Payer: UnitedHealthcare Community & State	$5.54
Rate for Payer: Wellpoint Medicaid Managed Care	$6.09

BOOTIES SUTURE AID YELL 30-702

Facility

$5.78

Hospital Charge Code	270646080
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.89
Rate for Payer: Aetna Commercial	$2.20
Rate for Payer: Aetna Medicare Advantage	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.47
Rate for Payer: Cigna Commercial	$2.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.73
Rate for Payer: Oxford Commercial	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$1.16
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

BOOTIES SUTURE AID YELL 30-702

Facility

$5.78

Hospital Charge Code	270646080
Hospital Revenue Code	272
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

BOOTIE SUTURE-AID YEL 05-1-003

Facility

$24.85

Hospital Charge Code	270060185
Hospital Revenue Code	272
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$9.44
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.46
Rate for Payer: Oxford Commercial	$4.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$4.97
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

BOOTIE SUTURE-AID YEL 05-1-003

Facility

$24.85

Hospital Charge Code	270060185
Hospital Revenue Code	272
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

BOOTLEG DISPOSABLE FLUID PROTE

Facility

$42.10

Hospital Charge Code	270657352
Hospital Revenue Code	270
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$6.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.32

BOOTLEG DISPOSABLE FLUID PROTE

Facility

$42.10

Hospital Charge Code	270657352
Hospital Revenue Code	270
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$21.05
Rate for Payer: Aetna Commercial	$16.00
Rate for Payer: Aetna Medicare Advantage	$12.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.74
Rate for Payer: Cigna Commercial	$21.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.63
Rate for Payer: Oxford Commercial	$8.42
Rate for Payer: Qualcare PPO/HMO/WC	$6.32
Rate for Payer: UnitedHealthcare Commercial	$8.42
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

BOOT LEG FLUID PROTECTION

Facility

$106.00

Hospital Charge Code	270335514
Hospital Revenue Code	272
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

BOOT LEG FLUID PROTECTION

Facility

$106.00

Hospital Charge Code	270335514
Hospital Revenue Code	272
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$53.00
Rate for Payer: Aetna Commercial	$40.28
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.80
Rate for Payer: Oxford Commercial	$21.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$21.20
Rate for Payer: UnitedHealthcare Community & State	$2.55
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

BOOT MULTIPODOUS LG 303404306D

Facility

$242.50

Hospital Charge Code	270302905
Hospital Revenue Code	272
Min. Negotiated Rate	$36.38
Max. Negotiated Rate	$36.38
Rate for Payer: Qualcare PPO/HMO/WC	$36.38

BOOT MULTIPODOUS LG 303404306D

Facility

$242.50

Hospital Charge Code	270302905
Hospital Revenue Code	272
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$121.25
Rate for Payer: Aetna Commercial	$92.15
Rate for Payer: Aetna Medicare Advantage	$72.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.84
Rate for Payer: Cigna Commercial	$121.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.75
Rate for Payer: Oxford Commercial	$48.50
Rate for Payer: Qualcare PPO/HMO/WC	$36.38
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: UnitedHealthcare Community & State	$5.84
Rate for Payer: Wellpoint Medicaid Managed Care	$6.43

BOOT MULTIPODUS SMALL 430B

Facility

$320.00

Service Code	HCPCS L4396
Hospital Charge Code	270612640
Hospital Revenue Code	274
Min. Negotiated Rate	$7.71
Max. Negotiated Rate	$160.00
Rate for Payer: Aetna Commercial	$121.60
Rate for Payer: Aetna Medicare Advantage	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.60
Rate for Payer: Cigna Commercial	$160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$70.40
Rate for Payer: Qualcare PPO/HMO/WC	$48.00
Rate for Payer: UnitedHealthcare Community & State	$7.71
Rate for Payer: Wellpoint Medicaid Managed Care	$8.48

BOOT MULTIPODUS SMALL 430B

Facility

$320.00

Service Code	HCPCS L4396
Hospital Charge Code	270612640
Hospital Revenue Code	274
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$70.40
Rate for Payer: Qualcare PPO/HMO/WC	$48.00

BOOT MULTIPOROUS AMB CUSTOM

Facility

$1,536.00

Hospital Charge Code	270613128
Hospital Revenue Code	274
Min. Negotiated Rate	$230.40
Max. Negotiated Rate	$371.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$371.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$337.92
Rate for Payer: Qualcare PPO/HMO/WC	$230.40

BOOT MULTIPOROUS AMB CUSTOM

Facility

$1,536.00

Hospital Charge Code	270613128
Hospital Revenue Code	274
Min. Negotiated Rate	$37.02
Max. Negotiated Rate	$768.00
Rate for Payer: Aetna Commercial	$583.68
Rate for Payer: Aetna Medicare Advantage	$460.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$391.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$391.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$391.68
Rate for Payer: Cigna Commercial	$768.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$371.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$337.92
Rate for Payer: Qualcare PPO/HMO/WC	$230.40
Rate for Payer: UnitedHealthcare Community & State	$37.02
Rate for Payer: Wellpoint Medicaid Managed Care	$40.70

BOOT N/C FULL COVER LARGE

Facility

$113.33

Hospital Charge Code	270650459
Hospital Revenue Code	272
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$56.66
Rate for Payer: Aetna Commercial	$43.07
Rate for Payer: Aetna Medicare Advantage	$34.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.90
Rate for Payer: Cigna Commercial	$56.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.00
Rate for Payer: Oxford Commercial	$22.67
Rate for Payer: Qualcare PPO/HMO/WC	$17.00
Rate for Payer: UnitedHealthcare Commercial	$22.67
Rate for Payer: UnitedHealthcare Community & State	$2.73
Rate for Payer: Wellpoint Medicaid Managed Care	$3.00

BOOT N/C FULL COVER LARGE

Facility

$113.33

Hospital Charge Code	270650459
Hospital Revenue Code	272
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.00

BOOT REGULAR TCC-EX

Facility

$351.75

Hospital Charge Code	270639683
Hospital Revenue Code	270
Min. Negotiated Rate	$8.48
Max. Negotiated Rate	$175.88
Rate for Payer: Aetna Commercial	$133.66
Rate for Payer: Aetna Medicare Advantage	$105.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.70
Rate for Payer: Cigna Commercial	$175.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.53
Rate for Payer: Oxford Commercial	$70.35
Rate for Payer: Qualcare PPO/HMO/WC	$52.76
Rate for Payer: UnitedHealthcare Commercial	$70.35
Rate for Payer: UnitedHealthcare Community & State	$8.48
Rate for Payer: Wellpoint Medicaid Managed Care	$9.32

BOOT REGULAR TCC-EX

Facility

$351.75

Hospital Charge Code	270639683
Hospital Revenue Code	270
Min. Negotiated Rate	$52.76
Max. Negotiated Rate	$52.76
Rate for Payer: Qualcare PPO/HMO/WC	$52.76

BOOT ROCKER LEFT CUST.

Facility

$1,659.25

Hospital Charge Code	270612781
Hospital Revenue Code	270
Min. Negotiated Rate	$248.89
Max. Negotiated Rate	$248.89
Rate for Payer: Qualcare PPO/HMO/WC	$248.89

BOOT ROCKER LEFT CUST.

Facility

$1,659.25

Hospital Charge Code	270612781
Hospital Revenue Code	270
Min. Negotiated Rate	$39.99
Max. Negotiated Rate	$829.62
Rate for Payer: Aetna Commercial	$630.51
Rate for Payer: Aetna Medicare Advantage	$497.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$423.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$423.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$423.11
Rate for Payer: Cigna Commercial	$829.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$497.77
Rate for Payer: Oxford Commercial	$331.85
Rate for Payer: Qualcare PPO/HMO/WC	$248.89
Rate for Payer: UnitedHealthcare Commercial	$331.85
Rate for Payer: UnitedHealthcare Community & State	$39.99
Rate for Payer: Wellpoint Medicaid Managed Care	$43.97

BOOT UNNA W/ZINC 3 GL30001

Facility

$28.08

Hospital Charge Code	270639056
Hospital Revenue Code	270
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$4.21
Rate for Payer: Qualcare PPO/HMO/WC	$4.21

Know your out-of-pocket cost for care.

All Charges