Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CAP REVEAL DIS ATT O.D. 11.8

Facility

$90.00

Hospital Charge Code	270685847
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CAP REVEAL DIS ATT O.D. 11.8

Facility

$90.00

Hospital Charge Code	270685847
Hospital Revenue Code	272
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.00
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

CAP REVEAL DIS ATT O.D. 13.4

Facility

$90.00

Hospital Charge Code	270685848
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CAP REVEAL DIS ATT O.D. 13.4

Facility

$90.00

Hospital Charge Code	270685848
Hospital Revenue Code	272
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.00
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

CAP REVEAL DIS ATT O.D. 15.0

Facility

$90.00

Hospital Charge Code	270685849
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CAP REVEAL DIS ATT O.D. 15.0

Facility

$90.00

Hospital Charge Code	270685849
Hospital Revenue Code	272
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.00
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

CAPROSYN* 0 UNDYED 36 GS-21

Facility

$7.05

Hospital Charge Code	270657585
Hospital Revenue Code	270
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.52
Rate for Payer: Aetna Commercial	$2.68
Rate for Payer: Aetna Medicare Advantage	$2.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.80
Rate for Payer: Cigna Commercial	$3.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.12
Rate for Payer: Oxford Commercial	$1.41
Rate for Payer: Qualcare PPO/HMO/WC	$1.06
Rate for Payer: UnitedHealthcare Commercial	$1.41
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

CAPROSYN* 0 UNDYED 36 GS-21

Facility

$7.05

Hospital Charge Code	270657585
Hospital Revenue Code	270
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.06
Rate for Payer: Qualcare PPO/HMO/WC	$1.06

CAPROSYN 2-0 UNDYED 36

Facility

$8.34

Hospital Charge Code	270651122
Hospital Revenue Code	270
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.25

CAPROSYN 2-0 UNDYED 36

Facility

$8.34

Hospital Charge Code	270651122
Hospital Revenue Code	270
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$4.17
Rate for Payer: Aetna Commercial	$3.17
Rate for Payer: Aetna Medicare Advantage	$2.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.13
Rate for Payer: Cigna Commercial	$4.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.50
Rate for Payer: Oxford Commercial	$1.67
Rate for Payer: Qualcare PPO/HMO/WC	$1.25
Rate for Payer: UnitedHealthcare Commercial	$1.67
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

CAPS

Facility

$875.00

Hospital Charge Code	270669468
Hospital Revenue Code	272
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

CAPS

Facility

$875.00

Hospital Charge Code	270659159
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$211.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$192.50
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

CAPS

Facility

$875.00

Hospital Charge Code	270669468
Hospital Revenue Code	272
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$21.09
Rate for Payer: Wellpoint Medicaid Managed Care	$23.19

CAPS

Facility

$875.00

Hospital Charge Code	270659159
Hospital Revenue Code	278
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$192.50
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Community & State	$21.09
Rate for Payer: Wellpoint Medicaid Managed Care	$23.19

CAPSAICIN 0.025% CREAM

Facility

$1.95

Hospital Charge Code	6007322
Hospital Revenue Code	251
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.98
Rate for Payer: Aetna Commercial	$0.74
Rate for Payer: Aetna Medicare Advantage	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.50
Rate for Payer: Cigna Commercial	$0.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.59
Rate for Payer: Oxford Commercial	$0.39
Rate for Payer: Qualcare PPO/HMO/WC	$0.29
Rate for Payer: UnitedHealthcare Commercial	$0.39
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

CAPSAICIN 0.025% CREAM

Facility

$1.95

Hospital Charge Code	6007322
Hospital Revenue Code	251
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Qualcare PPO/HMO/WC	$0.29

CAPSAICIN 0.075% CRE

Facility

$181.65

Hospital Charge Code	60628411
Hospital Revenue Code	250
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$90.83
Rate for Payer: Aetna Commercial	$69.03
Rate for Payer: Aetna Medicare Advantage	$54.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.32
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.49
Rate for Payer: Oxford Commercial	$36.33
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$36.33
Rate for Payer: UnitedHealthcare Community & State	$4.38
Rate for Payer: Wellpoint Medicaid Managed Care	$4.81

CAPSAICIN 0.075% CRE

Facility

$181.65

Hospital Charge Code	60628411
Hospital Revenue Code	250
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

CAPSAICIN 0.1% CREAM

Facility

$102.04

Service Code	NDC 41167075142
Hospital Charge Code	606390225
Hospital Revenue Code	250
Min. Negotiated Rate	$15.31
Max. Negotiated Rate	$15.31
Rate for Payer: Qualcare PPO/HMO/WC	$15.31

CAPSAICIN 0.1% CREAM

Facility

$102.04

Service Code	NDC 41167075142
Hospital Charge Code	606390225
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$51.02
Rate for Payer: Aetna Commercial	$38.78
Rate for Payer: Aetna Medicare Advantage	$30.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.02
Rate for Payer: Cigna Commercial	$51.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.61
Rate for Payer: Oxford Commercial	$20.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.31
Rate for Payer: UnitedHealthcare Commercial	$20.41
Rate for Payer: UnitedHealthcare Community & State	$2.46
Rate for Payer: Wellpoint Medicaid Managed Care	$2.70

CAP SCREW ASSEMBLY

Facility

$1,025.00

Hospital Charge Code	270671062
Hospital Revenue Code	272
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$153.75
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

CAP SCREW ASSEMBLY

Facility

$1,025.00

Hospital Charge Code	270671062
Hospital Revenue Code	272
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.50
Rate for Payer: Oxford Commercial	$205.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Commercial	$205.00
Rate for Payer: UnitedHealthcare Community & State	$24.70
Rate for Payer: Wellpoint Medicaid Managed Care	$27.16

CAP SCREW LOCKING

Facility

$995.00

Service Code	HCPCS C1713
Hospital Charge Code	270691932
Hospital Revenue Code	278
Min. Negotiated Rate	$23.98
Max. Negotiated Rate	$497.50
Rate for Payer: Aetna Commercial	$378.10
Rate for Payer: Aetna Medicare Advantage	$298.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.72
Rate for Payer: Cigna Commercial	$497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$218.90
Rate for Payer: Qualcare PPO/HMO/WC	$149.25
Rate for Payer: UnitedHealthcare Community & State	$23.98
Rate for Payer: Wellpoint Medicaid Managed Care	$26.37

CAP SCREW LOCKING

Facility

$995.00

Service Code	HCPCS C1713
Hospital Charge Code	270691932
Hospital Revenue Code	278
Min. Negotiated Rate	$149.25
Max. Negotiated Rate	$240.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$218.90
Rate for Payer: Qualcare PPO/HMO/WC	$149.25

CAPS DEPUY 1770.91.060

Facility

$1,388.85

Hospital Charge Code	270629834
Hospital Revenue Code	272
Min. Negotiated Rate	$208.33
Max. Negotiated Rate	$208.33
Rate for Payer: Qualcare PPO/HMO/WC	$208.33

Know your out-of-pocket cost for care.

All Charges