Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CAST FINGER APPLICATION OF****

Facility

$122.00

Hospital Charge Code	4000014
Hospital Revenue Code	279
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$18.30
Rate for Payer: Qualcare PPO/HMO/WC	$18.30

CASTING TAPE 3 4YD DELTA

Facility

$162.85

Hospital Charge Code	270651747
Hospital Revenue Code	272
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$81.42
Rate for Payer: Aetna Commercial	$61.88
Rate for Payer: Aetna Medicare Advantage	$48.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.53
Rate for Payer: Cigna Commercial	$81.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.85
Rate for Payer: Oxford Commercial	$32.57
Rate for Payer: Qualcare PPO/HMO/WC	$24.43
Rate for Payer: UnitedHealthcare Commercial	$32.57
Rate for Payer: UnitedHealthcare Community & State	$3.92
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

CASTING TAPE 3 4YD DELTA

Facility

$162.85

Hospital Charge Code	270651747
Hospital Revenue Code	272
Min. Negotiated Rate	$24.43
Max. Negotiated Rate	$24.43
Rate for Payer: Qualcare PPO/HMO/WC	$24.43

CASTING TAPE 5INX4YRD DELTA LT

Facility

$21.26

Hospital Charge Code	270651748
Hospital Revenue Code	270
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$3.19
Rate for Payer: Qualcare PPO/HMO/WC	$3.19

CASTING TAPE 5INX4YRD DELTA LT

Facility

$21.26

Hospital Charge Code	270651748
Hospital Revenue Code	270
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.63
Rate for Payer: Aetna Commercial	$8.08
Rate for Payer: Aetna Medicare Advantage	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.42
Rate for Payer: Cigna Commercial	$10.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.38
Rate for Payer: Oxford Commercial	$4.25
Rate for Payer: Qualcare PPO/HMO/WC	$3.19
Rate for Payer: UnitedHealthcare Commercial	$4.25
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

CAST LONG LEG APPLICATION OF

Facility

$688.85

Hospital Charge Code	4000030
Hospital Revenue Code	270
Min. Negotiated Rate	$16.60
Max. Negotiated Rate	$344.43
Rate for Payer: Aetna Commercial	$261.76
Rate for Payer: Aetna Medicare Advantage	$206.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.66
Rate for Payer: Cigna Commercial	$344.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.66
Rate for Payer: Oxford Commercial	$137.77
Rate for Payer: Qualcare PPO/HMO/WC	$103.33
Rate for Payer: UnitedHealthcare Commercial	$137.77
Rate for Payer: UnitedHealthcare Community & State	$16.60
Rate for Payer: Wellpoint Medicaid Managed Care	$18.25

CAST LONG LEG APPLICATION OF

Facility

$688.85

Hospital Charge Code	4000030
Hospital Revenue Code	270
Min. Negotiated Rate	$103.33
Max. Negotiated Rate	$103.33
Rate for Payer: Qualcare PPO/HMO/WC	$103.33

CASTOR OIL

Facility

$11.25

Hospital Charge Code	60628124
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

CASTOR OIL

Facility

$11.25

Hospital Charge Code	60628124
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

CASTOR OIL EMULSION/3OZ

Facility

$31.36

Service Code	NDC 395051592
Hospital Charge Code	60634578
Hospital Revenue Code	250
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$4.70
Rate for Payer: Qualcare PPO/HMO/WC	$4.70

CASTOR OIL EMULSION/3OZ

Facility

$31.36

Service Code	NDC 395051592
Hospital Charge Code	60634578
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$15.68
Rate for Payer: Aetna Commercial	$11.92
Rate for Payer: Aetna Medicare Advantage	$9.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.00
Rate for Payer: Cigna Commercial	$15.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.41
Rate for Payer: Oxford Commercial	$6.27
Rate for Payer: Qualcare PPO/HMO/WC	$4.70
Rate for Payer: UnitedHealthcare Commercial	$6.27
Rate for Payer: UnitedHealthcare Community & State	$0.76
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

CAST PAD DELTA ROLL 3SYNTH.

Facility

$38.00

Hospital Charge Code	270331610
Hospital Revenue Code	270
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$14.44
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.40
Rate for Payer: Oxford Commercial	$7.60
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

CAST PAD DELTA ROLL 3SYNTH.

Facility

$38.00

Hospital Charge Code	270331610
Hospital Revenue Code	270
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

CAST PADDING 2 4YDS

Facility

$2.18

Hospital Charge Code	270650468
Hospital Revenue Code	270
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.09
Rate for Payer: Aetna Commercial	$0.83
Rate for Payer: Aetna Medicare Advantage	$0.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.56
Rate for Payer: Cigna Commercial	$1.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.65
Rate for Payer: Oxford Commercial	$0.44
Rate for Payer: Qualcare PPO/HMO/WC	$0.33
Rate for Payer: UnitedHealthcare Commercial	$0.44
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

CAST PADDING 2 4YDS

Facility

$2.18

Hospital Charge Code	270650468
Hospital Revenue Code	270
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Qualcare PPO/HMO/WC	$0.33

CAST PADDING 4 IN X 4 YDS

Facility

$3.13

Hospital Charge Code	270660495
Hospital Revenue Code	270
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.56
Rate for Payer: Aetna Commercial	$1.19
Rate for Payer: Aetna Medicare Advantage	$0.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.80
Rate for Payer: Cigna Commercial	$1.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.94
Rate for Payer: Oxford Commercial	$0.63
Rate for Payer: Qualcare PPO/HMO/WC	$0.47
Rate for Payer: UnitedHealthcare Commercial	$0.63
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

CAST PADDING 4 IN X 4 YDS

Facility

$3.13

Hospital Charge Code	270660495
Hospital Revenue Code	270
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.47
Rate for Payer: Qualcare PPO/HMO/WC	$0.47

CAST PADDING 4YD 2 45090CMW02

Facility

$3.25

Hospital Charge Code	270635913
Hospital Revenue Code	272
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.62
Rate for Payer: Aetna Commercial	$1.24
Rate for Payer: Aetna Medicare Advantage	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.83
Rate for Payer: Cigna Commercial	$1.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.98
Rate for Payer: Oxford Commercial	$0.65
Rate for Payer: Qualcare PPO/HMO/WC	$0.49
Rate for Payer: UnitedHealthcare Commercial	$0.65
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.09

CAST PADDING 4YD 2 45090CMW02

Facility

$3.25

Hospital Charge Code	270635913
Hospital Revenue Code	272
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.49

CAST PADDING 6 4 YDS 3489

Facility

$5.20

Hospital Charge Code	270649199
Hospital Revenue Code	270
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Commercial	$1.98
Rate for Payer: Aetna Medicare Advantage	$1.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.33
Rate for Payer: Cigna Commercial	$2.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.56
Rate for Payer: Oxford Commercial	$1.04
Rate for Payer: Qualcare PPO/HMO/WC	$0.78
Rate for Payer: UnitedHealthcare Commercial	$1.04
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

CAST PADDING 6 4 YDS 3489

Facility

$5.20

Hospital Charge Code	270649199
Hospital Revenue Code	270
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$0.78
Rate for Payer: Qualcare PPO/HMO/WC	$0.78

CAST PADDING WEBRIL STER 3

Facility

$5.78

Hospital Charge Code	270649174
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

CAST PADDING WEBRIL STER 3

Facility

$5.78

Hospital Charge Code	270649174
Hospital Revenue Code	272
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

CAST PADDING WEBRIL STER 4

Facility

$5.08

Hospital Charge Code	270649176
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.54
Rate for Payer: Aetna Commercial	$1.93
Rate for Payer: Aetna Medicare Advantage	$1.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.30
Rate for Payer: Cigna Commercial	$2.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.52
Rate for Payer: Oxford Commercial	$1.02
Rate for Payer: Qualcare PPO/HMO/WC	$0.76
Rate for Payer: UnitedHealthcare Commercial	$1.02
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

CAST PADDING WEBRIL STER 4

Facility

$5.08

Hospital Charge Code	270649176
Hospital Revenue Code	272
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Qualcare PPO/HMO/WC	$0.76

Know your out-of-pocket cost for care.

All Charges