Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DERMAZIP****

Facility

$72.00

Hospital Charge Code	1800119
Hospital Revenue Code	279
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$27.36
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.60
Rate for Payer: Oxford Commercial	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$14.40
Rate for Payer: UnitedHealthcare Community & State	$1.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

DERMICELL DECELL RETIC 6X7

Facility

$5,435.00

Hospital Charge Code	270703188
Hospital Revenue Code	278
Min. Negotiated Rate	$130.98
Max. Negotiated Rate	$2,717.50
Rate for Payer: Aetna Commercial	$2,065.30
Rate for Payer: Aetna Medicare Advantage	$1,630.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,385.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,385.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,087.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,385.92
Rate for Payer: Cigna Commercial	$2,717.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,315.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,195.70
Rate for Payer: Qualcare PPO/HMO/WC	$815.25
Rate for Payer: UnitedHealthcare Community & State	$130.98
Rate for Payer: Wellpoint Medicaid Managed Care	$144.03

DERMICELL DECELL RETIC 6X7

Facility

$5,435.00

Hospital Charge Code	270703188
Hospital Revenue Code	278
Min. Negotiated Rate	$815.25
Max. Negotiated Rate	$1,315.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,087.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,315.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,195.70
Rate for Payer: Qualcare PPO/HMO/WC	$815.25

DERML REPAIR MATRIX 6x6CM

Facility

$8,050.00

Hospital Charge Code	270674973
Hospital Revenue Code	636
Min. Negotiated Rate	$1,207.50
Max. Negotiated Rate	$1,948.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,948.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,207.50

DERML REPAIR MATRIX 6x6CM

Facility

$8,050.00

Hospital Charge Code	270674973
Hospital Revenue Code	636
Min. Negotiated Rate	$194.00
Max. Negotiated Rate	$4,025.00
Rate for Payer: Aetna Commercial	$3,059.00
Rate for Payer: Aetna Medicare Advantage	$2,415.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,052.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,052.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,052.75
Rate for Payer: Cigna Commercial	$4,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,948.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,207.50
Rate for Payer: UnitedHealthcare Community & State	$194.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.32

DERML REP MATRIX 6x6CM/SQCMJW

Facility

$223.61

Hospital Charge Code	270674973W
Hospital Revenue Code	636
Min. Negotiated Rate	$33.54
Max. Negotiated Rate	$54.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.11
Rate for Payer: Qualcare PPO/HMO/WC	$33.54

DERML REP MATRIX 6x6CM/SQCMJW

Facility

$223.61

Hospital Charge Code	270674973W
Hospital Revenue Code	636
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$111.81
Rate for Payer: Aetna Commercial	$84.97
Rate for Payer: Aetna Medicare Advantage	$67.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.02
Rate for Payer: Cigna Commercial	$111.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.11
Rate for Payer: Qualcare PPO/HMO/WC	$33.54
Rate for Payer: UnitedHealthcare Community & State	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$5.93

DERMOPLAST 20%/82.5ML

Facility

$26.00

Hospital Charge Code	60632801
Hospital Revenue Code	250
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

DERMOPLAST 20%/82.5ML

Facility

$26.00

Hospital Charge Code	60632801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Commercial	$9.88
Rate for Payer: Aetna Medicare Advantage	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.63
Rate for Payer: Cigna Commercial	$13.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.80
Rate for Payer: Oxford Commercial	$5.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.90
Rate for Payer: UnitedHealthcare Commercial	$5.20
Rate for Payer: UnitedHealthcare Community & State	$0.63
Rate for Payer: Wellpoint Medicaid Managed Care	$0.69

DERMOPLAST SPRAY

Facility

$32.50

Service Code	NDC 63029850401
Hospital Charge Code	60632355
Hospital Revenue Code	250
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$4.88
Rate for Payer: Qualcare PPO/HMO/WC	$4.88

DERMOPLAST SPRAY

Facility

$32.50

Service Code	NDC 63029850401
Hospital Charge Code	60632355
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$16.25
Rate for Payer: Aetna Commercial	$12.35
Rate for Payer: Aetna Medicare Advantage	$9.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.29
Rate for Payer: Cigna Commercial	$16.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.75
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.88
Rate for Payer: UnitedHealthcare Commercial	$6.50
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

DESC HYPROCURE SZ 9

Facility

$9,950.00

Service Code	HCPCS C1776
Hospital Charge Code	270688253
Hospital Revenue Code	278
Min. Negotiated Rate	$239.79
Max. Negotiated Rate	$4,975.00
Rate for Payer: Aetna Commercial	$3,781.00
Rate for Payer: Aetna Medicare Advantage	$2,985.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,537.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,537.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,537.25
Rate for Payer: Cigna Commercial	$4,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,407.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,189.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,492.50
Rate for Payer: UnitedHealthcare Community & State	$239.79
Rate for Payer: Wellpoint Medicaid Managed Care	$263.68

DESC HYPROCURE SZ 9

Facility

$9,950.00

Service Code	HCPCS C1776
Hospital Charge Code	270688253
Hospital Revenue Code	278
Min. Negotiated Rate	$1,492.50
Max. Negotiated Rate	$2,407.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,407.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,189.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,492.50

DESC LINER RETENTIVE 3R RSS

Facility

$6,428.70

Service Code	HCPCS C1776
Hospital Charge Code	270692424
Hospital Revenue Code	278
Min. Negotiated Rate	$964.30
Max. Negotiated Rate	$1,555.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,285.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,555.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,414.31
Rate for Payer: Qualcare PPO/HMO/WC	$964.30

DESC LINER RETENTIVE 3R RSS

Facility

$6,428.70

Service Code	HCPCS C1776
Hospital Charge Code	270692424
Hospital Revenue Code	278
Min. Negotiated Rate	$154.93
Max. Negotiated Rate	$3,214.35
Rate for Payer: Aetna Commercial	$2,442.91
Rate for Payer: Aetna Medicare Advantage	$1,928.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,639.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,639.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,285.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,639.32
Rate for Payer: Cigna Commercial	$3,214.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,555.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,414.31
Rate for Payer: Qualcare PPO/HMO/WC	$964.30
Rate for Payer: UnitedHealthcare Community & State	$154.93
Rate for Payer: Wellpoint Medicaid Managed Care	$170.36

DESCOVY TABLET

Facility

$421.50

Service Code	NDC 61958200201
Hospital Charge Code	606390473
Hospital Revenue Code	250
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$210.75
Rate for Payer: Aetna Commercial	$160.17
Rate for Payer: Aetna Medicare Advantage	$126.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.48
Rate for Payer: Cigna Commercial	$210.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.45
Rate for Payer: Oxford Commercial	$84.30
Rate for Payer: Qualcare PPO/HMO/WC	$63.23
Rate for Payer: UnitedHealthcare Commercial	$84.30
Rate for Payer: UnitedHealthcare Community & State	$10.16
Rate for Payer: Wellpoint Medicaid Managed Care	$11.17

DESCOVY TABLET

Facility

$421.50

Service Code	NDC 61958200201
Hospital Charge Code	606390473
Hospital Revenue Code	250
Min. Negotiated Rate	$63.23
Max. Negotiated Rate	$63.23
Rate for Payer: Qualcare PPO/HMO/WC	$63.23

DESC PLATE SCREW PYENESS MONO

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270692456
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$1,577.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,434.40
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

DESC PLATE SCREW PYENESS MONO

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270692456
Hospital Revenue Code	278
Min. Negotiated Rate	$157.13
Max. Negotiated Rate	$3,260.00
Rate for Payer: Aetna Commercial	$2,477.60
Rate for Payer: Aetna Medicare Advantage	$1,956.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,662.60
Rate for Payer: Cigna Commercial	$3,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,434.40
Rate for Payer: Qualcare PPO/HMO/WC	$978.00
Rate for Payer: UnitedHealthcare Community & State	$157.13
Rate for Payer: Wellpoint Medicaid Managed Care	$172.78

DESFERAL VL 500MG***

Facility

$40.00

Service Code	HCPCS J0895
Hospital Charge Code	6007744P
Hospital Revenue Code	259
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

DESFERAL VL 500MG***

Facility

$40.00

Service Code	HCPCS J0895
Hospital Charge Code	6007744P
Hospital Revenue Code	259
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

DESFLURANE

Facility

$387.20

Hospital Charge Code	6017214
Hospital Revenue Code	250
Min. Negotiated Rate	$9.33
Max. Negotiated Rate	$193.60
Rate for Payer: Aetna Commercial	$147.14
Rate for Payer: Aetna Medicare Advantage	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.74
Rate for Payer: Cigna Commercial	$193.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: Oxford Commercial	$77.44
Rate for Payer: Qualcare PPO/HMO/WC	$58.08
Rate for Payer: UnitedHealthcare Commercial	$77.44
Rate for Payer: UnitedHealthcare Community & State	$9.33
Rate for Payer: Wellpoint Medicaid Managed Care	$10.26

DESFLURANE

Facility

$387.20

Hospital Charge Code	6017214
Hospital Revenue Code	250
Min. Negotiated Rate	$58.08
Max. Negotiated Rate	$58.08
Rate for Payer: Qualcare PPO/HMO/WC	$58.08

DESFLURANE 100% GAS

Facility

$1,288.14

Service Code	NDC 10019064134
Hospital Charge Code	60627666
Hospital Revenue Code	250
Min. Negotiated Rate	$193.22
Max. Negotiated Rate	$193.22
Rate for Payer: Qualcare PPO/HMO/WC	$193.22

DESFLURANE 100% GAS

Facility

$1,288.14

Service Code	NDC 10019064134
Hospital Charge Code	60627666
Hospital Revenue Code	250
Min. Negotiated Rate	$31.04
Max. Negotiated Rate	$644.07
Rate for Payer: Aetna Commercial	$489.49
Rate for Payer: Aetna Medicare Advantage	$386.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$328.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$328.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$328.48
Rate for Payer: Cigna Commercial	$644.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$386.44
Rate for Payer: Oxford Commercial	$257.63
Rate for Payer: Qualcare PPO/HMO/WC	$193.22
Rate for Payer: UnitedHealthcare Commercial	$257.63
Rate for Payer: UnitedHealthcare Community & State	$31.04
Rate for Payer: Wellpoint Medicaid Managed Care	$34.14

Know your out-of-pocket cost for care.

All Charges