Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DRAPE HEAD STER 89438

Facility

$12.85

Hospital Charge Code	270620010
Hospital Revenue Code	272
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.42
Rate for Payer: Aetna Commercial	$4.88
Rate for Payer: Aetna Medicare Advantage	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.28
Rate for Payer: Cigna Commercial	$6.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.85
Rate for Payer: Oxford Commercial	$2.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.93
Rate for Payer: UnitedHealthcare Commercial	$2.57
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

DRAPE HEAD STER 89438

Facility

$12.85

Hospital Charge Code	270620010
Hospital Revenue Code	272
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.93

DRAPE INCISION DIRECTIONAL PED

Facility

$7.17

Hospital Charge Code	270649768
Hospital Revenue Code	270
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.58
Rate for Payer: Aetna Commercial	$2.72
Rate for Payer: Aetna Medicare Advantage	$2.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.83
Rate for Payer: Cigna Commercial	$3.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.15
Rate for Payer: Oxford Commercial	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.08
Rate for Payer: UnitedHealthcare Commercial	$1.43
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

DRAPE INCISION DIRECTIONAL PED

Facility

$7.17

Hospital Charge Code	270649768
Hospital Revenue Code	270
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.08

DRAPE IOBAN 23X17 INCISE ANTI-

Facility

$26.60

Hospital Charge Code	270653225
Hospital Revenue Code	270
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.30
Rate for Payer: Aetna Commercial	$10.11
Rate for Payer: Aetna Medicare Advantage	$7.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.78
Rate for Payer: Cigna Commercial	$13.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.98
Rate for Payer: Oxford Commercial	$5.32
Rate for Payer: Qualcare PPO/HMO/WC	$3.99
Rate for Payer: UnitedHealthcare Commercial	$5.32
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

DRAPE IOBAN 23X17 INCISE ANTI-

Facility

$26.60

Hospital Charge Code	270653225
Hospital Revenue Code	270
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$3.99
Rate for Payer: Qualcare PPO/HMO/WC	$3.99

DRAPE IOBAN II 23x17

Facility

$29.95

Hospital Charge Code	270651841
Hospital Revenue Code	272
Min. Negotiated Rate	$4.49
Max. Negotiated Rate	$4.49
Rate for Payer: Qualcare PPO/HMO/WC	$4.49

DRAPE IOBAN II 23x17

Facility

$29.95

Hospital Charge Code	270651841
Hospital Revenue Code	272
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$14.97
Rate for Payer: Aetna Commercial	$11.38
Rate for Payer: Aetna Medicare Advantage	$8.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.64
Rate for Payer: Cigna Commercial	$14.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.98
Rate for Payer: Oxford Commercial	$5.99
Rate for Payer: Qualcare PPO/HMO/WC	$4.49
Rate for Payer: UnitedHealthcare Commercial	$5.99
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

DRAPE IOBAN II IODOPHOR 6617

Facility

$267.25

Hospital Charge Code	270600248
Hospital Revenue Code	272
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$133.62
Rate for Payer: Aetna Commercial	$101.56
Rate for Payer: Aetna Medicare Advantage	$80.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.15
Rate for Payer: Cigna Commercial	$133.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.17
Rate for Payer: Oxford Commercial	$53.45
Rate for Payer: Qualcare PPO/HMO/WC	$40.09
Rate for Payer: UnitedHealthcare Commercial	$53.45
Rate for Payer: UnitedHealthcare Community & State	$6.44
Rate for Payer: Wellpoint Medicaid Managed Care	$7.08

DRAPE IOBAN II IODOPHOR 6617

Facility

$267.25

Hospital Charge Code	270600248
Hospital Revenue Code	272
Min. Negotiated Rate	$40.09
Max. Negotiated Rate	$40.09
Rate for Payer: Qualcare PPO/HMO/WC	$40.09

DRAPE IOBAN II STER ******

Facility

$120.00

Hospital Charge Code	1608017
Hospital Revenue Code	251
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna Commercial	$45.60
Rate for Payer: Aetna Medicare Advantage	$36.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.60
Rate for Payer: Cigna Commercial	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.00
Rate for Payer: Oxford Commercial	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00
Rate for Payer: UnitedHealthcare Commercial	$24.00
Rate for Payer: UnitedHealthcare Community & State	$2.89
Rate for Payer: Wellpoint Medicaid Managed Care	$3.18

DRAPE IOBAN II STER ******

Facility

$120.00

Hospital Charge Code	1608017
Hospital Revenue Code	251
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.00

DRAPE IOBAN LG 6648

Facility

$39.31

Hospital Charge Code	270621156
Hospital Revenue Code	272
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$5.90
Rate for Payer: Qualcare PPO/HMO/WC	$5.90

DRAPE IOBAN LG 6648

Facility

$39.31

Hospital Charge Code	270621156
Hospital Revenue Code	272
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$19.66
Rate for Payer: Aetna Commercial	$14.94
Rate for Payer: Aetna Medicare Advantage	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.02
Rate for Payer: Cigna Commercial	$19.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.79
Rate for Payer: Oxford Commercial	$7.86
Rate for Payer: Qualcare PPO/HMO/WC	$5.90
Rate for Payer: UnitedHealthcare Commercial	$7.86
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

DRAPE IOBAN PT ISOLATION SYS**

Facility

$113.00

Hospital Charge Code	1603075
Hospital Revenue Code	272
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$56.50
Rate for Payer: Aetna Commercial	$42.94
Rate for Payer: Aetna Medicare Advantage	$33.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.82
Rate for Payer: Cigna Commercial	$56.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.90
Rate for Payer: Oxford Commercial	$22.60
Rate for Payer: Qualcare PPO/HMO/WC	$16.95
Rate for Payer: UnitedHealthcare Commercial	$22.60
Rate for Payer: UnitedHealthcare Community & State	$2.72
Rate for Payer: Wellpoint Medicaid Managed Care	$2.99

DRAPE IOBAN PT ISOLATION SYS**

Facility

$113.00

Hospital Charge Code	1603075
Hospital Revenue Code	272
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$16.95
Rate for Payer: Qualcare PPO/HMO/WC	$16.95

DRAPE ISO VI INTESTINE 1003M

Facility

$39.16

Hospital Charge Code	270650805
Hospital Revenue Code	270
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$19.58
Rate for Payer: Aetna Commercial	$14.88
Rate for Payer: Aetna Medicare Advantage	$11.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.99
Rate for Payer: Cigna Commercial	$19.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.75
Rate for Payer: Oxford Commercial	$7.83
Rate for Payer: Qualcare PPO/HMO/WC	$5.87
Rate for Payer: UnitedHealthcare Commercial	$7.83
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

DRAPE ISO VI INTESTINE 1003M

Facility

$39.16

Hospital Charge Code	270650805
Hospital Revenue Code	270
Min. Negotiated Rate	$5.87
Max. Negotiated Rate	$5.87
Rate for Payer: Qualcare PPO/HMO/WC	$5.87

DRAPE LAPAROTOMY 89232

Facility

$65.65

Hospital Charge Code	270609208
Hospital Revenue Code	272
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$32.83
Rate for Payer: Aetna Commercial	$24.95
Rate for Payer: Aetna Medicare Advantage	$19.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.74
Rate for Payer: Cigna Commercial	$32.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.70
Rate for Payer: Oxford Commercial	$13.13
Rate for Payer: Qualcare PPO/HMO/WC	$9.85
Rate for Payer: UnitedHealthcare Commercial	$13.13
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.74

DRAPE LAPAROTOMY 89232

Facility

$65.65

Hospital Charge Code	270609208
Hospital Revenue Code	272
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Qualcare PPO/HMO/WC	$9.85

DRAPE LAPAROTOMY W/POUCH

Facility

$85.65

Hospital Charge Code	270609679
Hospital Revenue Code	272
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$42.83
Rate for Payer: Aetna Commercial	$32.55
Rate for Payer: Aetna Medicare Advantage	$25.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.84
Rate for Payer: Cigna Commercial	$42.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.70
Rate for Payer: Oxford Commercial	$17.13
Rate for Payer: Qualcare PPO/HMO/WC	$12.85
Rate for Payer: UnitedHealthcare Commercial	$17.13
Rate for Payer: UnitedHealthcare Community & State	$2.06
Rate for Payer: Wellpoint Medicaid Managed Care	$2.27

DRAPE LAPAROTOMY W/POUCH

Facility

$85.65

Hospital Charge Code	270609679
Hospital Revenue Code	272
Min. Negotiated Rate	$12.85
Max. Negotiated Rate	$12.85
Rate for Payer: Qualcare PPO/HMO/WC	$12.85

DRAPE LAPAROTOMY W/POUCH 89235

Facility

$151.25

Hospital Charge Code	27609679
Hospital Revenue Code	272
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$75.62
Rate for Payer: Aetna Commercial	$57.48
Rate for Payer: Aetna Medicare Advantage	$45.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.57
Rate for Payer: Cigna Commercial	$75.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.38
Rate for Payer: Oxford Commercial	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$22.69
Rate for Payer: UnitedHealthcare Commercial	$30.25
Rate for Payer: UnitedHealthcare Community & State	$3.65
Rate for Payer: Wellpoint Medicaid Managed Care	$4.01

DRAPE LAPAROTOMY W/POUCH 89235

Facility

$151.25

Hospital Charge Code	27609679
Hospital Revenue Code	272
Min. Negotiated Rate	$22.69
Max. Negotiated Rate	$22.69
Rate for Payer: Qualcare PPO/HMO/WC	$22.69

DRAPE LAP CHOLE 89225

Facility

$140.00

Hospital Charge Code	270609215
Hospital Revenue Code	272
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

Know your out-of-pocket cost for care.

All Charges