Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DREAMTOME RX 44 SPINCTEROTOME

Facility

$2,095.85

Hospital Charge Code	270679137
Hospital Revenue Code	272
Min. Negotiated Rate	$50.51
Max. Negotiated Rate	$1,047.92
Rate for Payer: Aetna Commercial	$796.42
Rate for Payer: Aetna Medicare Advantage	$628.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$534.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$534.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$534.44
Rate for Payer: Cigna Commercial	$1,047.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$628.75
Rate for Payer: Oxford Commercial	$419.17
Rate for Payer: Qualcare PPO/HMO/WC	$314.38
Rate for Payer: UnitedHealthcare Commercial	$419.17
Rate for Payer: UnitedHealthcare Community & State	$50.51
Rate for Payer: Wellpoint Medicaid Managed Care	$55.54

DREAMTOME RX 44 SPINCTEROTOME

Facility

$2,095.85

Hospital Charge Code	270679137
Hospital Revenue Code	272
Min. Negotiated Rate	$314.38
Max. Negotiated Rate	$314.38
Rate for Payer: Qualcare PPO/HMO/WC	$314.38

DREAMWIRE F/G 0.035x260 5612

Facility

$859.98

Hospital Charge Code	270643738
Hospital Revenue Code	272
Min. Negotiated Rate	$20.73
Max. Negotiated Rate	$429.99
Rate for Payer: Aetna Commercial	$326.79
Rate for Payer: Aetna Medicare Advantage	$257.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.29
Rate for Payer: Cigna Commercial	$429.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$257.99
Rate for Payer: Oxford Commercial	$172.00
Rate for Payer: Qualcare PPO/HMO/WC	$129.00
Rate for Payer: UnitedHealthcare Commercial	$172.00
Rate for Payer: UnitedHealthcare Community & State	$20.73
Rate for Payer: Wellpoint Medicaid Managed Care	$22.79

DREAMWIRE F/G 0.035x260 5612

Facility

$859.98

Hospital Charge Code	270643738
Hospital Revenue Code	272
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$129.00
Rate for Payer: Qualcare PPO/HMO/WC	$129.00

DREAMWIRE F/G .035/260cm ANGL

Facility

$987.50

Hospital Charge Code	270644053
Hospital Revenue Code	272
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$493.75
Rate for Payer: Aetna Commercial	$375.25
Rate for Payer: Aetna Medicare Advantage	$296.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.81
Rate for Payer: Cigna Commercial	$493.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.25
Rate for Payer: Oxford Commercial	$197.50
Rate for Payer: Qualcare PPO/HMO/WC	$148.12
Rate for Payer: UnitedHealthcare Commercial	$197.50
Rate for Payer: UnitedHealthcare Community & State	$23.80
Rate for Payer: Wellpoint Medicaid Managed Care	$26.17

DREAMWIRE F/G .035/260cm ANGL

Facility

$987.50

Hospital Charge Code	270644053
Hospital Revenue Code	272
Min. Negotiated Rate	$148.12
Max. Negotiated Rate	$148.12
Rate for Payer: Qualcare PPO/HMO/WC	$148.12

DREAMWIRE F/G .035/260CM STR

Facility

$857.83

Service Code	HCPCS C1769
Hospital Charge Code	270676497
Hospital Revenue Code	278
Min. Negotiated Rate	$20.67
Max. Negotiated Rate	$428.92
Rate for Payer: Aetna Commercial	$325.98
Rate for Payer: Aetna Medicare Advantage	$257.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.75
Rate for Payer: Cigna Commercial	$428.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$188.72
Rate for Payer: Qualcare PPO/HMO/WC	$128.67
Rate for Payer: UnitedHealthcare Community & State	$20.67
Rate for Payer: Wellpoint Medicaid Managed Care	$22.73

DREAMWIRE F/G .035/260CM STR

Facility

$857.83

Service Code	HCPCS C1769
Hospital Charge Code	270676497
Hospital Revenue Code	278
Min. Negotiated Rate	$128.67
Max. Negotiated Rate	$207.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$188.72
Rate for Payer: Qualcare PPO/HMO/WC	$128.67

DREAMWIRE F/G .035/450cm STR

Facility

$859.98

Service Code	HCPCS C1769
Hospital Charge Code	270643470
Hospital Revenue Code	278
Min. Negotiated Rate	$20.73
Max. Negotiated Rate	$429.99
Rate for Payer: Aetna Commercial	$326.79
Rate for Payer: Aetna Medicare Advantage	$257.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.29
Rate for Payer: Cigna Commercial	$429.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.20
Rate for Payer: Qualcare PPO/HMO/WC	$129.00
Rate for Payer: UnitedHealthcare Community & State	$20.73
Rate for Payer: Wellpoint Medicaid Managed Care	$22.79

DREAMWIRE F/G .035/450cm STR

Facility

$859.98

Service Code	HCPCS C1769
Hospital Charge Code	270643470
Hospital Revenue Code	278
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$208.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$189.20
Rate for Payer: Qualcare PPO/HMO/WC	$129.00

DREAMWIRE F/G .035/STIFF/450

Facility

$987.50

Hospital Charge Code	270648013
Hospital Revenue Code	272
Min. Negotiated Rate	$148.12
Max. Negotiated Rate	$148.12
Rate for Payer: Qualcare PPO/HMO/WC	$148.12

DREAMWIRE F/G .035/STIFF/450

Facility

$987.50

Hospital Charge Code	270648013
Hospital Revenue Code	272
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$493.75
Rate for Payer: Aetna Commercial	$375.25
Rate for Payer: Aetna Medicare Advantage	$296.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.81
Rate for Payer: Cigna Commercial	$493.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.25
Rate for Payer: Oxford Commercial	$197.50
Rate for Payer: Qualcare PPO/HMO/WC	$148.12
Rate for Payer: UnitedHealthcare Commercial	$197.50
Rate for Payer: UnitedHealthcare Community & State	$23.80
Rate for Payer: Wellpoint Medicaid Managed Care	$26.17

DREAMWIREF/G.035x260cmGuidewr

Facility

$790.00

Hospital Charge Code	643738
Hospital Revenue Code	272
Min. Negotiated Rate	$118.50
Max. Negotiated Rate	$118.50
Rate for Payer: Qualcare PPO/HMO/WC	$118.50

DREAMWIREF/G.035x260cmGuidewr

Facility

$790.00

Hospital Charge Code	643738
Hospital Revenue Code	272
Min. Negotiated Rate	$19.04
Max. Negotiated Rate	$395.00
Rate for Payer: Aetna Commercial	$300.20
Rate for Payer: Aetna Medicare Advantage	$237.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.45
Rate for Payer: Cigna Commercial	$395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.00
Rate for Payer: Oxford Commercial	$158.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.50
Rate for Payer: UnitedHealthcare Commercial	$158.00
Rate for Payer: UnitedHealthcare Community & State	$19.04
Rate for Payer: Wellpoint Medicaid Managed Care	$20.93

DRESS BIL MATRIX WOUND BMW4101

Facility

$22,370.00

Hospital Charge Code	270636056
Hospital Revenue Code	272
Min. Negotiated Rate	$3,355.50
Max. Negotiated Rate	$3,355.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,355.50

DRESS BIL MATRIX WOUND BMW4101

Facility

$22,370.00

Hospital Charge Code	270636056
Hospital Revenue Code	272
Min. Negotiated Rate	$539.12
Max. Negotiated Rate	$11,185.00
Rate for Payer: Aetna Commercial	$8,500.60
Rate for Payer: Aetna Medicare Advantage	$6,711.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,704.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,704.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,704.35
Rate for Payer: Cigna Commercial	$11,185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,711.00
Rate for Payer: Oxford Commercial	$4,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,355.50
Rate for Payer: UnitedHealthcare Commercial	$4,474.00
Rate for Payer: UnitedHealthcare Community & State	$539.12
Rate for Payer: Wellpoint Medicaid Managed Care	$592.80

DRESS BILYR MTRX WOUND BMW4051

Facility

$13,625.00

Service Code	HCPCS Q4104
Hospital Charge Code	270635917
Hospital Revenue Code	636
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,297.25
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.66
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75
Rate for Payer: UnitedHealthcare Community & State	$328.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$361.06

DRESS BILYR MTRX WOUND BMW4051

Facility

$13,625.00

Service Code	HCPCS Q4104
Hospital Charge Code	270635917
Hospital Revenue Code	636
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$3,297.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

DRESS/DEBRIDE, WO ANESTH;SMALL

Facility

$354.45

Service Code	HCPCS 16020
Hospital Charge Code	2500363
Hospital Revenue Code	761
Min. Negotiated Rate	$53.17
Max. Negotiated Rate	$53.17
Rate for Payer: Qualcare PPO/HMO/WC	$53.17

DRESS/DEBRIDE, WO ANESTH;SMALL

Facility

$354.45

Service Code	HCPCS 16020
Hospital Charge Code	2500363
Hospital Revenue Code	761
Min. Negotiated Rate	$8.54
Max. Negotiated Rate	$860.41
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.41
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.33
Rate for Payer: Oxford Commercial	$70.89
Rate for Payer: Qualcare PPO/HMO/WC	$53.17
Rate for Payer: UnitedHealthcare Commercial	$70.89
Rate for Payer: UnitedHealthcare Community & State	$8.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$9.39

DRESSG 2X2 STER BOX *****

Facility

$9.00

Hospital Charge Code	8000499
Hospital Revenue Code	279
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

DRESSG 2X2 STER BOX *****

Facility

$9.00

Hospital Charge Code	8000499
Hospital Revenue Code	279
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

DRESSG 2x2 STER BX

Facility

$11.25

Hospital Charge Code	270350065
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

DRESSG 2x2 STER BX

Facility

$11.25

Hospital Charge Code	270350065
Hospital Revenue Code	272
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

DRESSG 3X3 BOX ******

Facility

$9.00

Hospital Charge Code	8000507
Hospital Revenue Code	279
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

Know your out-of-pocket cost for care.

All Charges