Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DRESSG DUODERM 4X4 EA *****

Facility

$18.00

Service Code	HCPCS K0255
Hospital Charge Code	6007231
Hospital Revenue Code	259
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

DRESSG DUODERM 4X4 EA *****

Facility

$18.00

Service Code	HCPCS K0255
Hospital Charge Code	6007231
Hospital Revenue Code	259
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

DRESSG EPI-LOCK PLOY FM 6X8***

Facility

$48.00

Hospital Charge Code	8003881
Hospital Revenue Code	272
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

DRESSG EPI-LOCK PLOY FM 6X8***

Facility

$48.00

Hospital Charge Code	8003881
Hospital Revenue Code	272
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

DRESSG EPI-LOCK POLY FM 4X4***

Facility

$18.00

Hospital Charge Code	8003873
Hospital Revenue Code	272
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

DRESSG EPI-LOCK POLY FM 4X4***

Facility

$18.00

Hospital Charge Code	8003873
Hospital Revenue Code	272
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

DRESSG GLASSCK EAR ADULT B-50A

Facility

$91.25

Hospital Charge Code	270620190
Hospital Revenue Code	272
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

DRESSG GLASSCK EAR ADULT B-50A

Facility

$91.25

Hospital Charge Code	270620190
Hospital Revenue Code	272
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$45.62
Rate for Payer: Aetna Commercial	$34.67
Rate for Payer: Aetna Medicare Advantage	$27.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.27
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.38
Rate for Payer: Oxford Commercial	$18.25
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$18.25
Rate for Payer: UnitedHealthcare Community & State	$2.20
Rate for Payer: Wellpoint Medicaid Managed Care	$2.42

DRESSG GLASSCK EAR B-500P

Facility

$61.65

Hospital Charge Code	270623968
Hospital Revenue Code	272
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$30.82
Rate for Payer: Aetna Commercial	$23.43
Rate for Payer: Aetna Medicare Advantage	$18.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.72
Rate for Payer: Cigna Commercial	$30.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.50
Rate for Payer: Oxford Commercial	$12.33
Rate for Payer: Qualcare PPO/HMO/WC	$9.25
Rate for Payer: UnitedHealthcare Commercial	$12.33
Rate for Payer: UnitedHealthcare Community & State	$1.49
Rate for Payer: Wellpoint Medicaid Managed Care	$1.63

DRESSG GLASSCK EAR B-500P

Facility

$61.65

Hospital Charge Code	270623968
Hospital Revenue Code	272
Min. Negotiated Rate	$9.25
Max. Negotiated Rate	$9.25
Rate for Payer: Qualcare PPO/HMO/WC	$9.25

DRESSG GLASSCK EAR MED B-500M

Facility

$74.45

Hospital Charge Code	270623969
Hospital Revenue Code	272
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$37.23
Rate for Payer: Aetna Commercial	$28.29
Rate for Payer: Aetna Medicare Advantage	$22.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.98
Rate for Payer: Cigna Commercial	$37.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.34
Rate for Payer: Oxford Commercial	$14.89
Rate for Payer: Qualcare PPO/HMO/WC	$11.17
Rate for Payer: UnitedHealthcare Commercial	$14.89
Rate for Payer: UnitedHealthcare Community & State	$1.79
Rate for Payer: Wellpoint Medicaid Managed Care	$1.97

DRESSG GLASSCK EAR MED B-500M

Facility

$74.45

Hospital Charge Code	270623969
Hospital Revenue Code	272
Min. Negotiated Rate	$11.17
Max. Negotiated Rate	$11.17
Rate for Payer: Qualcare PPO/HMO/WC	$11.17

DRESSG KALOSTAT 2GM CAL-SOD***

Facility

$23.00

Hospital Charge Code	8003907
Hospital Revenue Code	272
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

DRESSG KALOSTAT 2GM CAL-SOD***

Facility

$23.00

Hospital Charge Code	8003907
Hospital Revenue Code	272
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

DRESSG KALOSTAT 7.5CM/12CM

Facility

$18.00

Hospital Charge Code	8003899
Hospital Revenue Code	272
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

DRESSG KALOSTAT 7.5CM/12CM

Facility

$18.00

Hospital Charge Code	8003899
Hospital Revenue Code	272
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

DRESSG OPTFOAM 4X4

Facility

$13.55

Hospital Charge Code	270350275W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.78
Rate for Payer: Aetna Commercial	$5.15
Rate for Payer: Aetna Medicare Advantage	$4.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.46
Rate for Payer: Cigna Commercial	$6.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.07
Rate for Payer: Oxford Commercial	$2.71
Rate for Payer: Qualcare PPO/HMO/WC	$2.03
Rate for Payer: UnitedHealthcare Commercial	$2.71
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

DRESSG OPTFOAM 4X4

Facility

$13.55

Hospital Charge Code	270350275W
Hospital Revenue Code	272
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$2.03
Rate for Payer: Qualcare PPO/HMO/WC	$2.03

DRESSG OPTIFOAM SAC 6x5.6

Facility

$35.92

Hospital Charge Code	270641299
Hospital Revenue Code	272
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$17.96
Rate for Payer: Aetna Commercial	$13.65
Rate for Payer: Aetna Medicare Advantage	$10.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.16
Rate for Payer: Cigna Commercial	$17.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.78
Rate for Payer: Oxford Commercial	$7.18
Rate for Payer: Qualcare PPO/HMO/WC	$5.39
Rate for Payer: UnitedHealthcare Commercial	$7.18
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

DRESSG OPTIFOAM SAC 6x5.6

Facility

$35.92

Hospital Charge Code	270641299
Hospital Revenue Code	272
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$5.39
Rate for Payer: Qualcare PPO/HMO/WC	$5.39

DRESSG PRECUT 3 7/8 / 2 7/8

Facility

$11.25

Hospital Charge Code	270350260
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 PRECUT 3 7/8 / 2 7/8

Facility

$11.25

Hospital Charge Code	270350260
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

DRESSG PRECUT 5 7/8 / 11

Facility

$19.25

Hospital Charge Code	270350270
Hospital Revenue Code	272
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.62
Rate for Payer: Aetna Commercial	$7.32
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.91
Rate for Payer: Cigna Commercial	$9.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.78
Rate for Payer: Oxford Commercial	$3.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.89
Rate for Payer: UnitedHealthcare Commercial	$3.85
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

DRESSG PRECUT 5 7/8 / 11

Facility

$19.25

Hospital Charge Code	270350270
Hospital Revenue Code	272
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.89

DRESSG PRECUT 5 7/8 / 5 7/8

Facility

$11.25

Hospital Charge Code	270350265
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

Know your out-of-pocket cost for care.

All Charges