Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

DRESSG SALINE STER 4X8

Facility

$6.92

Hospital Charge Code	270350020
Hospital Revenue Code	272
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.04
Rate for Payer: Qualcare PPO/HMO/WC	$1.04

DRESSG SALINE STER 4X8

Facility

$6.92

Hospital Charge Code	270350020
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.46
Rate for Payer: Aetna Commercial	$2.63
Rate for Payer: Aetna Medicare Advantage	$2.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.76
Rate for Payer: Cigna Commercial	$3.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.08
Rate for Payer: Oxford Commercial	$1.38
Rate for Payer: Qualcare PPO/HMO/WC	$1.04
Rate for Payer: UnitedHealthcare Commercial	$1.38
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

DRESSGS AND SUPPLIES *****

Facility

$143.00

Hospital Charge Code	1800275
Hospital Revenue Code	272
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$71.50
Rate for Payer: Aetna Commercial	$54.34
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.47
Rate for Payer: Cigna Commercial	$71.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.90
Rate for Payer: Oxford Commercial	$28.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.45
Rate for Payer: UnitedHealthcare Commercial	$28.60
Rate for Payer: UnitedHealthcare Community & State	$3.45
Rate for Payer: Wellpoint Medicaid Managed Care	$3.79

DRESSGS AND SUPPLIES *****

Facility

$143.00

Hospital Charge Code	1800275
Hospital Revenue Code	272
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$21.45
Rate for Payer: Qualcare PPO/HMO/WC	$21.45

DRESSG TEGAD 4 / 4 3/4

Facility

$8.22

Hospital Charge Code	270350210
Hospital Revenue Code	270
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$4.11
Rate for Payer: Aetna Commercial	$3.12
Rate for Payer: Aetna Medicare Advantage	$2.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.10
Rate for Payer: Cigna Commercial	$4.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.47
Rate for Payer: Oxford Commercial	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.23
Rate for Payer: UnitedHealthcare Commercial	$1.64
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

DRESSG TEGAD 4 / 4 3/4

Facility

$8.22

Hospital Charge Code	270350210
Hospital Revenue Code	270
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$1.23

DRESSG TEGAD 4X10

Facility

$5.86

Hospital Charge Code	270350215
Hospital Revenue Code	272
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.88

DRESSG TEGAD 4X10

Facility

$5.86

Hospital Charge Code	270350215
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.93
Rate for Payer: Aetna Commercial	$2.23
Rate for Payer: Aetna Medicare Advantage	$1.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.49
Rate for Payer: Cigna Commercial	$2.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.76
Rate for Payer: Oxford Commercial	$1.17
Rate for Payer: Qualcare PPO/HMO/WC	$0.88
Rate for Payer: UnitedHealthcare Commercial	$1.17
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

DRESSG TEGAD 5 1/2 / 7

Facility

$26.45

Hospital Charge Code	270350216
Hospital Revenue Code	272
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.97

DRESSG TEGAD 5 1/2 / 7

Facility

$26.45

Hospital Charge Code	270350216
Hospital Revenue Code	272
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.22
Rate for Payer: Aetna Commercial	$10.05
Rate for Payer: Aetna Medicare Advantage	$7.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.74
Rate for Payer: Cigna Commercial	$13.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$5.29
Rate for Payer: Qualcare PPO/HMO/WC	$3.97
Rate for Payer: UnitedHealthcare Commercial	$5.29
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

DRESSG TRACH BOX ******

Facility

$30.00

Hospital Charge Code	8000531
Hospital Revenue Code	279
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

DRESSG TRACH BOX ******

Facility

$30.00

Hospital Charge Code	8000531
Hospital Revenue Code	279
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.00
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

DRESSG TRACH DRAIN BOX

Facility

$74.45

Hospital Charge Code	270350105
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 TRACH DRAIN BOX

Facility

$74.45

Hospital Charge Code	270350105
Hospital Revenue Code	272
Min. Negotiated Rate	$11.17
Max. Negotiated Rate	$11.17
Rate for Payer: Qualcare PPO/HMO/WC	$11.17

DRESSG ULCER 2 3/4 X 3 1/2****

Facility

$13.00

Hospital Charge Code	8003642
Hospital Revenue Code	272
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

DRESSG ULCER 2 3/4 X 3 1/2****

Facility

$13.00

Hospital Charge Code	8003642
Hospital Revenue Code	272
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

DRESSG ULCER 4 X 4 3/4 *****

Facility

$19.00

Hospital Charge Code	8003659
Hospital Revenue Code	272
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

DRESSG ULCER 4 X 4 3/4 *****

Facility

$19.00

Hospital Charge Code	8003659
Hospital Revenue Code	272
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$9.50
Rate for Payer: Aetna Commercial	$7.22
Rate for Payer: Aetna Medicare Advantage	$5.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.84
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.70
Rate for Payer: Oxford Commercial	$3.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$3.80
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

DRESSG VERSIVA 5.5 BX 403206

Facility

$13.55

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

DRESSG VERSIVA 5.5 BX 403206

Facility

$13.55

Hospital Charge Code	270350275
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 VERSIVA 7.5 BX 403207

Facility

$221.70

Hospital Charge Code	270350280
Hospital Revenue Code	272
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$110.85
Rate for Payer: Aetna Commercial	$84.25
Rate for Payer: Aetna Medicare Advantage	$66.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.53
Rate for Payer: Cigna Commercial	$110.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.51
Rate for Payer: Oxford Commercial	$44.34
Rate for Payer: Qualcare PPO/HMO/WC	$33.26
Rate for Payer: UnitedHealthcare Commercial	$44.34
Rate for Payer: UnitedHealthcare Community & State	$5.34
Rate for Payer: Wellpoint Medicaid Managed Care	$5.88

DRESSG VERSIVA 7.5 BX 403207

Facility

$221.70

Hospital Charge Code	270350280
Hospital Revenue Code	272
Min. Negotiated Rate	$33.26
Max. Negotiated Rate	$33.26
Rate for Payer: Qualcare PPO/HMO/WC	$33.26

DRESSG VIGILON 13X24

Facility

$205.65

Hospital Charge Code	270350195
Hospital Revenue Code	272
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$102.83
Rate for Payer: Aetna Commercial	$78.15
Rate for Payer: Aetna Medicare Advantage	$61.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.44
Rate for Payer: Cigna Commercial	$102.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.70
Rate for Payer: Oxford Commercial	$41.13
Rate for Payer: Qualcare PPO/HMO/WC	$30.85
Rate for Payer: UnitedHealthcare Commercial	$41.13
Rate for Payer: UnitedHealthcare Community & State	$4.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.45

DRESSG VIGILON 13X24

Facility

$205.65

Hospital Charge Code	270350195
Hospital Revenue Code	272
Min. Negotiated Rate	$30.85
Max. Negotiated Rate	$30.85
Rate for Payer: Qualcare PPO/HMO/WC	$30.85

Know your out-of-pocket cost for care.

All Charges