Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DRESSING AQUACEL AG 9x15cm

Facility

$123.48

Hospital Charge Code	270666440
Hospital Revenue Code	272
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$61.74
Rate for Payer: Aetna Commercial	$46.92
Rate for Payer: Aetna Medicare Advantage	$37.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.49
Rate for Payer: Cigna Commercial	$61.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.04
Rate for Payer: Oxford Commercial	$24.70
Rate for Payer: Qualcare PPO/HMO/WC	$18.52
Rate for Payer: UnitedHealthcare Commercial	$24.70
Rate for Payer: UnitedHealthcare Community & State	$2.98
Rate for Payer: Wellpoint Medicaid Managed Care	$3.27

DRESSING AQUACEL FOAM 4x4

Facility

$17.03

Hospital Charge Code	270649177
Hospital Revenue Code	272
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.55

DRESSING AQUACEL FOAM 4x4

Facility

$17.03

Hospital Charge Code	270649177
Hospital Revenue Code	272
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.52
Rate for Payer: Aetna Commercial	$6.47
Rate for Payer: Aetna Medicare Advantage	$5.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.34
Rate for Payer: Cigna Commercial	$8.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.11
Rate for Payer: Oxford Commercial	$3.41
Rate for Payer: Qualcare PPO/HMO/WC	$2.55
Rate for Payer: UnitedHealthcare Commercial	$3.41
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

DRESSING AQUACEL FOAM 5x5

Facility

$30.86

Hospital Charge Code	270420619
Hospital Revenue Code	272
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$15.43
Rate for Payer: Aetna Commercial	$11.73
Rate for Payer: Aetna Medicare Advantage	$9.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.87
Rate for Payer: Cigna Commercial	$15.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.26
Rate for Payer: Oxford Commercial	$6.17
Rate for Payer: Qualcare PPO/HMO/WC	$4.63
Rate for Payer: UnitedHealthcare Commercial	$6.17
Rate for Payer: UnitedHealthcare Community & State	$0.74
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

DRESSING AQUACEL FOAM 5x5

Facility

$30.86

Hospital Charge Code	270420619
Hospital Revenue Code	272
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$4.63
Rate for Payer: Qualcare PPO/HMO/WC	$4.63

DRESSING AQUACEL FOAM 7x7

Facility

$53.40

Hospital Charge Code	270420621
Hospital Revenue Code	272
Min. Negotiated Rate	$8.01
Max. Negotiated Rate	$8.01
Rate for Payer: Qualcare PPO/HMO/WC	$8.01

DRESSING AQUACEL FOAM 7x7

Facility

$53.40

Hospital Charge Code	270420621
Hospital Revenue Code	272
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$26.70
Rate for Payer: Aetna Commercial	$20.29
Rate for Payer: Aetna Medicare Advantage	$16.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.62
Rate for Payer: Cigna Commercial	$26.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.02
Rate for Payer: Oxford Commercial	$10.68
Rate for Payer: Qualcare PPO/HMO/WC	$8.01
Rate for Payer: UnitedHealthcare Commercial	$10.68
Rate for Payer: UnitedHealthcare Community & State	$1.29
Rate for Payer: Wellpoint Medicaid Managed Care	$1.42

DRESSING AQUACL 6x6 1638403710

Facility

$30.12

Hospital Charge Code	270350295
Hospital Revenue Code	272
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.06
Rate for Payer: Aetna Commercial	$11.45
Rate for Payer: Aetna Medicare Advantage	$9.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.68
Rate for Payer: Cigna Commercial	$15.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.04
Rate for Payer: Oxford Commercial	$6.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.52
Rate for Payer: UnitedHealthcare Commercial	$6.02
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

DRESSING AQUACL 6x6 1638403710

Facility

$30.12

Hospital Charge Code	270350295
Hospital Revenue Code	272
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$4.52
Rate for Payer: Qualcare PPO/HMO/WC	$4.52

DRESSING BANDAGE ROLL STRETCHD

Facility

$7.60

Hospital Charge Code	270650292
Hospital Revenue Code	272
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.14
Rate for Payer: Qualcare PPO/HMO/WC	$1.14

DRESSING BANDAGE ROLL STRETCHD

Facility

$7.60

Hospital Charge Code	270650292
Hospital Revenue Code	272
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.80
Rate for Payer: Aetna Commercial	$2.89
Rate for Payer: Aetna Medicare Advantage	$2.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.94
Rate for Payer: Cigna Commercial	$3.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.28
Rate for Payer: Oxford Commercial	$1.52
Rate for Payer: Qualcare PPO/HMO/WC	$1.14
Rate for Payer: UnitedHealthcare Commercial	$1.52
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

DRESSING BANDAGE SPANDAGE SZ.2

Facility

$239.00

Hospital Charge Code	270650558
Hospital Revenue Code	270
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

DRESSING BANDAGE SPANDAGE SZ.2

Facility

$239.00

Hospital Charge Code	270650558
Hospital Revenue Code	270
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$119.50
Rate for Payer: Aetna Commercial	$90.82
Rate for Payer: Aetna Medicare Advantage	$71.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.95
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.70
Rate for Payer: Oxford Commercial	$47.80
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Commercial	$47.80
Rate for Payer: UnitedHealthcare Community & State	$5.76
Rate for Payer: Wellpoint Medicaid Managed Care	$6.33

DRESSING BANDAGE SPANDAGE SZ.4

Facility

$80.60

Hospital Charge Code	270650559
Hospital Revenue Code	270
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$40.30
Rate for Payer: Aetna Commercial	$30.63
Rate for Payer: Aetna Medicare Advantage	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.55
Rate for Payer: Cigna Commercial	$40.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.18
Rate for Payer: Oxford Commercial	$16.12
Rate for Payer: Qualcare PPO/HMO/WC	$12.09
Rate for Payer: UnitedHealthcare Commercial	$16.12
Rate for Payer: UnitedHealthcare Community & State	$1.94
Rate for Payer: Wellpoint Medicaid Managed Care	$2.14

DRESSING BANDAGE SPANDAGE SZ.4

Facility

$80.60

Hospital Charge Code	270650559
Hospital Revenue Code	270
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$12.09
Rate for Payer: Qualcare PPO/HMO/WC	$12.09

DRESSING BANDAGE SPANDAGE SZ.8

Facility

$111.25

Hospital Charge Code	270649757
Hospital Revenue Code	270
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$55.62
Rate for Payer: Aetna Commercial	$42.27
Rate for Payer: Aetna Medicare Advantage	$33.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.37
Rate for Payer: Cigna Commercial	$55.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.38
Rate for Payer: Oxford Commercial	$22.25
Rate for Payer: Qualcare PPO/HMO/WC	$16.69
Rate for Payer: UnitedHealthcare Commercial	$22.25
Rate for Payer: UnitedHealthcare Community & State	$2.68
Rate for Payer: Wellpoint Medicaid Managed Care	$2.95

DRESSING BANDAGE SPANDAGE SZ.8

Facility

$111.25

Hospital Charge Code	270649757
Hospital Revenue Code	270
Min. Negotiated Rate	$16.69
Max. Negotiated Rate	$16.69
Rate for Payer: Qualcare PPO/HMO/WC	$16.69

DRESSING BILAYER MATRIX 2X2

Facility

$7,815.00

Service Code	HCPCS Q4104
Hospital Charge Code	270636417
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,891.23
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	$1,563.00
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	$1,891.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,719.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,172.25
Rate for Payer: UnitedHealthcare Community & State	$188.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$207.10

DRESSING BILAYER MATRIX 2X2

Facility

$7,815.00

Service Code	HCPCS Q4104
Hospital Charge Code	270636417
Hospital Revenue Code	278
Min. Negotiated Rate	$1,172.25
Max. Negotiated Rate	$1,891.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,563.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,891.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,719.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,172.25

DRESSING BIOPATCH 1 IN 4150

Facility

$34.98

Hospital Charge Code	270350300
Hospital Revenue Code	272
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$17.49
Rate for Payer: Aetna Commercial	$13.29
Rate for Payer: Aetna Medicare Advantage	$10.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.92
Rate for Payer: Cigna Commercial	$17.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.49
Rate for Payer: Oxford Commercial	$7.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$7.00
Rate for Payer: UnitedHealthcare Community & State	$0.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

DRESSING BIOPATCH 1 IN 4150

Facility

$34.98

Hospital Charge Code	270350300
Hospital Revenue Code	272
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

DRESSING BIOPATCH 1 IN 4150

Facility

$43.75

Hospital Charge Code	270350300N
Hospital Revenue Code	272
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$21.88
Rate for Payer: Aetna Commercial	$16.62
Rate for Payer: Aetna Medicare Advantage	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.16
Rate for Payer: Cigna Commercial	$21.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.12
Rate for Payer: Oxford Commercial	$8.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.56
Rate for Payer: UnitedHealthcare Commercial	$8.75
Rate for Payer: UnitedHealthcare Community & State	$1.05
Rate for Payer: Wellpoint Medicaid Managed Care	$1.16

DRESSING BIOPATCH 1 IN 4150

Facility

$43.75

Hospital Charge Code	270350300N
Hospital Revenue Code	272
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$6.56
Rate for Payer: Qualcare PPO/HMO/WC	$6.56

DRESSING BIOPATCH 1 IN 4150

Facility

$34.98

Hospital Charge Code	270350300R
Hospital Revenue Code	272
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$17.49
Rate for Payer: Aetna Commercial	$13.29
Rate for Payer: Aetna Medicare Advantage	$10.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.92
Rate for Payer: Cigna Commercial	$17.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.49
Rate for Payer: Oxford Commercial	$7.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$7.00
Rate for Payer: UnitedHealthcare Community & State	$0.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

DRESSING BIOPATCH 1 IN 4150

Facility

$34.98

Hospital Charge Code	270350300R
Hospital Revenue Code	272
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

Know your out-of-pocket cost for care.

All Charges