Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DRESSING BORDER LITE 1.6 X2 IN

Facility

$7.44

Hospital Charge Code	270679148
Hospital Revenue Code	272
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.72
Rate for Payer: Aetna Commercial	$2.83
Rate for Payer: Aetna Medicare Advantage	$2.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.90
Rate for Payer: Cigna Commercial	$3.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.23
Rate for Payer: Oxford Commercial	$1.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$1.49
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

DRESSING BORDER LITE 1.6 X2 IN

Facility

$7.44

Hospital Charge Code	270679148
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

DRESSING CALCIUM ALGINATE ROPE

Facility

$988.65

Hospital Charge Code	270650205
Hospital Revenue Code	272
Min. Negotiated Rate	$23.83
Max. Negotiated Rate	$494.32
Rate for Payer: Aetna Commercial	$375.69
Rate for Payer: Aetna Medicare Advantage	$296.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.11
Rate for Payer: Cigna Commercial	$494.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.60
Rate for Payer: Oxford Commercial	$197.73
Rate for Payer: Qualcare PPO/HMO/WC	$148.30
Rate for Payer: UnitedHealthcare Commercial	$197.73
Rate for Payer: UnitedHealthcare Community & State	$23.83
Rate for Payer: Wellpoint Medicaid Managed Care	$26.20

DRESSING CALCIUM ALGINATE ROPE

Facility

$988.65

Hospital Charge Code	270650205
Hospital Revenue Code	272
Min. Negotiated Rate	$148.30
Max. Negotiated Rate	$148.30
Rate for Payer: Qualcare PPO/HMO/WC	$148.30

DRESSING CONTACT LAYER VER 4x7

Facility

$41.99

Hospital Charge Code	270673598
Hospital Revenue Code	272
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$6.30

DRESSING CONTACT LAYER VER 4x7

Facility

$41.99

Hospital Charge Code	270673598
Hospital Revenue Code	272
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Commercial	$15.96
Rate for Payer: Aetna Medicare Advantage	$12.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.71
Rate for Payer: Cigna Commercial	$21.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.60
Rate for Payer: Oxford Commercial	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$6.30
Rate for Payer: UnitedHealthcare Commercial	$8.40
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

DRESSING CURITY 4X4 STERILE

Facility

$295.45

Hospital Charge Code	370350100
Hospital Revenue Code	272
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$147.72
Rate for Payer: Aetna Commercial	$112.27
Rate for Payer: Aetna Medicare Advantage	$88.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.34
Rate for Payer: Cigna Commercial	$147.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.64
Rate for Payer: Oxford Commercial	$59.09
Rate for Payer: Qualcare PPO/HMO/WC	$44.32
Rate for Payer: UnitedHealthcare Commercial	$59.09
Rate for Payer: UnitedHealthcare Community & State	$7.12
Rate for Payer: Wellpoint Medicaid Managed Care	$7.83

DRESSING CURITY 4X4 STERILE

Facility

$295.45

Hospital Charge Code	370350100
Hospital Revenue Code	272
Min. Negotiated Rate	$44.32
Max. Negotiated Rate	$44.32
Rate for Payer: Qualcare PPO/HMO/WC	$44.32

DRESSING DUODERM 8x9 403333

Facility

$42.72

Hospital Charge Code	270350288
Hospital Revenue Code	272
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$6.41
Rate for Payer: Qualcare PPO/HMO/WC	$6.41

DRESSING DUODERM 8x9 403333

Facility

$42.72

Hospital Charge Code	270350288
Hospital Revenue Code	272
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$21.36
Rate for Payer: Aetna Commercial	$16.23
Rate for Payer: Aetna Medicare Advantage	$12.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.89
Rate for Payer: Cigna Commercial	$21.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.82
Rate for Payer: Oxford Commercial	$8.54
Rate for Payer: Qualcare PPO/HMO/WC	$6.41
Rate for Payer: UnitedHealthcare Commercial	$8.54
Rate for Payer: UnitedHealthcare Community & State	$1.03
Rate for Payer: Wellpoint Medicaid Managed Care	$1.13

DRESSING DUODRM 5.5x5.5 403327

Facility

$26.08

Hospital Charge Code	270350287
Hospital Revenue Code	272
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$13.04
Rate for Payer: Aetna Commercial	$9.91
Rate for Payer: Aetna Medicare Advantage	$7.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.65
Rate for Payer: Cigna Commercial	$13.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.82
Rate for Payer: Oxford Commercial	$5.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.91
Rate for Payer: UnitedHealthcare Commercial	$5.22
Rate for Payer: UnitedHealthcare Community & State	$0.63
Rate for Payer: Wellpoint Medicaid Managed Care	$0.69

DRESSING DUODRM 5.5x5.5 403327

Facility

$26.08

Hospital Charge Code	270350287
Hospital Revenue Code	272
Min. Negotiated Rate	$3.91
Max. Negotiated Rate	$3.91
Rate for Payer: Qualcare PPO/HMO/WC	$3.91

DRESSING EXUDERM 6X6

Facility

$26.08

Hospital Charge Code	270350287W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$13.04
Rate for Payer: Aetna Commercial	$9.91
Rate for Payer: Aetna Medicare Advantage	$7.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.65
Rate for Payer: Cigna Commercial	$13.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.82
Rate for Payer: Oxford Commercial	$5.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.91
Rate for Payer: UnitedHealthcare Commercial	$5.22
Rate for Payer: UnitedHealthcare Community & State	$0.63
Rate for Payer: Wellpoint Medicaid Managed Care	$0.69

DRESSING EXUDERM 6X6

Facility

$26.08

Hospital Charge Code	270350287W
Hospital Revenue Code	272
Min. Negotiated Rate	$3.91
Max. Negotiated Rate	$3.91
Rate for Payer: Qualcare PPO/HMO/WC	$3.91

DRESSING EXUDERM 8x8

Facility

$42.72

Hospital Charge Code	270350288W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$21.36
Rate for Payer: Aetna Commercial	$16.23
Rate for Payer: Aetna Medicare Advantage	$12.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.89
Rate for Payer: Cigna Commercial	$21.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.82
Rate for Payer: Oxford Commercial	$8.54
Rate for Payer: Qualcare PPO/HMO/WC	$6.41
Rate for Payer: UnitedHealthcare Commercial	$8.54
Rate for Payer: UnitedHealthcare Community & State	$1.03
Rate for Payer: Wellpoint Medicaid Managed Care	$1.13

DRESSING EXUDERM 8x8

Facility

$42.72

Hospital Charge Code	270350288W
Hospital Revenue Code	272
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$6.41
Rate for Payer: Qualcare PPO/HMO/WC	$6.41

DRESSING EXUFIBER AG 4X5 IN

Facility

$33.81

Hospital Charge Code	270685407
Hospital Revenue Code	272
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$16.91
Rate for Payer: Aetna Commercial	$12.85
Rate for Payer: Aetna Medicare Advantage	$10.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.62
Rate for Payer: Cigna Commercial	$16.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.14
Rate for Payer: Oxford Commercial	$6.76
Rate for Payer: Qualcare PPO/HMO/WC	$5.07
Rate for Payer: UnitedHealthcare Commercial	$6.76
Rate for Payer: UnitedHealthcare Community & State	$0.81
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

DRESSING EXUFIBER AG 4X5 IN

Facility

$33.81

Hospital Charge Code	270685407
Hospital Revenue Code	272
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$5.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.07

DRESSING FOAM OVAL 2.5x3 90611

Facility

$18.47

Hospital Charge Code	270641296W
Hospital Revenue Code	272
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.77

DRESSING FOAM OVAL 2.5x3 90611

Facility

$18.47

Hospital Charge Code	270641296W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$9.23
Rate for Payer: Aetna Commercial	$7.02
Rate for Payer: Aetna Medicare Advantage	$5.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.71
Rate for Payer: Cigna Commercial	$9.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.54
Rate for Payer: Oxford Commercial	$3.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.77
Rate for Payer: UnitedHealthcare Commercial	$3.69
Rate for Payer: UnitedHealthcare Community & State	$0.45
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

DRESSING FOAM OVAL 4x4.5 90613

Facility

$23.67

Hospital Charge Code	270641298W
Hospital Revenue Code	272
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$3.55
Rate for Payer: Qualcare PPO/HMO/WC	$3.55

DRESSING FOAM OVAL 4x4.5 90613

Facility

$23.67

Hospital Charge Code	270641298W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$11.84
Rate for Payer: Aetna Commercial	$8.99
Rate for Payer: Aetna Medicare Advantage	$7.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.04
Rate for Payer: Cigna Commercial	$11.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.10
Rate for Payer: Oxford Commercial	$4.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.55
Rate for Payer: UnitedHealthcare Commercial	$4.73
Rate for Payer: UnitedHealthcare Community & State	$0.57
Rate for Payer: Wellpoint Medicaid Managed Care	$0.63

DRESSING FOAM OVAL HEEL 3x3

Facility

$23.20

Hospital Charge Code	270641300
Hospital Revenue Code	272
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$3.48
Rate for Payer: Qualcare PPO/HMO/WC	$3.48

DRESSING FOAM OVAL HEEL 3x3

Facility

$23.20

Hospital Charge Code	270641300
Hospital Revenue Code	272
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$11.60
Rate for Payer: Aetna Commercial	$8.82
Rate for Payer: Aetna Medicare Advantage	$6.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.92
Rate for Payer: Cigna Commercial	$11.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.96
Rate for Payer: Oxford Commercial	$4.64
Rate for Payer: Qualcare PPO/HMO/WC	$3.48
Rate for Payer: UnitedHealthcare Commercial	$4.64
Rate for Payer: UnitedHealthcare Community & State	$0.56
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

DRESSING GAUZE BOR 4x4 MSC3244

Facility

$2.00

Hospital Charge Code	270639868W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

Know your out-of-pocket cost for care.

All Charges