Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DRESSING GAUZE BOR 4x4 MSC3244

Facility

$2.00

Hospital Charge Code	270639868W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

DRESSING GAUZE BOR 6x6 MSC3266

Facility

$11.73

Hospital Charge Code	270639869W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$1.76
Rate for Payer: Qualcare PPO/HMO/WC	$1.76

DRESSING GAUZE BOR 6x6 MSC3266

Facility

$11.73

Hospital Charge Code	270639869W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$5.87
Rate for Payer: Aetna Commercial	$4.46
Rate for Payer: Aetna Medicare Advantage	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.99
Rate for Payer: Cigna Commercial	$5.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.52
Rate for Payer: Oxford Commercial	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.76
Rate for Payer: UnitedHealthcare Commercial	$2.35
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

DRESSING GAUZE VASELINE 3X9

Facility

$1.99

Hospital Charge Code	270649993
Hospital Revenue Code	270
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

DRESSING GAUZE VASELINE 3X9

Facility

$1.99

Hospital Charge Code	270649993
Hospital Revenue Code	270
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

DRESSING GAUZE VASELINE 6X36

Facility

$5.05

Hospital Charge Code	270649716
Hospital Revenue Code	270
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Qualcare PPO/HMO/WC	$0.76

DRESSING GAUZE VASELINE 6X36

Facility

$5.05

Hospital Charge Code	270649716
Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.52
Rate for Payer: Aetna Commercial	$1.92
Rate for Payer: Aetna Medicare Advantage	$1.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.29
Rate for Payer: Cigna Commercial	$2.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.51
Rate for Payer: Oxford Commercial	$1.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.76
Rate for Payer: UnitedHealthcare Commercial	$1.01
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

DRESSING GEL WOUND TRIAD 2.5OZ

Facility

$24.86

Hospital Charge Code	270689567
Hospital Revenue Code	272
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$9.45
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.46
Rate for Payer: Oxford Commercial	$4.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$4.97
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

DRESSING GEL WOUND TRIAD 2.5OZ

Facility

$24.86

Hospital Charge Code	270689567
Hospital Revenue Code	272
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

DRESSING GERM FLX 7 S 1X24 IN

Facility

$114.70

Hospital Charge Code	270684785
Hospital Revenue Code	272
Min. Negotiated Rate	$17.20
Max. Negotiated Rate	$17.20
Rate for Payer: Qualcare PPO/HMO/WC	$17.20

DRESSING GERM FLX 7 S 1X24 IN

Facility

$114.70

Hospital Charge Code	270684785
Hospital Revenue Code	272
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$57.35
Rate for Payer: Aetna Commercial	$43.59
Rate for Payer: Aetna Medicare Advantage	$34.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.25
Rate for Payer: Cigna Commercial	$57.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.41
Rate for Payer: Oxford Commercial	$22.94
Rate for Payer: Qualcare PPO/HMO/WC	$17.20
Rate for Payer: UnitedHealthcare Commercial	$22.94
Rate for Payer: UnitedHealthcare Community & State	$2.76
Rate for Payer: Wellpoint Medicaid Managed Care	$3.04

DRESSING HONEY CA ALGINATE 4X5

Facility

$43.07

Hospital Charge Code	270666018
Hospital Revenue Code	272
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.54
Rate for Payer: Aetna Commercial	$16.37
Rate for Payer: Aetna Medicare Advantage	$12.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.98
Rate for Payer: Cigna Commercial	$21.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.92
Rate for Payer: Oxford Commercial	$8.61
Rate for Payer: Qualcare PPO/HMO/WC	$6.46
Rate for Payer: UnitedHealthcare Commercial	$8.61
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

DRESSING HONEY CA ALGINATE 4X5

Facility

$43.07

Hospital Charge Code	270666018
Hospital Revenue Code	272
Min. Negotiated Rate	$6.46
Max. Negotiated Rate	$6.46
Rate for Payer: Qualcare PPO/HMO/WC	$6.46

DRESSING HYDROCOLLOID 6X6

Facility

$12.74

Hospital Charge Code	270649914
Hospital Revenue Code	272
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.37
Rate for Payer: Aetna Commercial	$4.84
Rate for Payer: Aetna Medicare Advantage	$3.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.25
Rate for Payer: Cigna Commercial	$6.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.82
Rate for Payer: Oxford Commercial	$2.55
Rate for Payer: Qualcare PPO/HMO/WC	$1.91
Rate for Payer: UnitedHealthcare Commercial	$2.55
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

DRESSING HYDROCOLLOID 6X6

Facility

$12.74

Hospital Charge Code	270649914
Hospital Revenue Code	272
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$1.91
Rate for Payer: Qualcare PPO/HMO/WC	$1.91

DRESSING IODOSORB GEL

Facility

$405.00

Hospital Charge Code	270639054
Hospital Revenue Code	272
Min. Negotiated Rate	$9.76
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$153.90
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.50
Rate for Payer: Oxford Commercial	$81.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Commercial	$81.00
Rate for Payer: UnitedHealthcare Community & State	$9.76
Rate for Payer: Wellpoint Medicaid Managed Care	$10.73

DRESSING IODOSORB GEL

Facility

$405.00

Hospital Charge Code	270639054
Hospital Revenue Code	272
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

DRESSING IODOSORB PAK

Facility

$54.00

Hospital Charge Code	270639055
Hospital Revenue Code	270
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$20.52
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.77
Rate for Payer: Cigna Commercial	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.20
Rate for Payer: Oxford Commercial	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$8.10
Rate for Payer: UnitedHealthcare Commercial	$10.80
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

DRESSING IODOSORB PAK

Facility

$54.00

Hospital Charge Code	270639055
Hospital Revenue Code	270
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

DRESSING IV TRANSP 6x8

Facility

$6.22

Hospital Charge Code	270650240
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$3.11
Rate for Payer: Aetna Commercial	$2.36
Rate for Payer: Aetna Medicare Advantage	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.59
Rate for Payer: Cigna Commercial	$3.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.87
Rate for Payer: Oxford Commercial	$1.24
Rate for Payer: Qualcare PPO/HMO/WC	$0.93
Rate for Payer: UnitedHealthcare Commercial	$1.24
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

DRESSING IV TRANSP 6x8

Facility

$6.22

Hospital Charge Code	270650240
Hospital Revenue Code	272
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$0.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.93

DRESSING JOBST 4 LAYER 4927

Facility

$54.60

Hospital Charge Code	270659789
Hospital Revenue Code	272
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$8.19
Rate for Payer: Qualcare PPO/HMO/WC	$8.19

DRESSING JOBST 4 LAYER 4927

Facility

$54.60

Hospital Charge Code	270659789
Hospital Revenue Code	272
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$27.30
Rate for Payer: Aetna Commercial	$20.75
Rate for Payer: Aetna Medicare Advantage	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.92
Rate for Payer: Cigna Commercial	$27.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.38
Rate for Payer: Oxford Commercial	$10.92
Rate for Payer: Qualcare PPO/HMO/WC	$8.19
Rate for Payer: UnitedHealthcare Commercial	$10.92
Rate for Payer: UnitedHealthcare Community & State	$1.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

DRESSING JUMP START

Facility

$95.00

Hospital Charge Code	270690016
Hospital Revenue Code	272
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$47.50
Rate for Payer: Aetna Commercial	$36.10
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.50
Rate for Payer: Oxford Commercial	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$19.00
Rate for Payer: UnitedHealthcare Community & State	$2.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.52

DRESSING JUMP START

Facility

$95.00

Hospital Charge Code	270690016
Hospital Revenue Code	272
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

Know your out-of-pocket cost for care.

All Charges