Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DRESSING TUBIGRIP DZ E 151434

Facility

$145.55

Hospital Charge Code	270639043
Hospital Revenue Code	272
Min. Negotiated Rate	$21.83
Max. Negotiated Rate	$21.83
Rate for Payer: Qualcare PPO/HMO/WC	$21.83

DRESSING TUBIGRIP DZ E 151434

Facility

$145.55

Hospital Charge Code	270639043
Hospital Revenue Code	272
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$72.78
Rate for Payer: Aetna Commercial	$55.31
Rate for Payer: Aetna Medicare Advantage	$43.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.12
Rate for Payer: Cigna Commercial	$72.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.66
Rate for Payer: Oxford Commercial	$29.11
Rate for Payer: Qualcare PPO/HMO/WC	$21.83
Rate for Payer: UnitedHealthcare Commercial	$29.11
Rate for Payer: UnitedHealthcare Community & State	$3.51
Rate for Payer: Wellpoint Medicaid Managed Care	$3.86

DRESSING TUBIGRIP SZ D 151437

Facility

$138.40

Hospital Charge Code	270639042
Hospital Revenue Code	272
Min. Negotiated Rate	$20.76
Max. Negotiated Rate	$20.76
Rate for Payer: Qualcare PPO/HMO/WC	$20.76

DRESSING TUBIGRIP SZ D 151437

Facility

$138.40

Hospital Charge Code	270639042
Hospital Revenue Code	272
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$69.20
Rate for Payer: Aetna Commercial	$52.59
Rate for Payer: Aetna Medicare Advantage	$41.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.29
Rate for Payer: Cigna Commercial	$69.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.52
Rate for Payer: Oxford Commercial	$27.68
Rate for Payer: Qualcare PPO/HMO/WC	$20.76
Rate for Payer: UnitedHealthcare Commercial	$27.68
Rate for Payer: UnitedHealthcare Community & State	$3.34
Rate for Payer: Wellpoint Medicaid Managed Care	$3.67

DRESSING TUBIGRIP SZ F 151438

Facility

$170.40

Hospital Charge Code	270639044
Hospital Revenue Code	272
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$85.20
Rate for Payer: Aetna Commercial	$64.75
Rate for Payer: Aetna Medicare Advantage	$51.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.45
Rate for Payer: Cigna Commercial	$85.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.12
Rate for Payer: Oxford Commercial	$34.08
Rate for Payer: Qualcare PPO/HMO/WC	$25.56
Rate for Payer: UnitedHealthcare Commercial	$34.08
Rate for Payer: UnitedHealthcare Community & State	$4.11
Rate for Payer: Wellpoint Medicaid Managed Care	$4.52

DRESSING TUBIGRIP SZ F 151438

Facility

$170.40

Hospital Charge Code	270639044
Hospital Revenue Code	272
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$25.56
Rate for Payer: Qualcare PPO/HMO/WC	$25.56

DRESSING TUBIGRIP SZ G 151439

Facility

$196.95

Hospital Charge Code	270639045
Hospital Revenue Code	272
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$98.47
Rate for Payer: Aetna Commercial	$74.84
Rate for Payer: Aetna Medicare Advantage	$59.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.22
Rate for Payer: Cigna Commercial	$98.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.09
Rate for Payer: Oxford Commercial	$39.39
Rate for Payer: Qualcare PPO/HMO/WC	$29.54
Rate for Payer: UnitedHealthcare Commercial	$39.39
Rate for Payer: UnitedHealthcare Community & State	$4.75
Rate for Payer: Wellpoint Medicaid Managed Care	$5.22

DRESSING TUBIGRIP SZ G 151439

Facility

$196.95

Hospital Charge Code	270639045
Hospital Revenue Code	272
Min. Negotiated Rate	$29.54
Max. Negotiated Rate	$29.54
Rate for Payer: Qualcare PPO/HMO/WC	$29.54

DRESSING WOUND DERMA GEL 3OZ

Facility

$24.68

Hospital Charge Code	270649160
Hospital Revenue Code	270
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$3.70
Rate for Payer: Qualcare PPO/HMO/WC	$3.70

DRESSING WOUND DERMA GEL 3OZ

Facility

$24.68

Hospital Charge Code	270649160
Hospital Revenue Code	270
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$12.34
Rate for Payer: Aetna Commercial	$9.38
Rate for Payer: Aetna Medicare Advantage	$7.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.29
Rate for Payer: Cigna Commercial	$12.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.40
Rate for Payer: Oxford Commercial	$4.94
Rate for Payer: Qualcare PPO/HMO/WC	$3.70
Rate for Payer: UnitedHealthcare Commercial	$4.94
Rate for Payer: UnitedHealthcare Community & State	$0.59
Rate for Payer: Wellpoint Medicaid Managed Care	$0.65

DRESSING WOUND NON-ADHESIVE 3X

Facility

$20.33

Hospital Charge Code	270659162
Hospital Revenue Code	270
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$10.16
Rate for Payer: Aetna Commercial	$7.73
Rate for Payer: Aetna Medicare Advantage	$6.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.18
Rate for Payer: Cigna Commercial	$10.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.10
Rate for Payer: Oxford Commercial	$4.07
Rate for Payer: Qualcare PPO/HMO/WC	$3.05
Rate for Payer: UnitedHealthcare Commercial	$4.07
Rate for Payer: UnitedHealthcare Community & State	$0.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.54

DRESSING WOUND NON-ADHESIVE 3X

Facility

$20.33

Hospital Charge Code	270659162
Hospital Revenue Code	270
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$3.05
Rate for Payer: Qualcare PPO/HMO/WC	$3.05

DRESSING WOUNDVAC SILVER LG

Facility

$403.06

Hospital Charge Code	270641667
Hospital Revenue Code	272
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$201.53
Rate for Payer: Aetna Commercial	$153.16
Rate for Payer: Aetna Medicare Advantage	$120.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.78
Rate for Payer: Cigna Commercial	$201.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.92
Rate for Payer: Oxford Commercial	$80.61
Rate for Payer: Qualcare PPO/HMO/WC	$60.46
Rate for Payer: UnitedHealthcare Commercial	$80.61
Rate for Payer: UnitedHealthcare Community & State	$9.71
Rate for Payer: Wellpoint Medicaid Managed Care	$10.68

DRESSING WOUNDVAC SILVER LG

Facility

$403.06

Hospital Charge Code	270641667
Hospital Revenue Code	272
Min. Negotiated Rate	$60.46
Max. Negotiated Rate	$60.46
Rate for Payer: Qualcare PPO/HMO/WC	$60.46

DRESSING XERFORM 1X8 OVRP

Facility

$2.32

Hospital Charge Code	270649934
Hospital Revenue Code	270
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.16
Rate for Payer: Aetna Commercial	$0.88
Rate for Payer: Aetna Medicare Advantage	$0.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.59
Rate for Payer: Cigna Commercial	$1.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.70
Rate for Payer: Oxford Commercial	$0.46
Rate for Payer: Qualcare PPO/HMO/WC	$0.35
Rate for Payer: UnitedHealthcare Commercial	$0.46
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

DRESSING XERFORM 1X8 OVRP

Facility

$2.32

Hospital Charge Code	270649934
Hospital Revenue Code	270
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Qualcare PPO/HMO/WC	$0.35

DRESSSING DERMA GEL HYRDO 4x4

Facility

$23.93

Hospital Charge Code	270646036
Hospital Revenue Code	272
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$3.59
Rate for Payer: Qualcare PPO/HMO/WC	$3.59

DRESSSING DERMA GEL HYRDO 4x4

Facility

$23.93

Hospital Charge Code	270646036
Hospital Revenue Code	272
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$11.96
Rate for Payer: Aetna Commercial	$9.09
Rate for Payer: Aetna Medicare Advantage	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.10
Rate for Payer: Cigna Commercial	$11.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.18
Rate for Payer: Oxford Commercial	$4.79
Rate for Payer: Qualcare PPO/HMO/WC	$3.59
Rate for Payer: UnitedHealthcare Commercial	$4.79
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.63

DRG XTRNL AUD CANAL ABSC

Facility

$653.03

Hospital Charge Code	5792240
Hospital Revenue Code	450
Min. Negotiated Rate	$17.31
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$248.15
Rate for Payer: Aetna Medicare Advantage	$195.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.52
Rate for Payer: Cigna Commercial	$326.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$850.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.95
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$17.31

DRG XTRNL AUD CANAL ABSC

Facility

$653.03

Hospital Charge Code	5792240
Hospital Revenue Code	450
Min. Negotiated Rate	$97.95
Max. Negotiated Rate	$97.95
Rate for Payer: Qualcare PPO/HMO/WC	$97.95

DRIAN DUET EXTERNAL

Facility

$2,092.50

Service Code	HCPCS C1729
Hospital Charge Code	270697602
Hospital Revenue Code	278
Min. Negotiated Rate	$50.43
Max. Negotiated Rate	$1,046.25
Rate for Payer: Aetna Commercial	$795.15
Rate for Payer: Aetna Medicare Advantage	$627.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$418.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.59
Rate for Payer: Cigna Commercial	$1,046.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$506.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$460.35
Rate for Payer: Qualcare PPO/HMO/WC	$313.88
Rate for Payer: UnitedHealthcare Community & State	$50.43
Rate for Payer: Wellpoint Medicaid Managed Care	$55.45

DRIAN DUET EXTERNAL

Facility

$2,092.50

Service Code	HCPCS C1729
Hospital Charge Code	270697602
Hospital Revenue Code	278
Min. Negotiated Rate	$313.88
Max. Negotiated Rate	$506.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$418.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$506.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$460.35
Rate for Payer: Qualcare PPO/HMO/WC	$313.88

DRIL, 1.5MM SUBCHONDRAL

Facility

$1,629.80

Hospital Charge Code	270642228
Hospital Revenue Code	272
Min. Negotiated Rate	$244.47
Max. Negotiated Rate	$244.47
Rate for Payer: Qualcare PPO/HMO/WC	$244.47

DRIL, 1.5MM SUBCHONDRAL

Facility

$1,629.80

Hospital Charge Code	270642228
Hospital Revenue Code	272
Min. Negotiated Rate	$39.28
Max. Negotiated Rate	$814.90
Rate for Payer: Aetna Commercial	$619.32
Rate for Payer: Aetna Medicare Advantage	$488.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$415.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$415.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$415.60
Rate for Payer: Cigna Commercial	$814.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$488.94
Rate for Payer: Oxford Commercial	$325.96
Rate for Payer: Qualcare PPO/HMO/WC	$244.47
Rate for Payer: UnitedHealthcare Commercial	$325.96
Rate for Payer: UnitedHealthcare Community & State	$39.28
Rate for Payer: Wellpoint Medicaid Managed Care	$43.19

DRIL BIT1.8m W/DEP MARK310.509

Facility

$650.00

Hospital Charge Code	270637244
Hospital Revenue Code	272
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Commercial	$130.00
Rate for Payer: UnitedHealthcare Community & State	$15.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.23

Know your out-of-pocket cost for care.

All Charges