Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DRSG ACRYL CL ABSORB 450909807

Facility

$46.00

Hospital Charge Code	270641453W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$23.00
Rate for Payer: Aetna Commercial	$17.48
Rate for Payer: Aetna Medicare Advantage	$13.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.73
Rate for Payer: Cigna Commercial	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.80
Rate for Payer: Oxford Commercial	$9.20
Rate for Payer: Qualcare PPO/HMO/WC	$6.90
Rate for Payer: UnitedHealthcare Commercial	$9.20
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

DRSG ACRYL CL ABSORB 450909807

Facility

$46.00

Hospital Charge Code	270641453W
Hospital Revenue Code	272
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.90

DRSG ALLEVYN NON ADH 66927637

Facility

$16.75

Hospital Charge Code	270632166
Hospital Revenue Code	272
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$2.51
Rate for Payer: Qualcare PPO/HMO/WC	$2.51

DRSG ALLEVYN NON ADH 66927637

Facility

$16.75

Hospital Charge Code	270632166
Hospital Revenue Code	272
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$8.38
Rate for Payer: Aetna Commercial	$6.37
Rate for Payer: Aetna Medicare Advantage	$5.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.27
Rate for Payer: Cigna Commercial	$8.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.03
Rate for Payer: Oxford Commercial	$3.35
Rate for Payer: Qualcare PPO/HMO/WC	$2.51
Rate for Payer: UnitedHealthcare Commercial	$3.35
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

DRSG DUODERM EXTRA THIN 187955

Facility

$9.39

Hospital Charge Code	270350289
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.70
Rate for Payer: Aetna Commercial	$3.57
Rate for Payer: Aetna Medicare Advantage	$2.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.39
Rate for Payer: Cigna Commercial	$4.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.82
Rate for Payer: Oxford Commercial	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.41
Rate for Payer: UnitedHealthcare Commercial	$1.88
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

DRSG DUODERM EXTRA THIN 187955

Facility

$9.39

Hospital Charge Code	270350289
Hospital Revenue Code	272
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.41
Rate for Payer: Qualcare PPO/HMO/WC	$1.41

DRSG EXUDERM 4X4

Facility

$10.00

Hospital Charge Code	270350289W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

DRSG EXUDERM 4X4

Facility

$10.00

Hospital Charge Code	270350289W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.80
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.00
Rate for Payer: Oxford Commercial	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Commercial	$2.00
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

DRSG FOAM OVAL HEEL 3x3 90619

Facility

$23.20

Hospital Charge Code	270641300W
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

DRSG FOAM OVAL HEEL 3x3 90619

Facility

$23.20

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

DRSG MATRIX WOUND 2x2CM/SQCMJW

Facility

$2,605.90

Hospital Charge Code	270636500W
Hospital Revenue Code	636
Min. Negotiated Rate	$62.80
Max. Negotiated Rate	$1,302.95
Rate for Payer: Aetna Commercial	$990.24
Rate for Payer: Aetna Medicare Advantage	$781.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$664.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$664.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$664.50
Rate for Payer: Cigna Commercial	$1,302.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$630.63
Rate for Payer: Qualcare PPO/HMO/WC	$390.88
Rate for Payer: UnitedHealthcare Community & State	$62.80
Rate for Payer: Wellpoint Medicaid Managed Care	$69.06

DRSG MATRIX WOUND 2x2CM/SQCMJW

Facility

$2,605.90

Hospital Charge Code	270636500W
Hospital Revenue Code	636
Min. Negotiated Rate	$390.88
Max. Negotiated Rate	$630.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$630.63
Rate for Payer: Qualcare PPO/HMO/WC	$390.88

DRSG MATRIX WOUND 2x2IN

Facility

$7,290.00

Service Code	HCPCS Q4108
Hospital Charge Code	270636500
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,764.18
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	$1,458.00
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	$1,764.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,603.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,093.50
Rate for Payer: UnitedHealthcare Community & State	$175.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$193.19

DRSG MATRIX WOUND 2x2IN

Facility

$7,290.00

Service Code	HCPCS Q4108
Hospital Charge Code	270636500
Hospital Revenue Code	278
Min. Negotiated Rate	$1,093.50
Max. Negotiated Rate	$1,764.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,458.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,603.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,093.50

DRSG OAS MATX 3.7 306813100037

Facility

$401.00

Hospital Charge Code	270641695W
Hospital Revenue Code	272
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$200.50
Rate for Payer: Aetna Commercial	$152.38
Rate for Payer: Aetna Medicare Advantage	$120.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.25
Rate for Payer: Cigna Commercial	$200.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.30
Rate for Payer: Oxford Commercial	$80.20
Rate for Payer: Qualcare PPO/HMO/WC	$60.15
Rate for Payer: UnitedHealthcare Commercial	$80.20
Rate for Payer: UnitedHealthcare Community & State	$9.66
Rate for Payer: Wellpoint Medicaid Managed Care	$10.63

DRSG OAS MATX 3.7 306813100037

Facility

$401.00

Hospital Charge Code	270641695W
Hospital Revenue Code	272
Min. Negotiated Rate	$60.15
Max. Negotiated Rate	$60.15
Rate for Payer: Qualcare PPO/HMO/WC	$60.15

DRSG OAS WOD 3x3.5 30681310033

Facility

$401.00

Hospital Charge Code	270641694W
Hospital Revenue Code	272
Min. Negotiated Rate	$60.15
Max. Negotiated Rate	$60.15
Rate for Payer: Qualcare PPO/HMO/WC	$60.15

DRSG OAS WOD 3x3.5 30681310033

Facility

$401.00

Hospital Charge Code	270641694
Hospital Revenue Code	272
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$200.50
Rate for Payer: Aetna Commercial	$152.38
Rate for Payer: Aetna Medicare Advantage	$120.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.25
Rate for Payer: Cigna Commercial	$200.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.30
Rate for Payer: Oxford Commercial	$80.20
Rate for Payer: Qualcare PPO/HMO/WC	$60.15
Rate for Payer: UnitedHealthcare Commercial	$80.20
Rate for Payer: UnitedHealthcare Community & State	$9.66
Rate for Payer: Wellpoint Medicaid Managed Care	$10.63

DRSG OAS WOD 3x3.5 30681310033

Facility

$401.00

Hospital Charge Code	270641694W
Hospital Revenue Code	272
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$200.50
Rate for Payer: Aetna Commercial	$152.38
Rate for Payer: Aetna Medicare Advantage	$120.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.25
Rate for Payer: Cigna Commercial	$200.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.30
Rate for Payer: Oxford Commercial	$80.20
Rate for Payer: Qualcare PPO/HMO/WC	$60.15
Rate for Payer: UnitedHealthcare Commercial	$80.20
Rate for Payer: UnitedHealthcare Community & State	$9.66
Rate for Payer: Wellpoint Medicaid Managed Care	$10.63

DRSG OAS WOD 3x3.5 30681310033

Facility

$401.00

Hospital Charge Code	270641694
Hospital Revenue Code	272
Min. Negotiated Rate	$60.15
Max. Negotiated Rate	$60.15
Rate for Payer: Qualcare PPO/HMO/WC	$60.15

DRSG OD ABOSOB 4X43 3158519904

Facility

$15.67

Hospital Charge Code	270641733W
Hospital Revenue Code	272
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$2.35

DRSG OD ABOSOB 4X43 3158519904

Facility

$15.67

Hospital Charge Code	270641733W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$7.83
Rate for Payer: Aetna Commercial	$5.95
Rate for Payer: Aetna Medicare Advantage	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.00
Rate for Payer: Cigna Commercial	$7.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.70
Rate for Payer: Oxford Commercial	$3.13
Rate for Payer: Qualcare PPO/HMO/WC	$2.35
Rate for Payer: UnitedHealthcare Commercial	$3.13
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

DRSG OPTIFOAM OVAL 6X5.6

Facility

$35.92

Hospital Charge Code	270641299W
Hospital Revenue Code	272
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$5.39
Rate for Payer: Qualcare PPO/HMO/WC	$5.39

DRSG OPTIFOAM OVAL 6X5.6

Facility

$35.92

Hospital Charge Code	270641299W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$17.96
Rate for Payer: Aetna Commercial	$13.65
Rate for Payer: Aetna Medicare Advantage	$10.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.16
Rate for Payer: Cigna Commercial	$17.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.78
Rate for Payer: Oxford Commercial	$7.18
Rate for Payer: Qualcare PPO/HMO/WC	$5.39
Rate for Payer: UnitedHealthcare Commercial	$7.18
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

DRSG REST ALGT 1X12 3158529969

Facility

$39.63

Hospital Charge Code	270641732W
Hospital Revenue Code	272
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$5.94
Rate for Payer: Qualcare PPO/HMO/WC	$5.94

Know your out-of-pocket cost for care.

All Charges