Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DRSG REST ALGT 1X12 3158529969

Facility

$39.63

Hospital Charge Code	270641732W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$19.82
Rate for Payer: Aetna Commercial	$15.06
Rate for Payer: Aetna Medicare Advantage	$11.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.11
Rate for Payer: Cigna Commercial	$19.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.89
Rate for Payer: Oxford Commercial	$7.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.94
Rate for Payer: UnitedHealthcare Commercial	$7.93
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.05

DRSG REST CONT 6X8 3158509342

Facility

$168.50

Hospital Charge Code	270641731W
Hospital Revenue Code	272
Min. Negotiated Rate	$25.27
Max. Negotiated Rate	$25.27
Rate for Payer: Qualcare PPO/HMO/WC	$25.27

DRSG REST CONT 6X8 3158509342

Facility

$168.50

Hospital Charge Code	270641731W
Hospital Revenue Code	272
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$84.25
Rate for Payer: Aetna Commercial	$64.03
Rate for Payer: Aetna Medicare Advantage	$50.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.97
Rate for Payer: Cigna Commercial	$84.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.55
Rate for Payer: Oxford Commercial	$33.70
Rate for Payer: Qualcare PPO/HMO/WC	$25.27
Rate for Payer: UnitedHealthcare Commercial	$33.70
Rate for Payer: UnitedHealthcare Community & State	$4.06
Rate for Payer: Wellpoint Medicaid Managed Care	$4.47

DRSG SIL CON LYR4x5 3158509341

Facility

$42.97

Hospital Charge Code	270641730W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.48
Rate for Payer: Aetna Commercial	$16.33
Rate for Payer: Aetna Medicare Advantage	$12.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.89
Rate for Payer: Oxford Commercial	$8.59
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$8.59
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

DRSG SIL CON LYR4x5 3158509341

Facility

$42.97

Hospital Charge Code	270641730W
Hospital Revenue Code	272
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

DRSG SYS THREEFLEX MSC4300

Facility

$48.58

Service Code	HCPCS A6449
Hospital Charge Code	270639039
Hospital Revenue Code	272
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$24.29
Rate for Payer: Aetna Commercial	$18.46
Rate for Payer: Aetna Medicare Advantage	$14.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.39
Rate for Payer: Cigna Commercial	$24.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.57
Rate for Payer: Oxford Commercial	$9.72
Rate for Payer: Qualcare PPO/HMO/WC	$7.29
Rate for Payer: UnitedHealthcare Commercial	$9.72
Rate for Payer: UnitedHealthcare Community & State	$1.17
Rate for Payer: Wellpoint Medicaid Managed Care	$1.29

DRSG SYS THREEFLEX MSC4300

Facility

$48.58

Service Code	HCPCS A6449
Hospital Charge Code	270639039
Hospital Revenue Code	272
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$7.29
Rate for Payer: Qualcare PPO/HMO/WC	$7.29

DRSG TEGADRM FOAM SQ 2x2 90610

Facility

$12.24

Hospital Charge Code	270641295W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$1.84
Rate for Payer: Qualcare PPO/HMO/WC	$1.84

DRSG TEGADRM FOAM SQ 2x2 90610

Facility

$12.24

Hospital Charge Code	270641295W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.12
Rate for Payer: Aetna Commercial	$4.65
Rate for Payer: Aetna Medicare Advantage	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.12
Rate for Payer: Cigna Commercial	$6.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.67
Rate for Payer: Oxford Commercial	$2.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.84
Rate for Payer: UnitedHealthcare Commercial	$2.45
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

DRSG TEGADRM FOAM SQ 4x4 90612

Facility

$20.00

Hospital Charge Code	270641297W
Hospital Revenue Code	272
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

DRSG TEGADRM FOAM SQ 4x4 90612

Facility

$20.00

Hospital Charge Code	270641297W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare Advantage	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.10
Rate for Payer: Cigna Commercial	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.00
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$4.00
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

DRS HEEL GENT BORDER 668000506

Facility

$57.71

Hospital Charge Code	270665240
Hospital Revenue Code	271
Min. Negotiated Rate	$8.66
Max. Negotiated Rate	$8.66
Rate for Payer: Qualcare PPO/HMO/WC	$8.66

DRS HEEL GENT BORDER 668000506

Facility

$57.71

Hospital Charge Code	270665240
Hospital Revenue Code	271
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$28.86
Rate for Payer: Aetna Commercial	$21.93
Rate for Payer: Aetna Medicare Advantage	$17.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.72
Rate for Payer: Cigna Commercial	$28.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.31
Rate for Payer: Oxford Commercial	$11.54
Rate for Payer: Qualcare PPO/HMO/WC	$8.66
Rate for Payer: UnitedHealthcare Commercial	$11.54
Rate for Payer: UnitedHealthcare Community & State	$1.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.53

DRSING MEROGL NASAL 4x4 157002

Facility

$280.25

Hospital Charge Code	270622521
Hospital Revenue Code	272
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$140.12
Rate for Payer: Aetna Commercial	$106.50
Rate for Payer: Aetna Medicare Advantage	$84.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.46
Rate for Payer: Cigna Commercial	$140.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.08
Rate for Payer: Oxford Commercial	$56.05
Rate for Payer: Qualcare PPO/HMO/WC	$42.04
Rate for Payer: UnitedHealthcare Commercial	$56.05
Rate for Payer: UnitedHealthcare Community & State	$6.75
Rate for Payer: Wellpoint Medicaid Managed Care	$7.43

DRSING MEROGL NASAL 4x4 157002

Facility

$280.25

Hospital Charge Code	270622521
Hospital Revenue Code	272
Min. Negotiated Rate	$42.04
Max. Negotiated Rate	$42.04
Rate for Payer: Qualcare PPO/HMO/WC	$42.04

DRSNG ABSORB ACTOCOAT AG ROPE

Facility

$38.46

Hospital Charge Code	270650151
Hospital Revenue Code	270
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$19.23
Rate for Payer: Aetna Commercial	$14.61
Rate for Payer: Aetna Medicare Advantage	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.81
Rate for Payer: Cigna Commercial	$19.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.54
Rate for Payer: Oxford Commercial	$7.69
Rate for Payer: Qualcare PPO/HMO/WC	$5.77
Rate for Payer: UnitedHealthcare Commercial	$7.69
Rate for Payer: UnitedHealthcare Community & State	$0.93
Rate for Payer: Wellpoint Medicaid Managed Care	$1.02

DRSNG ABSORB ACTOCOAT AG ROPE

Facility

$38.46

Hospital Charge Code	270650151
Hospital Revenue Code	270
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$5.77
Rate for Payer: Qualcare PPO/HMO/WC	$5.77

DRUG ABUSE PANEL 9,SERUM VI

Facility

$499.75

Service Code	HCPCS 8010191
Hospital Charge Code	39990001F
Hospital Revenue Code	301
Min. Negotiated Rate	$74.96
Max. Negotiated Rate	$74.96
Rate for Payer: Qualcare PPO/HMO/WC	$74.96

DRUG ABUSE PANEL 9,SERUM VI

Facility

$499.75

Service Code	HCPCS 8010191
Hospital Charge Code	39990001F
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$249.88
Rate for Payer: Aetna Commercial	$189.91
Rate for Payer: Aetna Medicare Advantage	$149.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.44
Rate for Payer: Cigna Commercial	$249.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.93
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.96
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.04
Rate for Payer: Wellpoint Medicaid Managed Care	$13.24

DRUG ADMIN & HEMODYNMIC MEAS

Facility

$12,026.00

Service Code	HCPCS 93463
Hospital Charge Code	411093463
Hospital Revenue Code	481
Min. Negotiated Rate	$289.83
Max. Negotiated Rate	$6,600.00
Rate for Payer: Aetna Commercial	$4,569.88
Rate for Payer: Aetna Medicare Advantage	$3,607.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,066.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,066.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,066.63
Rate for Payer: Cigna Commercial	$6,013.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,803.90
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$289.83
Rate for Payer: Wellpoint Medicaid Managed Care	$318.69

DRUG ADMIN & HEMODYNMIC MEAS

Facility

$12,026.00

Service Code	HCPCS 93463
Hospital Charge Code	411093463
Hospital Revenue Code	481
Min. Negotiated Rate	$1,803.90
Max. Negotiated Rate	$1,803.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,803.90

DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE

Facility

$4,824.65

Service Code	APR-DRG 7702
Min. Negotiated Rate	$4,730.05
Max. Negotiated Rate	$4,824.65
Rate for Payer: UnitedHealthcare Community & State	$4,730.05
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,824.65
Rate for Payer: Wellpoint Medicaid Managed Care	$4,730.05

DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE

Facility

$3,227.50

Service Code	APR-DRG 7701
Min. Negotiated Rate	$3,164.22
Max. Negotiated Rate	$3,227.50
Rate for Payer: UnitedHealthcare Community & State	$3,164.22
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$3,227.50
Rate for Payer: Wellpoint Medicaid Managed Care	$3,164.22

DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE

Facility

$7,531.34

Service Code	APR-DRG 7703
Min. Negotiated Rate	$7,383.67
Max. Negotiated Rate	$7,531.34
Rate for Payer: UnitedHealthcare Community & State	$7,383.67
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,531.34
Rate for Payer: Wellpoint Medicaid Managed Care	$7,383.67

DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE

Facility

$16,175.94

Service Code	APR-DRG 7704
Min. Negotiated Rate	$15,858.76
Max. Negotiated Rate	$16,175.94
Rate for Payer: UnitedHealthcare Community & State	$15,858.76
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,175.94
Rate for Payer: Wellpoint Medicaid Managed Care	$15,858.76

Know your out-of-pocket cost for care.

All Charges