Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FLOSEAL HEMOSTATIC MATRIX 10ml

Facility

$1,541.68

Service Code	HCPCS C2615
Hospital Charge Code	270680120
Hospital Revenue Code	278
Min. Negotiated Rate	$37.15
Max. Negotiated Rate	$770.84
Rate for Payer: Aetna Commercial	$585.84
Rate for Payer: Aetna Medicare Advantage	$462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$393.13
Rate for Payer: Cigna Commercial	$770.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$339.17
Rate for Payer: Qualcare PPO/HMO/WC	$231.25
Rate for Payer: UnitedHealthcare Community & State	$37.15
Rate for Payer: Wellpoint Medicaid Managed Care	$40.85

FLOSEAL HEMOSTATIC MATRIX 10ml

Facility

$1,541.68

Service Code	HCPCS C2615
Hospital Charge Code	270659236
Hospital Revenue Code	278
Min. Negotiated Rate	$231.25
Max. Negotiated Rate	$373.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$339.17
Rate for Payer: Qualcare PPO/HMO/WC	$231.25

FLOSEAL HEMOSTATIC MATRIX 10ml

Facility

$1,541.68

Service Code	HCPCS C2615
Hospital Charge Code	270659236
Hospital Revenue Code	278
Min. Negotiated Rate	$37.15
Max. Negotiated Rate	$770.84
Rate for Payer: Aetna Commercial	$585.84
Rate for Payer: Aetna Medicare Advantage	$462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$393.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$393.13
Rate for Payer: Cigna Commercial	$770.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$339.17
Rate for Payer: Qualcare PPO/HMO/WC	$231.25
Rate for Payer: UnitedHealthcare Community & State	$37.15
Rate for Payer: Wellpoint Medicaid Managed Care	$40.85

FLOSEAL HEMOSTATIC MATRIX 10ML

Facility

$2,892.59

Service Code	NDC 9039605
Hospital Charge Code	6063943109
Hospital Revenue Code	250
Min. Negotiated Rate	$433.89
Max. Negotiated Rate	$433.89
Rate for Payer: Qualcare PPO/HMO/WC	$433.89

FLOSEAL HEMOSTATIC MATRIX 10ML

Facility

$2,892.59

Service Code	NDC 9039605
Hospital Charge Code	6063943109
Hospital Revenue Code	250
Min. Negotiated Rate	$69.71
Max. Negotiated Rate	$1,446.30
Rate for Payer: Aetna Commercial	$1,099.18
Rate for Payer: Aetna Medicare Advantage	$867.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$737.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$737.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$737.61
Rate for Payer: Cigna Commercial	$1,446.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$867.78
Rate for Payer: Oxford Commercial	$578.52
Rate for Payer: Qualcare PPO/HMO/WC	$433.89
Rate for Payer: UnitedHealthcare Commercial	$578.52
Rate for Payer: UnitedHealthcare Community & State	$69.71
Rate for Payer: Wellpoint Medicaid Managed Care	$76.65

FLOSEAL HEMOSTATIC MATRIX 5ml

Facility

$842.66

Hospital Charge Code	270626027
Hospital Revenue Code	272
Min. Negotiated Rate	$126.40
Max. Negotiated Rate	$126.40
Rate for Payer: Qualcare PPO/HMO/WC	$126.40

FLOSEAL HEMOSTATIC MATRIX 5ml

Facility

$842.66

Hospital Charge Code	270626027
Hospital Revenue Code	272
Min. Negotiated Rate	$20.31
Max. Negotiated Rate	$421.33
Rate for Payer: Aetna Commercial	$320.21
Rate for Payer: Aetna Medicare Advantage	$252.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.88
Rate for Payer: Cigna Commercial	$421.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.80
Rate for Payer: Oxford Commercial	$168.53
Rate for Payer: Qualcare PPO/HMO/WC	$126.40
Rate for Payer: UnitedHealthcare Commercial	$168.53
Rate for Payer: UnitedHealthcare Community & State	$20.31
Rate for Payer: Wellpoint Medicaid Managed Care	$22.33

FLO-SEAL SEALANT

Facility

$280.00

Hospital Charge Code	270335689
Hospital Revenue Code	278
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$67.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.60
Rate for Payer: Qualcare PPO/HMO/WC	$42.00

FLO-SEAL SEALANT

Facility

$280.00

Hospital Charge Code	270335689
Hospital Revenue Code	278
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$140.00
Rate for Payer: Aetna Commercial	$106.40
Rate for Payer: Aetna Medicare Advantage	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.40
Rate for Payer: Cigna Commercial	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.60
Rate for Payer: Qualcare PPO/HMO/WC	$42.00
Rate for Payer: UnitedHealthcare Community & State	$6.75
Rate for Payer: Wellpoint Medicaid Managed Care	$7.42

FLO SWITCH

Facility

$22.56

Hospital Charge Code	270621573
Hospital Revenue Code	272
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.28
Rate for Payer: Aetna Commercial	$8.57
Rate for Payer: Aetna Medicare Advantage	$6.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.75
Rate for Payer: Cigna Commercial	$11.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.77
Rate for Payer: Oxford Commercial	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.51
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

FLO SWITCH

Facility

$22.56

Hospital Charge Code	270621573
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

FLO SWITCH HP

Facility

$22.56

Hospital Charge Code	270623272
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

FLO SWITCH HP

Facility

$22.56

Hospital Charge Code	270623272S
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

FLO SWITCH HP

Facility

$29.38

Hospital Charge Code	270623272N
Hospital Revenue Code	272
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$4.41
Rate for Payer: Qualcare PPO/HMO/WC	$4.41

FLO SWITCH HP

Facility

$22.56

Hospital Charge Code	270623272S
Hospital Revenue Code	272
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.28
Rate for Payer: Aetna Commercial	$8.57
Rate for Payer: Aetna Medicare Advantage	$6.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.75
Rate for Payer: Cigna Commercial	$11.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.77
Rate for Payer: Oxford Commercial	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.51
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

FLO SWITCH HP

Facility

$29.38

Hospital Charge Code	270623272N
Hospital Revenue Code	272
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$14.69
Rate for Payer: Aetna Commercial	$11.16
Rate for Payer: Aetna Medicare Advantage	$8.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.49
Rate for Payer: Cigna Commercial	$14.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.81
Rate for Payer: Oxford Commercial	$5.88
Rate for Payer: Qualcare PPO/HMO/WC	$4.41
Rate for Payer: UnitedHealthcare Commercial	$5.88
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

FLO SWITCH HP

Facility

$22.56

Hospital Charge Code	270623272
Hospital Revenue Code	272
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.28
Rate for Payer: Aetna Commercial	$8.57
Rate for Payer: Aetna Medicare Advantage	$6.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.75
Rate for Payer: Cigna Commercial	$11.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.77
Rate for Payer: Oxford Commercial	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.51
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

FLOSWITCH HP

Facility

$76.00

Hospital Charge Code	2008100
Hospital Revenue Code	272
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$38.00
Rate for Payer: Aetna Commercial	$28.88
Rate for Payer: Aetna Medicare Advantage	$22.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.38
Rate for Payer: Cigna Commercial	$38.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.80
Rate for Payer: Oxford Commercial	$15.20
Rate for Payer: Qualcare PPO/HMO/WC	$11.40
Rate for Payer: UnitedHealthcare Commercial	$15.20
Rate for Payer: UnitedHealthcare Community & State	$1.83
Rate for Payer: Wellpoint Medicaid Managed Care	$2.01

FLOSWITCH HP

Facility

$76.00

Hospital Charge Code	2008100
Hospital Revenue Code	272
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$11.40
Rate for Payer: Qualcare PPO/HMO/WC	$11.40

FLOTRAC SENSOR 84(213CM)

Facility

$1,802.50

Hospital Charge Code	270664027
Hospital Revenue Code	272
Min. Negotiated Rate	$270.38
Max. Negotiated Rate	$270.38
Rate for Payer: Qualcare PPO/HMO/WC	$270.38

FLOTRAC SENSOR 84(213CM)

Facility

$1,802.50

Hospital Charge Code	270664027
Hospital Revenue Code	272
Min. Negotiated Rate	$43.44
Max. Negotiated Rate	$901.25
Rate for Payer: Aetna Commercial	$684.95
Rate for Payer: Aetna Medicare Advantage	$540.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.64
Rate for Payer: Cigna Commercial	$901.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$540.75
Rate for Payer: Oxford Commercial	$360.50
Rate for Payer: Qualcare PPO/HMO/WC	$270.38
Rate for Payer: UnitedHealthcare Commercial	$360.50
Rate for Payer: UnitedHealthcare Community & State	$43.44
Rate for Payer: Wellpoint Medicaid Managed Care	$47.77

FLOURESCENT TREPONEMAL AB

Facility

$390.00

Service Code	HCPCS 86780
Hospital Charge Code	3001351
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FLOURESCENT TREPONEMAL AB

Facility

$390.00

Service Code	HCPCS 86780
Hospital Charge Code	3001351
Hospital Revenue Code	302
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$36.01
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.79
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.24
Rate for Payer: Clover Medicare Advantage	$12.58
Rate for Payer: EmblemHealth Commercial	$39.72
Rate for Payer: Humana Medicare Advantage	$13.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.24
Rate for Payer: Wellcare Medicare Advantage	$13.24
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

FLOUR,NON INF.AB SCREEN(1)

Facility

$225.00

Service Code	HCPCS 86255
Hospital Charge Code	38476257
Hospital Revenue Code	302
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.50
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

FLOUR,NON INF.AB SCREEN(1)

Facility

$225.00

Service Code	HCPCS 86255
Hospital Charge Code	38476257
Hospital Revenue Code	302
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

Know your out-of-pocket cost for care.

All Charges