Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FOAM DBM SM STRIP 15x15x8MM

Facility

$1,575.00

Hospital Charge Code	270671262
Hospital Revenue Code	278
Min. Negotiated Rate	$236.25
Max. Negotiated Rate	$381.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$346.50
Rate for Payer: Qualcare PPO/HMO/WC	$236.25

FOAM DRESSING DISC 4 IN

Facility

$7.74

Hospital Charge Code	270689724
Hospital Revenue Code	272
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

FOAM DRESSING DISC 4 IN

Facility

$7.74

Hospital Charge Code	270689724
Hospital Revenue Code	272
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.87
Rate for Payer: Aetna Commercial	$2.94
Rate for Payer: Aetna Medicare Advantage	$2.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.97
Rate for Payer: Cigna Commercial	$3.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.32
Rate for Payer: Oxford Commercial	$1.55
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.55
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

FOAM FINGER SPLINT 1 X 18

Facility

$33.00

Hospital Charge Code	270331640
Hospital Revenue Code	270
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$12.54
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.90
Rate for Payer: Oxford Commercial	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$6.60
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

FOAM FINGER SPLINT 1 X 18

Facility

$33.00

Hospital Charge Code	270331640
Hospital Revenue Code	270
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

FOAM GRAY SHEET 1/2 3'X6

Facility

$84.40

Hospital Charge Code	270636435
Hospital Revenue Code	271
Min. Negotiated Rate	$12.66
Max. Negotiated Rate	$12.66
Rate for Payer: Qualcare PPO/HMO/WC	$12.66

FOAM GRAY SHEET 1/2 3'X6

Facility

$84.40

Hospital Charge Code	270636435
Hospital Revenue Code	271
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$42.20
Rate for Payer: Aetna Commercial	$32.07
Rate for Payer: Aetna Medicare Advantage	$25.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.52
Rate for Payer: Cigna Commercial	$42.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.32
Rate for Payer: Oxford Commercial	$16.88
Rate for Payer: Qualcare PPO/HMO/WC	$12.66
Rate for Payer: UnitedHealthcare Commercial	$16.88
Rate for Payer: UnitedHealthcare Community & State	$2.03
Rate for Payer: Wellpoint Medicaid Managed Care	$2.24

FOAM GRAY SHEET 1/4 3'X6

Facility

$44.70

Hospital Charge Code	270636434
Hospital Revenue Code	271
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$22.35
Rate for Payer: Aetna Commercial	$16.99
Rate for Payer: Aetna Medicare Advantage	$13.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.40
Rate for Payer: Cigna Commercial	$22.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.41
Rate for Payer: Oxford Commercial	$8.94
Rate for Payer: Qualcare PPO/HMO/WC	$6.71
Rate for Payer: UnitedHealthcare Commercial	$8.94
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1.18

FOAM GRAY SHEET 1/4 3'X6

Facility

$44.70

Hospital Charge Code	270636434
Hospital Revenue Code	271
Min. Negotiated Rate	$6.71
Max. Negotiated Rate	$6.71
Rate for Payer: Qualcare PPO/HMO/WC	$6.71

FOAM SELF AD 3/16 4x196 M1563L

Facility

$42.08

Hospital Charge Code	270640897W
Hospital Revenue Code	272
Min. Negotiated Rate	$6.31
Max. Negotiated Rate	$6.31
Rate for Payer: Qualcare PPO/HMO/WC	$6.31

FOAM SELF AD 3/16 4x196 M1563L

Facility

$42.08

Hospital Charge Code	270640897W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$21.04
Rate for Payer: Aetna Commercial	$15.99
Rate for Payer: Aetna Medicare Advantage	$12.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.73
Rate for Payer: Cigna Commercial	$21.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.62
Rate for Payer: Oxford Commercial	$8.42
Rate for Payer: Qualcare PPO/HMO/WC	$6.31
Rate for Payer: UnitedHealthcare Commercial	$8.42
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

FOAM SOFT, COLLAR CERVICAL

Facility

$18.05

Hospital Charge Code	270658928
Hospital Revenue Code	270
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$2.71
Rate for Payer: Qualcare PPO/HMO/WC	$2.71

FOAM SOFT, COLLAR CERVICAL

Facility

$18.05

Hospital Charge Code	270658928
Hospital Revenue Code	270
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$9.03
Rate for Payer: Aetna Commercial	$6.86
Rate for Payer: Aetna Medicare Advantage	$5.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.60
Rate for Payer: Cigna Commercial	$9.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.42
Rate for Payer: Oxford Commercial	$3.61
Rate for Payer: Qualcare PPO/HMO/WC	$2.71
Rate for Payer: UnitedHealthcare Commercial	$3.61
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

FOAM VITOSS BA2X 5CC

Facility

$10,674.30

Service Code	HCPCS C1713
Hospital Charge Code	270667773
Hospital Revenue Code	278
Min. Negotiated Rate	$257.25
Max. Negotiated Rate	$5,337.15
Rate for Payer: Aetna Commercial	$4,056.23
Rate for Payer: Aetna Medicare Advantage	$3,202.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,721.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,721.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,134.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,721.95
Rate for Payer: Cigna Commercial	$5,337.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,348.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.14
Rate for Payer: UnitedHealthcare Community & State	$257.25
Rate for Payer: Wellpoint Medicaid Managed Care	$282.87

FOAM VITOSS BA2X 5CC

Facility

$10,674.30

Service Code	HCPCS C1713
Hospital Charge Code	270667773
Hospital Revenue Code	278
Min. Negotiated Rate	$1,601.14
Max. Negotiated Rate	$2,583.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,134.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,348.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.14

FOGARTY ART EMBO CATH 3FR 80CM

Facility

$308.00

Hospital Charge Code	270330913
Hospital Revenue Code	278
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$154.00
Rate for Payer: Aetna Commercial	$117.04
Rate for Payer: Aetna Medicare Advantage	$92.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.54
Rate for Payer: Cigna Commercial	$154.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$67.76
Rate for Payer: Qualcare PPO/HMO/WC	$46.20
Rate for Payer: UnitedHealthcare Community & State	$7.42
Rate for Payer: Wellpoint Medicaid Managed Care	$8.16

FOGARTY ART EMBO CATH 3FR 80CM

Facility

$308.00

Hospital Charge Code	270330913
Hospital Revenue Code	278
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$74.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.54
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$67.76
Rate for Payer: Qualcare PPO/HMO/WC	$46.20

FOGARTY ART EMBO CATH 4FR/80CM

Facility

$305.00

Hospital Charge Code	270330919
Hospital Revenue Code	278
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$152.50
Rate for Payer: Aetna Commercial	$115.90
Rate for Payer: Aetna Medicare Advantage	$91.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.78
Rate for Payer: Cigna Commercial	$152.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$67.10
Rate for Payer: Qualcare PPO/HMO/WC	$45.75
Rate for Payer: UnitedHealthcare Community & State	$7.35
Rate for Payer: Wellpoint Medicaid Managed Care	$8.08

FOGARTY ART EMBO CATH 4FR/80CM

Facility

$305.00

Hospital Charge Code	270330919
Hospital Revenue Code	278
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$73.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.81
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$67.10
Rate for Payer: Qualcare PPO/HMO/WC	$45.75

FOGARTYART IRRI CATH 4FR 80CM

Facility

$138.00

Hospital Charge Code	270330914
Hospital Revenue Code	278
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$33.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.36
Rate for Payer: Qualcare PPO/HMO/WC	$20.70

FOGARTYART IRRI CATH 4FR 80CM

Facility

$138.00

Hospital Charge Code	270330914
Hospital Revenue Code	278
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$69.00
Rate for Payer: Aetna Commercial	$52.44
Rate for Payer: Aetna Medicare Advantage	$41.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.19
Rate for Payer: Cigna Commercial	$69.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.36
Rate for Payer: Qualcare PPO/HMO/WC	$20.70
Rate for Payer: UnitedHealthcare Community & State	$3.33
Rate for Payer: Wellpoint Medicaid Managed Care	$3.66

FOGARTY BILIARY BALLOON CATH.

Facility

$296.00

Hospital Charge Code	270330809
Hospital Revenue Code	278
Min. Negotiated Rate	$7.13
Max. Negotiated Rate	$148.00
Rate for Payer: Aetna Commercial	$112.48
Rate for Payer: Aetna Medicare Advantage	$88.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.48
Rate for Payer: Cigna Commercial	$148.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$65.12
Rate for Payer: Qualcare PPO/HMO/WC	$44.40
Rate for Payer: UnitedHealthcare Community & State	$7.13
Rate for Payer: Wellpoint Medicaid Managed Care	$7.84

FOGARTY BILIARY BALLOON CATH.

Facility

$296.00

Hospital Charge Code	270330809
Hospital Revenue Code	278
Min. Negotiated Rate	$44.40
Max. Negotiated Rate	$71.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$65.12
Rate for Payer: Qualcare PPO/HMO/WC	$44.40

FOG-OUT SOLUTION/KENDALL

Facility

$12.08

Hospital Charge Code	270655926
Hospital Revenue Code	270
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.04
Rate for Payer: Aetna Commercial	$4.59
Rate for Payer: Aetna Medicare Advantage	$3.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.08
Rate for Payer: Cigna Commercial	$6.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.62
Rate for Payer: Oxford Commercial	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$1.81
Rate for Payer: UnitedHealthcare Commercial	$2.42
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

FOG-OUT SOLUTION/KENDALL

Facility

$12.08

Hospital Charge Code	270655926
Hospital Revenue Code	270
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$1.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.81

Know your out-of-pocket cost for care.

All Charges