Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GAUZE SPONGE 4X8 12-PLY STRL

Facility

$12.10

Hospital Charge Code	270655984
Hospital Revenue Code	271
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.05
Rate for Payer: Aetna Commercial	$4.60
Rate for Payer: Aetna Medicare Advantage	$3.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.09
Rate for Payer: Cigna Commercial	$6.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.63
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

GAUZE SPONGE 4X8 12-PLY STRL

Facility

$12.10

Hospital Charge Code	270655984
Hospital Revenue Code	271
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$1.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.81

GAUZE VASELINE 1/2/72

Facility

$13.65

Hospital Charge Code	270300995
Hospital Revenue Code	272
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.09
Rate for Payer: Oxford Commercial	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$2.73
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

GAUZE VASELINE 1/2/72

Facility

$13.65

Hospital Charge Code	270300995
Hospital Revenue Code	272
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

GAUZE VASELINE 3/1

Facility

$9.65

Hospital Charge Code	270301000
Hospital Revenue Code	272
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

GAUZE VASELINE 3/1

Facility

$9.65

Hospital Charge Code	270301000
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

GAUZE VASELINE STERILE 1X72

Facility

$2.47

Hospital Charge Code	270649714
Hospital Revenue Code	270
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

GAUZE VASELINE STERILE 1X72

Facility

$2.47

Hospital Charge Code	270649714
Hospital Revenue Code	270
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.24
Rate for Payer: Aetna Commercial	$0.94
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.63
Rate for Payer: Cigna Commercial	$1.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.74
Rate for Payer: Oxford Commercial	$0.49
Rate for Payer: Qualcare PPO/HMO/WC	$0.37
Rate for Payer: UnitedHealthcare Commercial	$0.49
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.07

GAUZE VASELINE STRIP *******

Facility

$20.00

Hospital Charge Code	8002156
Hospital Revenue Code	279
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

GAUZE VASELINE STRIP *******

Facility

$20.00

Hospital Charge Code	8002156
Hospital Revenue Code	279
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

GAUZE VASELINE STR WRAP 1/2X72

Facility

$3.90

Hospital Charge Code	270649205
Hospital Revenue Code	270
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.95
Rate for Payer: Aetna Commercial	$1.48
Rate for Payer: Aetna Medicare Advantage	$1.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.99
Rate for Payer: Cigna Commercial	$1.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$0.78
Rate for Payer: Qualcare PPO/HMO/WC	$0.59
Rate for Payer: UnitedHealthcare Commercial	$0.78
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.10

GAUZE VASELINE STR WRAP 1/2X72

Facility

$3.90

Hospital Charge Code	270649205
Hospital Revenue Code	270
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.59
Rate for Payer: Qualcare PPO/HMO/WC	$0.59

GAUZE VASELINE STR WRAP 1X8

Facility

$1.74

Hospital Charge Code	270649204
Hospital Revenue Code	270
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Qualcare PPO/HMO/WC	$0.26

GAUZE VASELINE STR WRAP 1X8

Facility

$1.74

Hospital Charge Code	270649204
Hospital Revenue Code	270
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.87
Rate for Payer: Aetna Commercial	$0.66
Rate for Payer: Aetna Medicare Advantage	$0.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.44
Rate for Payer: Cigna Commercial	$0.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$0.35
Rate for Payer: Qualcare PPO/HMO/WC	$0.26
Rate for Payer: UnitedHealthcare Commercial	$0.35
Rate for Payer: UnitedHealthcare Community & State	$0.04
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

GAUZE VERSALON 2x2 GAUZE

Facility

$5.00

Hospital Charge Code	270350115
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

GAUZE VERSALON 2x2 GAUZE

Facility

$5.00

Hospital Charge Code	270350115
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

GAUZE VERSALON 4x4 GAUZE

Facility

$5.00

Hospital Charge Code	270350120
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

GAUZE VERSALON 4x4 GAUZE

Facility

$5.00

Hospital Charge Code	270350120
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

GAUZE XEROFORM 5X9

Facility

$5.00

Hospital Charge Code	270301010
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

GAUZE XEROFORM 5X9

Facility

$5.00

Hospital Charge Code	270301010
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

GAUZE XEROFORM 5X9 *******

Facility

$23.00

Hospital Charge Code	8002180
Hospital Revenue Code	279
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$11.50
Rate for Payer: Aetna Commercial	$8.74
Rate for Payer: Aetna Medicare Advantage	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.87
Rate for Payer: Cigna Commercial	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$4.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.45
Rate for Payer: UnitedHealthcare Commercial	$4.60
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

GAUZE XEROFORM 5X9 *******

Facility

$23.00

Hospital Charge Code	8002180
Hospital Revenue Code	279
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

GAVISCON-2/TAB

Facility

$3.00

Hospital Charge Code	60633037
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

GAVISCON-2/TAB

Facility

$3.00

Hospital Charge Code	60633037
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

GAVISCON/360ML

Facility

$38.00

Hospital Charge Code	60633035
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

Know your out-of-pocket cost for care.

All Charges