Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GELATIN SPONGE 1 SPG SPG

Facility

$334.93

Service Code	NDC 9034201
Hospital Charge Code	60627525
Hospital Revenue Code	250
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$167.47
Rate for Payer: Aetna Commercial	$127.27
Rate for Payer: Aetna Medicare Advantage	$100.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.41
Rate for Payer: Cigna Commercial	$167.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.48
Rate for Payer: Oxford Commercial	$66.99
Rate for Payer: Qualcare PPO/HMO/WC	$50.24
Rate for Payer: UnitedHealthcare Commercial	$66.99
Rate for Payer: UnitedHealthcare Community & State	$8.07
Rate for Payer: Wellpoint Medicaid Managed Care	$8.88

GELATIN SPONGE 1 SPG SPG

Facility

$334.93

Service Code	NDC 9034201
Hospital Charge Code	60627525
Hospital Revenue Code	250
Min. Negotiated Rate	$50.24
Max. Negotiated Rate	$50.24
Rate for Payer: Qualcare PPO/HMO/WC	$50.24

GELATIN SURGIFLO HEMO 8ML

Facility

$910.00

Service Code	HCPCS C1765
Hospital Charge Code	270688738
Hospital Revenue Code	278
Min. Negotiated Rate	$21.93
Max. Negotiated Rate	$455.00
Rate for Payer: Aetna Commercial	$345.80
Rate for Payer: Aetna Medicare Advantage	$273.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$182.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.05
Rate for Payer: Cigna Commercial	$455.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$200.20
Rate for Payer: Qualcare PPO/HMO/WC	$136.50
Rate for Payer: UnitedHealthcare Community & State	$21.93
Rate for Payer: Wellpoint Medicaid Managed Care	$24.11

GELATIN SURGIFLO HEMO 8ML

Facility

$910.00

Service Code	HCPCS C1765
Hospital Charge Code	270688738
Hospital Revenue Code	278
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$220.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$182.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.22
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$200.20
Rate for Payer: Qualcare PPO/HMO/WC	$136.50

GEL CONDUCTIVITY 8OZ

Facility

$11.64

Hospital Charge Code	270649207
Hospital Revenue Code	270
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$1.75
Rate for Payer: Qualcare PPO/HMO/WC	$1.75

GEL CONDUCTIVITY 8OZ

Facility

$11.64

Hospital Charge Code	270649207
Hospital Revenue Code	270
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$5.82
Rate for Payer: Aetna Commercial	$4.42
Rate for Payer: Aetna Medicare Advantage	$3.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.97
Rate for Payer: Cigna Commercial	$5.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.49
Rate for Payer: Oxford Commercial	$2.33
Rate for Payer: Qualcare PPO/HMO/WC	$1.75
Rate for Payer: UnitedHealthcare Commercial	$2.33
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

GEL DIFFUSION QUALITATITIVE

Facility

$100.00

Service Code	HCPCS 86331
Hospital Charge Code	3009636B
Hospital Revenue Code	302
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

GEL DIFFUSION QUALITATITIVE

Facility

$100.00

Service Code	HCPCS 86331
Hospital Charge Code	3009636B
Hospital Revenue Code	302
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

GELFILM 100 X 125MM

Facility

$195.85

Hospital Charge Code	6006746
Hospital Revenue Code	250
Min. Negotiated Rate	$29.38
Max. Negotiated Rate	$29.38
Rate for Payer: Qualcare PPO/HMO/WC	$29.38

GELFILM 100 X 125MM

Facility

$195.85

Hospital Charge Code	6006746
Hospital Revenue Code	250
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$97.92
Rate for Payer: Aetna Commercial	$74.42
Rate for Payer: Aetna Medicare Advantage	$58.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.94
Rate for Payer: Cigna Commercial	$97.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.76
Rate for Payer: Oxford Commercial	$39.17
Rate for Payer: Qualcare PPO/HMO/WC	$29.38
Rate for Payer: UnitedHealthcare Commercial	$39.17
Rate for Payer: UnitedHealthcare Community & State	$4.72
Rate for Payer: Wellpoint Medicaid Managed Care	$5.19

GELFILM ABSORBABLE FILM 1X2 IN

Facility

$111.45

Hospital Charge Code	60629320
Hospital Revenue Code	270
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$55.73
Rate for Payer: Aetna Commercial	$42.35
Rate for Payer: Aetna Medicare Advantage	$33.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.42
Rate for Payer: Cigna Commercial	$55.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.44
Rate for Payer: Oxford Commercial	$22.29
Rate for Payer: Qualcare PPO/HMO/WC	$16.72
Rate for Payer: UnitedHealthcare Commercial	$22.29
Rate for Payer: UnitedHealthcare Community & State	$2.69
Rate for Payer: Wellpoint Medicaid Managed Care	$2.95

GELFILM ABSORBABLE FILM 1X2 IN

Facility

$111.45

Hospital Charge Code	60629320
Hospital Revenue Code	270
Min. Negotiated Rate	$16.72
Max. Negotiated Rate	$16.72
Rate for Payer: Qualcare PPO/HMO/WC	$16.72

GELFILM NON OPHT 10 X 12.5 CM

Facility

$265.59

Service Code	NDC 9029703
Hospital Charge Code	606350995
Hospital Revenue Code	250
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$132.79
Rate for Payer: Aetna Commercial	$100.92
Rate for Payer: Aetna Medicare Advantage	$79.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.73
Rate for Payer: Cigna Commercial	$132.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.68
Rate for Payer: Oxford Commercial	$53.12
Rate for Payer: Qualcare PPO/HMO/WC	$39.84
Rate for Payer: UnitedHealthcare Commercial	$53.12
Rate for Payer: UnitedHealthcare Community & State	$6.40
Rate for Payer: Wellpoint Medicaid Managed Care	$7.04

GELFILM NON OPHT 10 X 12.5 CM

Facility

$265.59

Service Code	NDC 9029703
Hospital Charge Code	606350995
Hospital Revenue Code	250
Min. Negotiated Rate	$39.84
Max. Negotiated Rate	$39.84
Rate for Payer: Qualcare PPO/HMO/WC	$39.84

GELFILM OPHTH

Facility

$80.00

Hospital Charge Code	60634788
Hospital Revenue Code	250
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.00
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$16.00
Rate for Payer: UnitedHealthcare Community & State	$1.93
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

GELFILM OPHTH

Facility

$80.00

Hospital Charge Code	60634788
Hospital Revenue Code	250
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

GELFILM OPHTH 25 X 50MM

Facility

$1,045.20

Service Code	NDC 9029703
Hospital Charge Code	60635623
Hospital Revenue Code	250
Min. Negotiated Rate	$25.19
Max. Negotiated Rate	$522.60
Rate for Payer: Aetna Commercial	$397.18
Rate for Payer: Aetna Medicare Advantage	$313.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.53
Rate for Payer: Cigna Commercial	$522.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.56
Rate for Payer: Oxford Commercial	$209.04
Rate for Payer: Qualcare PPO/HMO/WC	$156.78
Rate for Payer: UnitedHealthcare Commercial	$209.04
Rate for Payer: UnitedHealthcare Community & State	$25.19
Rate for Payer: Wellpoint Medicaid Managed Care	$27.70

GELFILM OPHTH 25 X 50MM

Facility

$1,045.20

Service Code	NDC 9029703
Hospital Charge Code	60635623
Hospital Revenue Code	250
Min. Negotiated Rate	$156.78
Max. Negotiated Rate	$156.78
Rate for Payer: Qualcare PPO/HMO/WC	$156.78

GELFILM OPHTH 25X50MM

Facility

$212.00

Hospital Charge Code	60635611
Hospital Revenue Code	250
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$106.00
Rate for Payer: Aetna Commercial	$80.56
Rate for Payer: Aetna Medicare Advantage	$63.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.06
Rate for Payer: Cigna Commercial	$106.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.60
Rate for Payer: Oxford Commercial	$42.40
Rate for Payer: Qualcare PPO/HMO/WC	$31.80
Rate for Payer: UnitedHealthcare Commercial	$42.40
Rate for Payer: UnitedHealthcare Community & State	$5.11
Rate for Payer: Wellpoint Medicaid Managed Care	$5.62

GELFILM OPHTH 25X50MM

Facility

$212.00

Hospital Charge Code	60635611
Hospital Revenue Code	250
Min. Negotiated Rate	$31.80
Max. Negotiated Rate	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$31.80

GELFOAM

Facility

$145.00

Hospital Charge Code	270335261
Hospital Revenue Code	272
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$21.75
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

GELFOAM

Facility

$145.00

Hospital Charge Code	270335261
Hospital Revenue Code	272
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$72.50
Rate for Payer: Aetna Commercial	$55.10
Rate for Payer: Aetna Medicare Advantage	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.98
Rate for Payer: Cigna Commercial	$72.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.50
Rate for Payer: Oxford Commercial	$29.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.75
Rate for Payer: UnitedHealthcare Commercial	$29.00
Rate for Payer: UnitedHealthcare Community & State	$3.49
Rate for Payer: Wellpoint Medicaid Managed Care	$3.84

GELFOAM 127MM SPONGE

Facility

$43.00

Hospital Charge Code	60635610
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$12.90
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	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$8.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$8.60
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

GELFOAM 127MM SPONGE

Facility

$43.00

Hospital Charge Code	60635610
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

GELFOAM COMPRESSED/EACH

Facility

$131.00

Hospital Charge Code	60633038
Hospital Revenue Code	250
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

Know your out-of-pocket cost for care.

All Charges