Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HEMOSPLIT 27CM

Facility

$1,615.00

Service Code	HCPCS C1750
Hospital Charge Code	270637768
Hospital Revenue Code	278
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$390.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$355.30
Rate for Payer: Qualcare PPO/HMO/WC	$242.25

HEMOSPLIT 31cm 5733313

Facility

$1,755.00

Service Code	HCPCS C1750
Hospital Charge Code	270637885
Hospital Revenue Code	278
Min. Negotiated Rate	$263.25
Max. Negotiated Rate	$424.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$351.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$386.10
Rate for Payer: Qualcare PPO/HMO/WC	$263.25

HEMOSPLIT 31cm 5733313

Facility

$1,755.00

Service Code	HCPCS C1750
Hospital Charge Code	270637885
Hospital Revenue Code	278
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$877.50
Rate for Payer: Aetna Commercial	$666.90
Rate for Payer: Aetna Medicare Advantage	$526.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$351.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$447.52
Rate for Payer: Cigna Commercial	$877.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$386.10
Rate for Payer: Qualcare PPO/HMO/WC	$263.25
Rate for Payer: UnitedHealthcare Community & State	$42.30
Rate for Payer: Wellpoint Medicaid Managed Care	$46.51

HEMOSPRAY HEMOSTAT HEMO7

Facility

$12,250.00

Service Code	HCPCS C1052
Hospital Charge Code	270687359
Hospital Revenue Code	272
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$1,837.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

HEMOSPRAY HEMOSTAT HEMO7

Facility

$12,250.00

Service Code	HCPCS C1052
Hospital Charge Code	270687359
Hospital Revenue Code	272
Min. Negotiated Rate	$295.23
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$4,655.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,675.00
Rate for Payer: Oxford Commercial	$2,450.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50
Rate for Payer: UnitedHealthcare Commercial	$2,450.00
Rate for Payer: UnitedHealthcare Community & State	$295.23
Rate for Payer: Wellpoint Medicaid Managed Care	$324.62

HEMOSTAT ABSORBABLE 2X3

Facility

$197.15

Hospital Charge Code	6006357
Hospital Revenue Code	250
Min. Negotiated Rate	$29.57
Max. Negotiated Rate	$29.57
Rate for Payer: Qualcare PPO/HMO/WC	$29.57

HEMOSTAT ABSORBABLE 2X3

Facility

$197.15

Hospital Charge Code	6006357
Hospital Revenue Code	250
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$98.58
Rate for Payer: Aetna Commercial	$74.92
Rate for Payer: Aetna Medicare Advantage	$59.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.27
Rate for Payer: Cigna Commercial	$98.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.15
Rate for Payer: Oxford Commercial	$39.43
Rate for Payer: Qualcare PPO/HMO/WC	$29.57
Rate for Payer: UnitedHealthcare Commercial	$39.43
Rate for Payer: UnitedHealthcare Community & State	$4.75
Rate for Payer: Wellpoint Medicaid Managed Care	$5.22

HEMOSTAT COSTASIS CSH201

Facility

$1,478.45

Hospital Charge Code	270622962
Hospital Revenue Code	272
Min. Negotiated Rate	$35.63
Max. Negotiated Rate	$739.23
Rate for Payer: Aetna Commercial	$561.81
Rate for Payer: Aetna Medicare Advantage	$443.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$377.00
Rate for Payer: Cigna Commercial	$739.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$443.54
Rate for Payer: Oxford Commercial	$295.69
Rate for Payer: Qualcare PPO/HMO/WC	$221.77
Rate for Payer: UnitedHealthcare Commercial	$295.69
Rate for Payer: UnitedHealthcare Community & State	$35.63
Rate for Payer: Wellpoint Medicaid Managed Care	$39.18

HEMOSTAT COSTASIS CSH201

Facility

$1,478.45

Hospital Charge Code	270622962
Hospital Revenue Code	272
Min. Negotiated Rate	$221.77
Max. Negotiated Rate	$221.77
Rate for Payer: Qualcare PPO/HMO/WC	$221.77

HEMOSTAT D-STAT FLOWABLE 4000

Facility

$625.00

Hospital Charge Code	270638461
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

HEMOSTAT D-STAT FLOWABLE 4000

Facility

$625.00

Hospital Charge Code	270638461
Hospital Revenue Code	272
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

HEMOSTAT OSTENE 1GM

Facility

$249.05

Hospital Charge Code	270697396
Hospital Revenue Code	272
Min. Negotiated Rate	$37.36
Max. Negotiated Rate	$37.36
Rate for Payer: Qualcare PPO/HMO/WC	$37.36

HEMOSTAT OSTENE 1GM

Facility

$249.05

Hospital Charge Code	270697396
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$124.53
Rate for Payer: Aetna Commercial	$94.64
Rate for Payer: Aetna Medicare Advantage	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.51
Rate for Payer: Cigna Commercial	$124.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.72
Rate for Payer: Oxford Commercial	$49.81
Rate for Payer: Qualcare PPO/HMO/WC	$37.36
Rate for Payer: UnitedHealthcare Commercial	$49.81
Rate for Payer: UnitedHealthcare Community & State	$6.00
Rate for Payer: Wellpoint Medicaid Managed Care	$6.60

HEMOSTAT SRGICL ABSRBABL 2x14

Facility

$596.60

Hospital Charge Code	270641925
Hospital Revenue Code	272
Min. Negotiated Rate	$14.38
Max. Negotiated Rate	$298.30
Rate for Payer: Aetna Commercial	$226.71
Rate for Payer: Aetna Medicare Advantage	$178.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.13
Rate for Payer: Cigna Commercial	$298.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.98
Rate for Payer: Oxford Commercial	$119.32
Rate for Payer: Qualcare PPO/HMO/WC	$89.49
Rate for Payer: UnitedHealthcare Commercial	$119.32
Rate for Payer: UnitedHealthcare Community & State	$14.38
Rate for Payer: Wellpoint Medicaid Managed Care	$15.81

HEMOSTAT SRGICL ABSRBABL 2x14

Facility

$596.60

Hospital Charge Code	270641925
Hospital Revenue Code	272
Min. Negotiated Rate	$89.49
Max. Negotiated Rate	$89.49
Rate for Payer: Qualcare PPO/HMO/WC	$89.49

HEMOSTAT SURGICEL 4x8in 1952

Facility

$383.25

Hospital Charge Code	270641926
Hospital Revenue Code	272
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$191.62
Rate for Payer: Aetna Commercial	$145.63
Rate for Payer: Aetna Medicare Advantage	$114.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.73
Rate for Payer: Cigna Commercial	$191.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.97
Rate for Payer: Oxford Commercial	$76.65
Rate for Payer: Qualcare PPO/HMO/WC	$57.49
Rate for Payer: UnitedHealthcare Commercial	$76.65
Rate for Payer: UnitedHealthcare Community & State	$9.24
Rate for Payer: Wellpoint Medicaid Managed Care	$10.16

HEMOSTAT SURGICEL 4x8in 1952

Facility

$383.25

Hospital Charge Code	270641926
Hospital Revenue Code	272
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$57.49
Rate for Payer: Qualcare PPO/HMO/WC	$57.49

HEMOSTREAM EXCHANGE CATHETER

Facility

$808.90

Hospital Charge Code	270654374
Hospital Revenue Code	272
Min. Negotiated Rate	$121.33
Max. Negotiated Rate	$121.33
Rate for Payer: Qualcare PPO/HMO/WC	$121.33

HEMOSTREAM EXCHANGE CATHETER

Facility

$808.90

Hospital Charge Code	270654374
Hospital Revenue Code	272
Min. Negotiated Rate	$19.49
Max. Negotiated Rate	$404.45
Rate for Payer: Aetna Commercial	$307.38
Rate for Payer: Aetna Medicare Advantage	$242.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$206.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$206.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$206.27
Rate for Payer: Cigna Commercial	$404.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.67
Rate for Payer: Oxford Commercial	$161.78
Rate for Payer: Qualcare PPO/HMO/WC	$121.33
Rate for Payer: UnitedHealthcare Commercial	$161.78
Rate for Payer: UnitedHealthcare Community & State	$19.49
Rate for Payer: Wellpoint Medicaid Managed Care	$21.44

HEMOTALIC INTRODUCER SYS 6F

Facility

$275.00

Hospital Charge Code	270671255
Hospital Revenue Code	272
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

HEMOTALIC INTRODUCER SYS 6F

Facility

$275.00

Hospital Charge Code	270671255
Hospital Revenue Code	272
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Oxford Commercial	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Commercial	$55.00
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

HEMOTALIC INTRODUCER SYS 8F

Facility

$275.00

Hospital Charge Code	270671253
Hospital Revenue Code	272
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Oxford Commercial	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Commercial	$55.00
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

HEMOTALIC INTRODUCER SYS 8F

Facility

$275.00

Hospital Charge Code	270671253
Hospital Revenue Code	272
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

HEMOVAC MED

Facility

$46.82

Hospital Charge Code	270649525
Hospital Revenue Code	272
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$23.41
Rate for Payer: Aetna Commercial	$17.79
Rate for Payer: Aetna Medicare Advantage	$14.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.94
Rate for Payer: Cigna Commercial	$23.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.05
Rate for Payer: Oxford Commercial	$9.36
Rate for Payer: Qualcare PPO/HMO/WC	$7.02
Rate for Payer: UnitedHealthcare Commercial	$9.36
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.24

HEMOVAC MED

Facility

$46.82

Hospital Charge Code	270649525
Hospital Revenue Code	272
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$7.02
Rate for Payer: Qualcare PPO/HMO/WC	$7.02

Know your out-of-pocket cost for care.

All Charges