Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHEET C/S 3M *******

Facility

$282.00

Hospital Charge Code	1800101
Hospital Revenue Code	279
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Qualcare PPO/HMO/WC	$42.30

SHEET DRAPE LG

Facility

$12.13

Hospital Charge Code	270649505
Hospital Revenue Code	272
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.07
Rate for Payer: Aetna Commercial	$4.61
Rate for Payer: Aetna Medicare Advantage	$3.64
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	$6.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.64
Rate for Payer: Oxford Commercial	$2.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.82
Rate for Payer: UnitedHealthcare Commercial	$2.43
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

SHEET DRAPE LG

Facility

$12.13

Hospital Charge Code	270649505
Hospital Revenue Code	272
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$1.82
Rate for Payer: Qualcare PPO/HMO/WC	$1.82

SHEET DRAPE STER DISP OR

Facility

$24.85

Hospital Charge Code	270061500
Hospital Revenue Code	272
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$9.44
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.46
Rate for Payer: Oxford Commercial	$4.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$4.97
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

SHEET DRAPE STER DISP OR

Facility

$24.85

Hospital Charge Code	270061500
Hospital Revenue Code	272
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

SHEET EXTREMITY W/ISO BAC

Facility

$27.73

Hospital Charge Code	270654100
Hospital Revenue Code	270
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$13.87
Rate for Payer: Aetna Commercial	$10.54
Rate for Payer: Aetna Medicare Advantage	$8.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.07
Rate for Payer: Cigna Commercial	$13.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Oxford Commercial	$5.55
Rate for Payer: Qualcare PPO/HMO/WC	$4.16
Rate for Payer: UnitedHealthcare Commercial	$5.55
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.73

SHEET EXTREMITY W/ISO BAC

Facility

$27.73

Hospital Charge Code	270654100
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$4.16
Rate for Payer: Qualcare PPO/HMO/WC	$4.16

SHEET FLAT LG LONG SP66115

Facility

$60.85

Hospital Charge Code	270603091
Hospital Revenue Code	272
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$30.43
Rate for Payer: Aetna Commercial	$23.12
Rate for Payer: Aetna Medicare Advantage	$18.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.52
Rate for Payer: Cigna Commercial	$30.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.25
Rate for Payer: Oxford Commercial	$12.17
Rate for Payer: Qualcare PPO/HMO/WC	$9.13
Rate for Payer: UnitedHealthcare Commercial	$12.17
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.61

SHEET FLAT LG LONG SP66115

Facility

$60.85

Hospital Charge Code	270603091
Hospital Revenue Code	272
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$9.13
Rate for Payer: Qualcare PPO/HMO/WC	$9.13

SHEETH 11 CM

Facility

$512.05

Hospital Charge Code	270662667
Hospital Revenue Code	270
Min. Negotiated Rate	$12.34
Max. Negotiated Rate	$256.02
Rate for Payer: Aetna Commercial	$194.58
Rate for Payer: Aetna Medicare Advantage	$153.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.57
Rate for Payer: Cigna Commercial	$256.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.62
Rate for Payer: Oxford Commercial	$102.41
Rate for Payer: Qualcare PPO/HMO/WC	$76.81
Rate for Payer: UnitedHealthcare Commercial	$102.41
Rate for Payer: UnitedHealthcare Community & State	$12.34
Rate for Payer: Wellpoint Medicaid Managed Care	$13.57

SHEETH 11 CM

Facility

$512.05

Hospital Charge Code	270662667
Hospital Revenue Code	270
Min. Negotiated Rate	$76.81
Max. Negotiated Rate	$76.81
Rate for Payer: Qualcare PPO/HMO/WC	$76.81

SHEETING SILICON 2x2x1mm

Facility

$101.00

Hospital Charge Code	270640675
Hospital Revenue Code	272
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$50.50
Rate for Payer: Aetna Commercial	$38.38
Rate for Payer: Aetna Medicare Advantage	$30.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.75
Rate for Payer: Cigna Commercial	$50.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.30
Rate for Payer: Oxford Commercial	$20.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.15
Rate for Payer: UnitedHealthcare Commercial	$20.20
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.68

SHEETING SILICON 2x2x1mm

Facility

$101.00

Hospital Charge Code	270640675
Hospital Revenue Code	272
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$15.15
Rate for Payer: Qualcare PPO/HMO/WC	$15.15

SHEET LAPAROTOMY CL030

Facility

$116.85

Hospital Charge Code	270600154
Hospital Revenue Code	272
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$58.42
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna Medicare Advantage	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.80
Rate for Payer: Cigna Commercial	$58.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.05
Rate for Payer: Oxford Commercial	$23.37
Rate for Payer: Qualcare PPO/HMO/WC	$17.53
Rate for Payer: UnitedHealthcare Commercial	$23.37
Rate for Payer: UnitedHealthcare Community & State	$2.82
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

SHEET LAPAROTOMY CL030

Facility

$116.85

Hospital Charge Code	270600154
Hospital Revenue Code	272
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

SHEET LAP PEDIATRIC

Facility

$20.27

Hospital Charge Code	270649506
Hospital Revenue Code	272
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$3.04
Rate for Payer: Qualcare PPO/HMO/WC	$3.04

SHEET LAP PEDIATRIC

Facility

$20.27

Hospital Charge Code	270649506
Hospital Revenue Code	272
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$10.13
Rate for Payer: Aetna Commercial	$7.70
Rate for Payer: Aetna Medicare Advantage	$6.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.17
Rate for Payer: Cigna Commercial	$10.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.08
Rate for Payer: Oxford Commercial	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$3.04
Rate for Payer: UnitedHealthcare Commercial	$4.05
Rate for Payer: UnitedHealthcare Community & State	$0.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.54

SHEET LAP W/IOS BAC

Facility

$27.60

Hospital Charge Code	270652545
Hospital Revenue Code	270
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$13.80
Rate for Payer: Aetna Commercial	$10.49
Rate for Payer: Aetna Medicare Advantage	$8.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.04
Rate for Payer: Cigna Commercial	$13.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.28
Rate for Payer: Oxford Commercial	$5.52
Rate for Payer: Qualcare PPO/HMO/WC	$4.14
Rate for Payer: UnitedHealthcare Commercial	$5.52
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.73

SHEET LAP W/IOS BAC

Facility

$27.60

Hospital Charge Code	270652545
Hospital Revenue Code	270
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$4.14
Rate for Payer: Qualcare PPO/HMO/WC	$4.14

SHEET MED POR38x50x0.85mm 7210

Facility

$1,289.65

Hospital Charge Code	270635948
Hospital Revenue Code	272
Min. Negotiated Rate	$193.45
Max. Negotiated Rate	$193.45
Rate for Payer: Qualcare PPO/HMO/WC	$193.45

SHEET MED POR38x50x0.85mm 7210

Facility

$1,289.65

Hospital Charge Code	270635948
Hospital Revenue Code	272
Min. Negotiated Rate	$31.08
Max. Negotiated Rate	$644.83
Rate for Payer: Aetna Commercial	$490.07
Rate for Payer: Aetna Medicare Advantage	$386.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$328.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$328.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$328.86
Rate for Payer: Cigna Commercial	$644.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$386.89
Rate for Payer: Oxford Commercial	$257.93
Rate for Payer: Qualcare PPO/HMO/WC	$193.45
Rate for Payer: UnitedHealthcare Commercial	$257.93
Rate for Payer: UnitedHealthcare Community & State	$31.08
Rate for Payer: Wellpoint Medicaid Managed Care	$34.18

SHEET SILIC 2x2x1.6m 1532530

Facility

$85.00

Hospital Charge Code	270640676
Hospital Revenue Code	278
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$42.50
Rate for Payer: Aetna Commercial	$32.30
Rate for Payer: Aetna Medicare Advantage	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.68
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$18.70
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Community & State	$2.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.25

SHEET SILIC 2x2x1.6m 1532530

Facility

$85.00

Hospital Charge Code	270640676
Hospital Revenue Code	278
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$20.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$18.70
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

SHEETS O.R. 50X50 T180

Facility

$37.50

Hospital Charge Code	270658728
Hospital Revenue Code	270
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$5.62

SHEETS O.R. 50X50 T180

Facility

$37.50

Hospital Charge Code	270658728
Hospital Revenue Code	270
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$18.75
Rate for Payer: Aetna Commercial	$14.25
Rate for Payer: Aetna Medicare Advantage	$11.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.56
Rate for Payer: Cigna Commercial	$18.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.25
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$5.62
Rate for Payer: UnitedHealthcare Commercial	$7.50
Rate for Payer: UnitedHealthcare Community & State	$0.90
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

Know your out-of-pocket cost for care.

All Charges