Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHIELD BREAST ********

Facility

$32.00

Hospital Charge Code	1800085
Hospital Revenue Code	279
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.60
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$6.40
Rate for Payer: UnitedHealthcare Community & State	$0.77
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

SHIELD BREAST ********

Facility

$32.00

Hospital Charge Code	1800085
Hospital Revenue Code	279
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

SHIELD BREAST 4295089922

Facility

$36.85

Hospital Charge Code	270622862
Hospital Revenue Code	272
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$18.43
Rate for Payer: Aetna Commercial	$14.00
Rate for Payer: Aetna Medicare Advantage	$11.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.40
Rate for Payer: Cigna Commercial	$18.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.05
Rate for Payer: Oxford Commercial	$7.37
Rate for Payer: Qualcare PPO/HMO/WC	$5.53
Rate for Payer: UnitedHealthcare Commercial	$7.37
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.98

SHIELD BREAST 4295089922

Facility

$36.85

Hospital Charge Code	270622862
Hospital Revenue Code	272
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$5.53
Rate for Payer: Qualcare PPO/HMO/WC	$5.53

SHIELD CONTACT NIPPLE 24MM

Facility

$21.67

Hospital Charge Code	270664917
Hospital Revenue Code	270
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$10.84
Rate for Payer: Aetna Commercial	$8.23
Rate for Payer: Aetna Medicare Advantage	$6.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.53
Rate for Payer: Cigna Commercial	$10.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$4.33
Rate for Payer: Qualcare PPO/HMO/WC	$3.25
Rate for Payer: UnitedHealthcare Commercial	$4.33
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.57

SHIELD CONTACT NIPPLE 24MM

Facility

$21.67

Hospital Charge Code	270664917
Hospital Revenue Code	270
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$3.25
Rate for Payer: Qualcare PPO/HMO/WC	$3.25

SHIELD DURA 10X15 555DS1015

Facility

$2,122.45

Hospital Charge Code	270619625
Hospital Revenue Code	278
Min. Negotiated Rate	$318.37
Max. Negotiated Rate	$513.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$424.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$513.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$466.94
Rate for Payer: Qualcare PPO/HMO/WC	$318.37

SHIELD DURA 10X15 555DS1015

Facility

$2,122.45

Hospital Charge Code	270619625
Hospital Revenue Code	278
Min. Negotiated Rate	$51.15
Max. Negotiated Rate	$1,061.22
Rate for Payer: Aetna Commercial	$806.53
Rate for Payer: Aetna Medicare Advantage	$636.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$541.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$541.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$424.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$541.22
Rate for Payer: Cigna Commercial	$1,061.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$513.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$466.94
Rate for Payer: Qualcare PPO/HMO/WC	$318.37
Rate for Payer: UnitedHealthcare Community & State	$51.15
Rate for Payer: Wellpoint Medicaid Managed Care	$56.24

SHIELD EYE

Facility

$7.00

Hospital Charge Code	8000663
Hospital Revenue Code	279
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.10
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

SHIELD EYE

Facility

$7.00

Hospital Charge Code	8000663
Hospital Revenue Code	279
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

SHIELD EYE CLEAR PLASTIC

Facility

$32.00

Hospital Charge Code	270061240
Hospital Revenue Code	272
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

SHIELD EYE CLEAR PLASTIC

Facility

$32.00

Hospital Charge Code	270061240
Hospital Revenue Code	272
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.60
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$6.40
Rate for Payer: UnitedHealthcare Community & State	$0.77
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

SHIELD EYE LASER I-5400

Facility

$2.45

Hospital Charge Code	270605617
Hospital Revenue Code	272
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Qualcare PPO/HMO/WC	$0.37

SHIELD EYE LASER I-5400

Facility

$2.45

Hospital Charge Code	270605617
Hospital Revenue Code	272
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.23
Rate for Payer: Aetna Commercial	$0.93
Rate for Payer: Aetna Medicare Advantage	$0.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.62
Rate for Payer: Cigna Commercial	$1.23
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	$0.06

SHIELD EYE UNIVERSAL *****

Facility

$13.00

Hospital Charge Code	1600873
Hospital Revenue Code	272
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

SHIELD EYE UNIVERSAL *****

Facility

$13.00

Hospital Charge Code	1600873
Hospital Revenue Code	272
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

SHIELD FOR EAR SYRINGE N0809M

Facility

$79.45

Hospital Charge Code	270620818
Hospital Revenue Code	272
Min. Negotiated Rate	$11.92
Max. Negotiated Rate	$11.92
Rate for Payer: Qualcare PPO/HMO/WC	$11.92

SHIELD FOR EAR SYRINGE N0809M

Facility

$79.45

Hospital Charge Code	270620818
Hospital Revenue Code	272
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$39.73
Rate for Payer: Aetna Commercial	$30.19
Rate for Payer: Aetna Medicare Advantage	$23.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.26
Rate for Payer: Cigna Commercial	$39.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.84
Rate for Payer: Oxford Commercial	$15.89
Rate for Payer: Qualcare PPO/HMO/WC	$11.92
Rate for Payer: UnitedHealthcare Commercial	$15.89
Rate for Payer: UnitedHealthcare Community & State	$1.91
Rate for Payer: Wellpoint Medicaid Managed Care	$2.11

SHIELD FULLER

Facility

$52.00

Hospital Charge Code	270301945
Hospital Revenue Code	270
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

SHIELD FULLER

Facility

$52.00

Hospital Charge Code	270301945
Hospital Revenue Code	270
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$19.76
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$10.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$10.40
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

SHIELD FULLER ******

Facility

$23.00

Hospital Charge Code	8000747
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

SHIELD FULLER ******

Facility

$23.00

Hospital Charge Code	8000747
Hospital Revenue Code	279
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$3.45

SHIELD MEROCEL CORNEAL 400106

Facility

$5.65

Hospital Charge Code	270616161
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.70
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

SHIELD MEROCEL CORNEAL 400106

Facility

$5.65

Hospital Charge Code	270616161
Hospital Revenue Code	272
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

SHIELD NIPPLE

Facility

$24.85

Hospital Charge Code	200600466
Hospital Revenue Code	272
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

Know your out-of-pocket cost for care.

All Charges