Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPN FSN WO DECMPR CERV BELW C2

Facility

$47,548.90

Service Code	HCPCS 22554
Hospital Charge Code	16000607
Hospital Revenue Code	360
Min. Negotiated Rate	$1,145.93
Max. Negotiated Rate	$55,057.64
Rate for Payer: Aetna Commercial	$41,487.32
Rate for Payer: Aetna Medicare Advantage	$49,418.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,057.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,057.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,252.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55,057.64
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: Cigna Medicare Advantage	$15,252.69
Rate for Payer: Clover Medicare Advantage	$14,490.06
Rate for Payer: EmblemHealth Commercial	$45,758.07
Rate for Payer: Humana Medicare Advantage	$15,710.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,252.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,264.67
Rate for Payer: Oxford Commercial	$8,679.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34
Rate for Payer: UnitedHealthcare Commercial	$14,834.00
Rate for Payer: UnitedHealthcare Community & State	$1,145.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,252.69
Rate for Payer: Wellcare Medicare Advantage	$15,252.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1,260.05

SPN FUSE&RMV CRV BLW C2,EA ADL

Facility

$47,548.90

Service Code	HCPCS 22552
Hospital Charge Code	16000606
Hospital Revenue Code	360
Min. Negotiated Rate	$1,145.93
Max. Negotiated Rate	$23,774.45
Rate for Payer: Aetna Commercial	$18,068.58
Rate for Payer: Aetna Medicare Advantage	$14,264.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,124.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,124.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,124.97
Rate for Payer: Cigna Commercial	$23,774.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,264.67
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$1,145.93
Rate for Payer: Wellpoint Medicaid Managed Care	$1,260.05

SPN FUSE&RMV CRV BLW C2,EA ADL

Facility

$47,548.90

Service Code	HCPCS 22552
Hospital Charge Code	1620002
Hospital Revenue Code	360
Min. Negotiated Rate	$1,145.93
Max. Negotiated Rate	$23,774.45
Rate for Payer: Aetna Commercial	$18,068.58
Rate for Payer: Aetna Medicare Advantage	$14,264.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,124.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,124.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,124.97
Rate for Payer: Cigna Commercial	$23,774.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,264.67
Rate for Payer: Oxford Commercial	$7,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34
Rate for Payer: UnitedHealthcare Commercial	$12,870.00
Rate for Payer: UnitedHealthcare Community & State	$1,145.93
Rate for Payer: Wellpoint Medicaid Managed Care	$1,260.05

SPN FUSE&RMV CRV BLW C2,EA ADL

Facility

$47,548.90

Service Code	HCPCS 22552
Hospital Charge Code	1620002
Hospital Revenue Code	360
Min. Negotiated Rate	$7,132.34
Max. Negotiated Rate	$7,132.34
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34

SPN FUSE&RMV CRV BLW C2,EA ADL

Facility

$47,548.90

Service Code	HCPCS 22552
Hospital Charge Code	16000606
Hospital Revenue Code	360
Min. Negotiated Rate	$7,132.34
Max. Negotiated Rate	$7,132.34
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34

SPNG FIL COP BONE VOID11031010

Facility

$9,218.75

Hospital Charge Code	270639515
Hospital Revenue Code	278
Min. Negotiated Rate	$222.17
Max. Negotiated Rate	$4,609.38
Rate for Payer: Aetna Commercial	$3,503.12
Rate for Payer: Aetna Medicare Advantage	$2,765.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,350.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,350.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,843.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,350.78
Rate for Payer: Cigna Commercial	$4,609.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,230.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,028.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,382.81
Rate for Payer: UnitedHealthcare Community & State	$222.17
Rate for Payer: Wellpoint Medicaid Managed Care	$244.30

SPNG FIL COP BONE VOID11031010

Facility

$9,218.75

Hospital Charge Code	270639515
Hospital Revenue Code	278
Min. Negotiated Rate	$1,382.81
Max. Negotiated Rate	$2,230.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,843.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,230.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,028.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,382.81

SPO2 CABLE

Facility

$945.00

Hospital Charge Code	270663011
Hospital Revenue Code	270
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$141.75
Rate for Payer: Qualcare PPO/HMO/WC	$141.75

SPO2 CABLE

Facility

$945.00

Hospital Charge Code	270663011
Hospital Revenue Code	270
Min. Negotiated Rate	$22.77
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna Commercial	$359.10
Rate for Payer: Aetna Medicare Advantage	$283.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.97
Rate for Payer: Cigna Commercial	$472.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$283.50
Rate for Payer: Oxford Commercial	$189.00
Rate for Payer: Qualcare PPO/HMO/WC	$141.75
Rate for Payer: UnitedHealthcare Commercial	$189.00
Rate for Payer: UnitedHealthcare Community & State	$22.77
Rate for Payer: Wellpoint Medicaid Managed Care	$25.04

SPONGE 3 PLY 2X2 N/STER

Facility

$0.02

Hospital Charge Code	270649003
Hospital Revenue Code	270
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare Advantage	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.01
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.01
Rate for Payer: Oxford Commercial	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SPONGE 3 PLY 2X2 N/STER

Facility

$0.02

Hospital Charge Code	270649003
Hospital Revenue Code	270
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SPONGE 3 PLY 4X4 N/STER

Facility

$0.05

Hospital Charge Code	270649004
Hospital Revenue Code	272
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.01

SPONGE 3 PLY 4X4 N/STER

Facility

$0.05

Hospital Charge Code	270649004
Hospital Revenue Code	272
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna Commercial	$0.02
Rate for Payer: Aetna Medicare Advantage	$0.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.01
Rate for Payer: Cigna Commercial	$0.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.02
Rate for Payer: Oxford Commercial	$0.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.01
Rate for Payer: UnitedHealthcare Commercial	$0.01
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SPONGE BATH HOMECRAFT A722-8

Facility

$16.85

Hospital Charge Code	270611386
Hospital Revenue Code	279
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$6.40
Rate for Payer: Aetna Medicare Advantage	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.05
Rate for Payer: Oxford Commercial	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.37
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

SPONGE BATH HOMECRAFT A722-8

Facility

$16.85

Hospital Charge Code	270611386
Hospital Revenue Code	279
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

SPONGE BF PRESSURIZER 1 PAIR

Facility

$123.50

Hospital Charge Code	270683001
Hospital Revenue Code	272
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$61.75
Rate for Payer: Aetna Commercial	$46.93
Rate for Payer: Aetna Medicare Advantage	$37.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.49
Rate for Payer: Cigna Commercial	$61.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.05
Rate for Payer: Oxford Commercial	$24.70
Rate for Payer: Qualcare PPO/HMO/WC	$18.52
Rate for Payer: UnitedHealthcare Commercial	$24.70
Rate for Payer: UnitedHealthcare Community & State	$2.98
Rate for Payer: Wellpoint Medicaid Managed Care	$3.27

SPONGE BF PRESSURIZER 1 PAIR

Facility

$123.50

Hospital Charge Code	270683001
Hospital Revenue Code	272
Min. Negotiated Rate	$18.52
Max. Negotiated Rate	$18.52
Rate for Payer: Qualcare PPO/HMO/WC	$18.52

SPONGE CBM 20X15X7MM

Facility

$4,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270694149
Hospital Revenue Code	278
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$998.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$618.75

SPONGE CBM 20X15X7MM

Facility

$4,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270694149
Hospital Revenue Code	278
Min. Negotiated Rate	$99.41
Max. Negotiated Rate	$2,062.50
Rate for Payer: Aetna Commercial	$1,567.50
Rate for Payer: Aetna Medicare Advantage	$1,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.88
Rate for Payer: Cigna Commercial	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$618.75
Rate for Payer: UnitedHealthcare Community & State	$99.41
Rate for Payer: Wellpoint Medicaid Managed Care	$109.31

SPONGE CBM 50X20X5MM

Facility

$6,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270694148
Hospital Revenue Code	278
Min. Negotiated Rate	$165.69
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,612.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25
Rate for Payer: UnitedHealthcare Community & State	$165.69
Rate for Payer: Wellpoint Medicaid Managed Care	$182.19

SPONGE CBM 50X20X5MM

Facility

$6,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270694148
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,663.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,663.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

SPONGE DRAIN EXCILON 4X4 FEN

Facility

$0.72

Hospital Charge Code	270649006
Hospital Revenue Code	270
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.11
Rate for Payer: Qualcare PPO/HMO/WC	$0.11

SPONGE DRAIN EXCILON 4X4 FEN

Facility

$0.72

Hospital Charge Code	270649006
Hospital Revenue Code	270
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.36
Rate for Payer: Aetna Commercial	$0.27
Rate for Payer: Aetna Medicare Advantage	$0.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.18
Rate for Payer: Cigna Commercial	$0.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.22
Rate for Payer: Oxford Commercial	$0.14
Rate for Payer: Qualcare PPO/HMO/WC	$0.11
Rate for Payer: UnitedHealthcare Commercial	$0.14
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.02

SPONGE DR FOG

Facility

$6.77

Hospital Charge Code	270600257
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$2.57
Rate for Payer: Aetna Medicare Advantage	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.73
Rate for Payer: Cigna Commercial	$3.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.03
Rate for Payer: Oxford Commercial	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.02
Rate for Payer: UnitedHealthcare Commercial	$1.35
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

SPONGE DR FOG

Facility

$6.77

Hospital Charge Code	270600257
Hospital Revenue Code	272
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.02
Rate for Payer: Qualcare PPO/HMO/WC	$1.02

Know your out-of-pocket cost for care.

All Charges