Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPONGE DURAFORM 1X3

Facility

$2,015.00

Hospital Charge Code	270660870
Hospital Revenue Code	278
Min. Negotiated Rate	$302.25
Max. Negotiated Rate	$487.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$403.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$443.30
Rate for Payer: Qualcare PPO/HMO/WC	$302.25

SPONGE DURAFORM 1X3

Facility

$2,015.00

Hospital Charge Code	270660870
Hospital Revenue Code	278
Min. Negotiated Rate	$48.56
Max. Negotiated Rate	$1,007.50
Rate for Payer: Aetna Commercial	$765.70
Rate for Payer: Aetna Medicare Advantage	$604.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$513.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$513.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$403.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$513.83
Rate for Payer: Cigna Commercial	$1,007.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.63
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$443.30
Rate for Payer: Qualcare PPO/HMO/WC	$302.25
Rate for Payer: UnitedHealthcare Community & State	$48.56
Rate for Payer: Wellpoint Medicaid Managed Care	$53.40

SPONGE GAUZE STERILE 8 PLY 4X4

Facility

$1.65

Hospital Charge Code	270650293
Hospital Revenue Code	272
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.83
Rate for Payer: Aetna Commercial	$0.63
Rate for Payer: Aetna Medicare Advantage	$0.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.42
Rate for Payer: Cigna Commercial	$0.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.50
Rate for Payer: Oxford Commercial	$0.33
Rate for Payer: Qualcare PPO/HMO/WC	$0.25
Rate for Payer: UnitedHealthcare Commercial	$0.33
Rate for Payer: UnitedHealthcare Community & State	$0.04
Rate for Payer: Wellpoint Medicaid Managed Care	$0.04

SPONGE GAUZE STERILE 8 PLY 4X4

Facility

$1.65

Hospital Charge Code	270650293
Hospital Revenue Code	272
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.25

SPONGE GAUZE VERSALON 3x3

Facility

$9.83

Hospital Charge Code	270650112
Hospital Revenue Code	272
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$4.92
Rate for Payer: Aetna Commercial	$3.74
Rate for Payer: Aetna Medicare Advantage	$2.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.51
Rate for Payer: Cigna Commercial	$4.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.95
Rate for Payer: Oxford Commercial	$1.97
Rate for Payer: Qualcare PPO/HMO/WC	$1.47
Rate for Payer: UnitedHealthcare Commercial	$1.97
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

SPONGE GAUZE VERSALON 3x3

Facility

$9.83

Hospital Charge Code	270650112
Hospital Revenue Code	272
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$1.47
Rate for Payer: Qualcare PPO/HMO/WC	$1.47

SPONGE GUAZE BULK 2 X 2-3 PLY

Facility

$15.00

Hospital Charge Code	270331891
Hospital Revenue Code	272
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

SPONGE GUAZE BULK 2 X 2-3 PLY

Facility

$15.00

Hospital Charge Code	270331891
Hospital Revenue Code	272
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

SPONGE GZE VERSALON STR 4X4

Facility

$6.98

Hospital Charge Code	270652833
Hospital Revenue Code	272
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

SPONGE GZE VERSALON STR 4X4

Facility

$6.98

Hospital Charge Code	270652833
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.49
Rate for Payer: Aetna Commercial	$2.65
Rate for Payer: Aetna Medicare Advantage	$2.09
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	$3.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.09
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	$0.18

SPONGE KEEL BF 1 PAIR

Facility

$247.00

Hospital Charge Code	270683000
Hospital Revenue Code	272
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Qualcare PPO/HMO/WC	$37.05

SPONGE KEEL BF 1 PAIR

Facility

$247.00

Hospital Charge Code	270683000
Hospital Revenue Code	272
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$123.50
Rate for Payer: Aetna Commercial	$93.86
Rate for Payer: Aetna Medicare Advantage	$74.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.98
Rate for Payer: Cigna Commercial	$123.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.10
Rate for Payer: Oxford Commercial	$49.40
Rate for Payer: Qualcare PPO/HMO/WC	$37.05
Rate for Payer: UnitedHealthcare Commercial	$49.40
Rate for Payer: UnitedHealthcare Community & State	$5.95
Rate for Payer: Wellpoint Medicaid Managed Care	$6.55

SPONGE KITTNER ENDOSCOPIC

Facility

$122.25

Hospital Charge Code	270652119
Hospital Revenue Code	272
Min. Negotiated Rate	$18.34
Max. Negotiated Rate	$18.34
Rate for Payer: Qualcare PPO/HMO/WC	$18.34

SPONGE KITTNER ENDOSCOPIC

Facility

$122.25

Hospital Charge Code	270652119
Hospital Revenue Code	272
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$61.12
Rate for Payer: Aetna Commercial	$46.45
Rate for Payer: Aetna Medicare Advantage	$36.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.17
Rate for Payer: Cigna Commercial	$61.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.67
Rate for Payer: Oxford Commercial	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$18.34
Rate for Payer: UnitedHealthcare Commercial	$24.45
Rate for Payer: UnitedHealthcare Community & State	$2.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.24

SPONGE NEVOS 22X15X05 DEMIN

Facility

$4,250.00

Service Code	HCPCS C1762
Hospital Charge Code	270692489
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

SPONGE NEVOS 22X15X05 DEMIN

Facility

$4,250.00

Service Code	HCPCS C1762
Hospital Charge Code	270692489
Hospital Revenue Code	278
Min. Negotiated Rate	$102.42
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,615.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$935.00
Rate for Payer: Qualcare PPO/HMO/WC	$637.50
Rate for Payer: UnitedHealthcare Community & State	$102.42
Rate for Payer: Wellpoint Medicaid Managed Care	$112.62

SPONGE NS 4 X 4 PLY BULK

Facility

$9.53

Hospital Charge Code	270654159
Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.43

SPONGE NS 4 X 4 PLY BULK

Facility

$9.53

Hospital Charge Code	270654159
Hospital Revenue Code	270
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.76
Rate for Payer: Aetna Commercial	$3.62
Rate for Payer: Aetna Medicare Advantage	$2.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.43
Rate for Payer: Cigna Commercial	$4.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.86
Rate for Payer: Oxford Commercial	$1.91
Rate for Payer: Qualcare PPO/HMO/WC	$1.43
Rate for Payer: UnitedHealthcare Commercial	$1.91
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

SPONGE PEANUT 3/8

Facility

$12.85

Hospital Charge Code	270061305
Hospital Revenue Code	272
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.42
Rate for Payer: Aetna Commercial	$4.88
Rate for Payer: Aetna Medicare Advantage	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.28
Rate for Payer: Cigna Commercial	$6.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.85
Rate for Payer: Oxford Commercial	$2.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.93
Rate for Payer: UnitedHealthcare Commercial	$2.57
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

SPONGE PEANUT 3/8

Facility

$12.85

Hospital Charge Code	270061305
Hospital Revenue Code	272
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.93

SPONGE PEANUT 3/8 7103

Facility

$10.41

Hospital Charge Code	270645141
Hospital Revenue Code	272
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Qualcare PPO/HMO/WC	$1.56

SPONGE PEANUT 3/8 7103

Facility

$10.41

Hospital Charge Code	270645141
Hospital Revenue Code	272
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$5.21
Rate for Payer: Aetna Commercial	$3.96
Rate for Payer: Aetna Medicare Advantage	$3.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.65
Rate for Payer: Cigna Commercial	$5.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.12
Rate for Payer: Oxford Commercial	$2.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.56
Rate for Payer: UnitedHealthcare Commercial	$2.08
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

SPONGE PEANUT DISSECTOR

Facility

$2,446.50

Hospital Charge Code	270652834
Hospital Revenue Code	272
Min. Negotiated Rate	$58.96
Max. Negotiated Rate	$1,223.25
Rate for Payer: Aetna Commercial	$929.67
Rate for Payer: Aetna Medicare Advantage	$733.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$623.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$623.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$623.86
Rate for Payer: Cigna Commercial	$1,223.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$733.95
Rate for Payer: Oxford Commercial	$489.30
Rate for Payer: Qualcare PPO/HMO/WC	$366.98
Rate for Payer: UnitedHealthcare Commercial	$489.30
Rate for Payer: UnitedHealthcare Community & State	$58.96
Rate for Payer: Wellpoint Medicaid Managed Care	$64.83

SPONGE PEANUT DISSECTOR

Facility

$2,446.50

Hospital Charge Code	270652834
Hospital Revenue Code	272
Min. Negotiated Rate	$366.98
Max. Negotiated Rate	$366.98
Rate for Payer: Qualcare PPO/HMO/WC	$366.98

SPONGE PRE-WASHED STR LAP 4X18

Facility

$6.92

Hospital Charge Code	270648974
Hospital Revenue Code	270
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.04
Rate for Payer: Qualcare PPO/HMO/WC	$1.04

Know your out-of-pocket cost for care.

All Charges