Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BANDAGE FABRIC 2 44102

Facility

$0.30

Hospital Charge Code	270350175C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.15
Rate for Payer: Aetna Commercial	$0.11
Rate for Payer: Aetna Medicare Advantage	$0.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.08
Rate for Payer: Cigna Commercial	$0.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.09
Rate for Payer: Oxford Commercial	$0.06
Rate for Payer: Qualcare PPO/HMO/WC	$0.05
Rate for Payer: UnitedHealthcare Commercial	$0.06
Rate for Payer: UnitedHealthcare Community & State	$0.01
Rate for Payer: Wellpoint Medicaid Managed Care	$0.01

BANDAGE FABRIC 2 44102

Facility

$0.30

Hospital Charge Code	270350175C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Qualcare PPO/HMO/WC	$0.05

BANDAGE GAUZE KERLIX 2 STER

Facility

$1.09

Hospital Charge Code	270650295
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Qualcare PPO/HMO/WC	$0.16

BANDAGE GAUZE KERLIX 2 STER

Facility

$1.09

Hospital Charge Code	270650295
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.55
Rate for Payer: Aetna Commercial	$0.41
Rate for Payer: Aetna Medicare Advantage	$0.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.28
Rate for Payer: Cigna Commercial	$0.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.33
Rate for Payer: Oxford Commercial	$0.22
Rate for Payer: Qualcare PPO/HMO/WC	$0.16
Rate for Payer: UnitedHealthcare Commercial	$0.22
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

BANDAGE GAUZE KERLIX 3 STER

Facility

$1.09

Hospital Charge Code	270650296
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.55
Rate for Payer: Aetna Commercial	$0.41
Rate for Payer: Aetna Medicare Advantage	$0.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.28
Rate for Payer: Cigna Commercial	$0.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.33
Rate for Payer: Oxford Commercial	$0.22
Rate for Payer: Qualcare PPO/HMO/WC	$0.16
Rate for Payer: UnitedHealthcare Commercial	$0.22
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

BANDAGE GAUZE KERLIX 3 STER

Facility

$1.09

Hospital Charge Code	270650296
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Qualcare PPO/HMO/WC	$0.16

BANDAGE GAUZE KERLIX 4 STER

Facility

$1.34

Hospital Charge Code	270650297
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.67
Rate for Payer: Aetna Commercial	$0.51
Rate for Payer: Aetna Medicare Advantage	$0.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.34
Rate for Payer: Cigna Commercial	$0.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.40
Rate for Payer: Oxford Commercial	$0.27
Rate for Payer: Qualcare PPO/HMO/WC	$0.20
Rate for Payer: UnitedHealthcare Commercial	$0.27
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.04

BANDAGE GAUZE KERLIX 4 STER

Facility

$1.34

Hospital Charge Code	270650297
Hospital Revenue Code	272
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.20

BANDAGE PLASTER 2X 3 YRD

Facility

$124.85

Hospital Charge Code	270609828
Hospital Revenue Code	272
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$18.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.73

BANDAGE PLASTER 2X 3 YRD

Facility

$124.85

Hospital Charge Code	270609828
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.42
Rate for Payer: Aetna Commercial	$47.44
Rate for Payer: Aetna Medicare Advantage	$37.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.84
Rate for Payer: Cigna Commercial	$62.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.45
Rate for Payer: Oxford Commercial	$24.97
Rate for Payer: Qualcare PPO/HMO/WC	$18.73
Rate for Payer: UnitedHealthcare Commercial	$24.97
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

BANDAGE PLASTER 3

Facility

$4.72

Hospital Charge Code	27060035
Hospital Revenue Code	270
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$0.71
Rate for Payer: Qualcare PPO/HMO/WC	$0.71

BANDAGE PLASTER 3

Facility

$13.65

Hospital Charge Code	270060035
Hospital Revenue Code	272
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.09
Rate for Payer: Oxford Commercial	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$2.73
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

BANDAGE PLASTER 3

Facility

$4.72

Hospital Charge Code	27060035
Hospital Revenue Code	270
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.36
Rate for Payer: Aetna Commercial	$1.79
Rate for Payer: Aetna Medicare Advantage	$1.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.20
Rate for Payer: Cigna Commercial	$2.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.42
Rate for Payer: Oxford Commercial	$0.94
Rate for Payer: Qualcare PPO/HMO/WC	$0.71
Rate for Payer: UnitedHealthcare Commercial	$0.94
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

BANDAGE PLASTER 3

Facility

$13.65

Hospital Charge Code	270060035
Hospital Revenue Code	272
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

BANDAGE PLASTER 4

Facility

$6.88

Hospital Charge Code	27060040
Hospital Revenue Code	270
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.44
Rate for Payer: Aetna Commercial	$2.61
Rate for Payer: Aetna Medicare Advantage	$2.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.75
Rate for Payer: Cigna Commercial	$3.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.06
Rate for Payer: Oxford Commercial	$1.38
Rate for Payer: Qualcare PPO/HMO/WC	$1.03
Rate for Payer: UnitedHealthcare Commercial	$1.38
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

BANDAGE PLASTER 4

Facility

$6.88

Hospital Charge Code	27060040
Hospital Revenue Code	270
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$1.03
Rate for Payer: Qualcare PPO/HMO/WC	$1.03

BANDAGE PLASTER 4 IN

Facility

$7.56

Hospital Charge Code	270060040
Hospital Revenue Code	272
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.78
Rate for Payer: Aetna Commercial	$2.87
Rate for Payer: Aetna Medicare Advantage	$2.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.93
Rate for Payer: Cigna Commercial	$3.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.27
Rate for Payer: Oxford Commercial	$1.51
Rate for Payer: Qualcare PPO/HMO/WC	$1.13
Rate for Payer: UnitedHealthcare Commercial	$1.51
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

BANDAGE PLASTER 4 IN

Facility

$7.56

Hospital Charge Code	270060040
Hospital Revenue Code	272
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$1.13

BANDAGE PLASTER 6

Facility

$8.61

Hospital Charge Code	27060045
Hospital Revenue Code	270
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.30
Rate for Payer: Aetna Commercial	$3.27
Rate for Payer: Aetna Medicare Advantage	$2.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.20
Rate for Payer: Cigna Commercial	$4.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.58
Rate for Payer: Oxford Commercial	$1.72
Rate for Payer: Qualcare PPO/HMO/WC	$1.29
Rate for Payer: UnitedHealthcare Commercial	$1.72
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

BANDAGE PLASTER 6

Facility

$8.61

Hospital Charge Code	27060045
Hospital Revenue Code	270
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.29
Rate for Payer: Qualcare PPO/HMO/WC	$1.29

BANDAGE PLASTER 6

Facility

$9.21

Hospital Charge Code	270060045
Hospital Revenue Code	272
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$1.38
Rate for Payer: Qualcare PPO/HMO/WC	$1.38

BANDAGE PLASTER 6

Facility

$9.21

Hospital Charge Code	270060045
Hospital Revenue Code	272
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.61
Rate for Payer: Aetna Commercial	$3.50
Rate for Payer: Aetna Medicare Advantage	$2.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.35
Rate for Payer: Cigna Commercial	$4.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.76
Rate for Payer: Oxford Commercial	$1.84
Rate for Payer: Qualcare PPO/HMO/WC	$1.38
Rate for Payer: UnitedHealthcare Commercial	$1.84
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

BANDAGE PLASTER FST SET 3X 3Y

Facility

$36.00

Hospital Charge Code	270331863
Hospital Revenue Code	272
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$13.68
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.80
Rate for Payer: Oxford Commercial	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Commercial	$7.20
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

BANDAGE PLASTER FST SET 3X 3Y

Facility

$36.00

Hospital Charge Code	270331863
Hospital Revenue Code	272
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

BANDAGE PLASTER FST SET 5 X 5

Facility

$62.00

Hospital Charge Code	270331278
Hospital Revenue Code	272
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$9.30
Rate for Payer: Qualcare PPO/HMO/WC	$9.30

Know your out-of-pocket cost for care.

All Charges