Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BARRICAID DEVICE

Facility

$30,000.00

Service Code	HCPCS C9757
Hospital Charge Code	270705080
Hospital Revenue Code	278
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,260.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00

BARRICAID DEVICE

Facility

$30,000.00

Service Code	HCPCS C9757
Hospital Charge Code	270705080
Hospital Revenue Code	278
Min. Negotiated Rate	$723.00
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	$6,000.00
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	$7,260.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00
Rate for Payer: UnitedHealthcare Community & State	$723.00
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	$795.00

BARRICAID DEVICE

Facility

$30,000.00

Service Code	HCPCS C9757
Hospital Charge Code	270507018
Hospital Revenue Code	278
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,260.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00

BARRICAID DEVICE

Facility

$30,000.00

Service Code	HCPCS C9757
Hospital Charge Code	270507018
Hospital Revenue Code	278
Min. Negotiated Rate	$723.00
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	$6,000.00
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	$7,260.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6,600.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,500.00
Rate for Payer: UnitedHealthcare Community & State	$723.00
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	$795.00

BARRIER ABSOR ADHES 3X4 4350**

Facility

$476.00

Hospital Charge Code	1604701
Hospital Revenue Code	272
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$71.40
Rate for Payer: Qualcare PPO/HMO/WC	$71.40

BARRIER ABSOR ADHES 3X4 4350**

Facility

$476.00

Hospital Charge Code	1604701
Hospital Revenue Code	272
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$238.00
Rate for Payer: Aetna Commercial	$180.88
Rate for Payer: Aetna Medicare Advantage	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.38
Rate for Payer: Cigna Commercial	$238.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.80
Rate for Payer: Oxford Commercial	$95.20
Rate for Payer: Qualcare PPO/HMO/WC	$71.40
Rate for Payer: UnitedHealthcare Commercial	$95.20
Rate for Payer: UnitedHealthcare Community & State	$11.47
Rate for Payer: Wellpoint Medicaid Managed Care	$12.61

BARRIER INCISE DRAPE 10 x 16

Facility

$48.00

Hospital Charge Code	270331785
Hospital Revenue Code	272
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.40
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

BARRIER INCISE DRAPE 10 x 16

Facility

$48.00

Hospital Charge Code	270331785
Hospital Revenue Code	272
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

BARRIER SKIN STOMACHESIVE1-3/4

Facility

$5.47

Hospital Charge Code	270650520
Hospital Revenue Code	272
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: Qualcare PPO/HMO/WC	$0.82

BARRIER SKIN STOMACHESIVE1-3/4

Facility

$5.47

Hospital Charge Code	270650520
Hospital Revenue Code	272
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.73
Rate for Payer: Aetna Commercial	$2.08
Rate for Payer: Aetna Medicare Advantage	$1.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.39
Rate for Payer: Cigna Commercial	$2.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.64
Rate for Payer: Oxford Commercial	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$0.82
Rate for Payer: UnitedHealthcare Commercial	$1.09
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

BARRIER SKIN STOMHESIVE MOLDBL

Facility

$14.78

Hospital Charge Code	270650275
Hospital Revenue Code	272
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$2.22
Rate for Payer: Qualcare PPO/HMO/WC	$2.22

BARRIER SKIN STOMHESIVE MOLDBL

Facility

$14.78

Hospital Charge Code	270650275
Hospital Revenue Code	272
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.39
Rate for Payer: Aetna Commercial	$5.62
Rate for Payer: Aetna Medicare Advantage	$4.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.77
Rate for Payer: Cigna Commercial	$7.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.43
Rate for Payer: Oxford Commercial	$2.96
Rate for Payer: Qualcare PPO/HMO/WC	$2.22
Rate for Payer: UnitedHealthcare Commercial	$2.96
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

BARRIERSKIN STOM MOLDABL 2-1/4

Facility

$14.78

Hospital Charge Code	270650525
Hospital Revenue Code	272
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$2.22
Rate for Payer: Qualcare PPO/HMO/WC	$2.22

BARRIERSKIN STOM MOLDABL 2-1/4

Facility

$14.78

Hospital Charge Code	270650525
Hospital Revenue Code	272
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.39
Rate for Payer: Aetna Commercial	$5.62
Rate for Payer: Aetna Medicare Advantage	$4.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.77
Rate for Payer: Cigna Commercial	$7.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.43
Rate for Payer: Oxford Commercial	$2.96
Rate for Payer: Qualcare PPO/HMO/WC	$2.22
Rate for Payer: UnitedHealthcare Commercial	$2.96
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

BARRON CORNEAL PUNCH 7.0MM

Facility

$350.00

Hospital Charge Code	270662308
Hospital Revenue Code	272
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Oxford Commercial	$70.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$70.00
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

BARRON CORNEAL PUNCH 7.0MM

Facility

$350.00

Hospital Charge Code	270662308
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BARRON CORNEAL PUNCH 7.25MM

Facility

$425.00

Hospital Charge Code	270671095
Hospital Revenue Code	272
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

BARRON CORNEAL PUNCH 7.25MM

Facility

$425.00

Hospital Charge Code	270671095
Hospital Revenue Code	272
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.50
Rate for Payer: Oxford Commercial	$85.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$85.00
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

BARRON CORNEAL PUNCH 7.5MM

Facility

$330.00

Hospital Charge Code	270654851
Hospital Revenue Code	272
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$49.50
Rate for Payer: Qualcare PPO/HMO/WC	$49.50

BARRON CORNEAL PUNCH 7.5MM

Facility

$330.00

Hospital Charge Code	270654851
Hospital Revenue Code	272
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$165.00
Rate for Payer: Aetna Commercial	$125.40
Rate for Payer: Aetna Medicare Advantage	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.15
Rate for Payer: Cigna Commercial	$165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.00
Rate for Payer: Oxford Commercial	$66.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.50
Rate for Payer: UnitedHealthcare Commercial	$66.00
Rate for Payer: UnitedHealthcare Community & State	$7.95
Rate for Payer: Wellpoint Medicaid Managed Care	$8.74

BARRON CORNEAL PUNCH 7.75MM

Facility

$425.00

Hospital Charge Code	270671097
Hospital Revenue Code	272
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

BARRON CORNEAL PUNCH 7.75MM

Facility

$425.00

Hospital Charge Code	270671097
Hospital Revenue Code	272
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.50
Rate for Payer: Oxford Commercial	$85.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$85.00
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

BARRON CORNEAL PUNCH 9.25MM

Facility

$425.00

Hospital Charge Code	270671098
Hospital Revenue Code	272
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.50
Rate for Payer: Oxford Commercial	$85.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$85.00
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

BARRON CORNEAL PUNCH 9.25MM

Facility

$425.00

Hospital Charge Code	270671098
Hospital Revenue Code	272
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

BARRON CORNEA PUNCH 8.0MM DIA

Facility

$330.00

Hospital Charge Code	270660738
Hospital Revenue Code	272
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$165.00
Rate for Payer: Aetna Commercial	$125.40
Rate for Payer: Aetna Medicare Advantage	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.15
Rate for Payer: Cigna Commercial	$165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.00
Rate for Payer: Oxford Commercial	$66.00
Rate for Payer: Qualcare PPO/HMO/WC	$49.50
Rate for Payer: UnitedHealthcare Commercial	$66.00
Rate for Payer: UnitedHealthcare Community & State	$7.95
Rate for Payer: Wellpoint Medicaid Managed Care	$8.74

Know your out-of-pocket cost for care.

All Charges