Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STOCKING ANTI-EM THIGH MED REG

Facility

$13.05

Hospital Charge Code	270648991
Hospital Revenue Code	272
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.53
Rate for Payer: Aetna Commercial	$4.96
Rate for Payer: Aetna Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.33
Rate for Payer: Cigna Commercial	$6.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.92
Rate for Payer: Oxford Commercial	$2.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.96
Rate for Payer: UnitedHealthcare Commercial	$2.61
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

STOCKING ANTI-EM THIGH MED REG

Facility

$13.05

Hospital Charge Code	270648991
Hospital Revenue Code	272
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$1.96
Rate for Payer: Qualcare PPO/HMO/WC	$1.96

STOCKING ANTI EM THIGH SM

Facility

$77.85

Hospital Charge Code	270649868
Hospital Revenue Code	272
Min. Negotiated Rate	$11.68
Max. Negotiated Rate	$11.68
Rate for Payer: Qualcare PPO/HMO/WC	$11.68

STOCKING ANTI EM THIGH SM

Facility

$77.85

Hospital Charge Code	270649868
Hospital Revenue Code	272
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$38.92
Rate for Payer: Aetna Commercial	$29.58
Rate for Payer: Aetna Medicare Advantage	$23.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.85
Rate for Payer: Cigna Commercial	$38.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.36
Rate for Payer: Oxford Commercial	$15.57
Rate for Payer: Qualcare PPO/HMO/WC	$11.68
Rate for Payer: UnitedHealthcare Commercial	$15.57
Rate for Payer: UnitedHealthcare Community & State	$1.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2.06

STOCKING/JOBST

Facility

$1,124.85

Hospital Charge Code	270606574
Hospital Revenue Code	270
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$562.42
Rate for Payer: Aetna Commercial	$427.44
Rate for Payer: Aetna Medicare Advantage	$337.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.84
Rate for Payer: Cigna Commercial	$562.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.45
Rate for Payer: Oxford Commercial	$224.97
Rate for Payer: Qualcare PPO/HMO/WC	$168.73
Rate for Payer: UnitedHealthcare Commercial	$224.97
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

STOCKING/JOBST

Facility

$1,124.85

Hospital Charge Code	270606574
Hospital Revenue Code	270
Min. Negotiated Rate	$168.73
Max. Negotiated Rate	$168.73
Rate for Payer: Qualcare PPO/HMO/WC	$168.73

STOCKING/JOBST COMPRESS

Facility

$1,124.85

Hospital Charge Code	270606215
Hospital Revenue Code	270
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$562.42
Rate for Payer: Aetna Commercial	$427.44
Rate for Payer: Aetna Medicare Advantage	$337.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.84
Rate for Payer: Cigna Commercial	$562.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.45
Rate for Payer: Oxford Commercial	$224.97
Rate for Payer: Qualcare PPO/HMO/WC	$168.73
Rate for Payer: UnitedHealthcare Commercial	$224.97
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

STOCKING/JOBST COMPRESS

Facility

$1,124.85

Hospital Charge Code	270606215
Hospital Revenue Code	270
Min. Negotiated Rate	$168.73
Max. Negotiated Rate	$168.73
Rate for Payer: Qualcare PPO/HMO/WC	$168.73

STOCKINGS SCD KENDALL *******

Facility

$149.00

Hospital Charge Code	1603117
Hospital Revenue Code	279
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$22.35
Rate for Payer: Qualcare PPO/HMO/WC	$22.35

STOCKINGS SCD KENDALL *******

Facility

$149.00

Hospital Charge Code	1603117
Hospital Revenue Code	279
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$74.50
Rate for Payer: Aetna Commercial	$56.62
Rate for Payer: Aetna Medicare Advantage	$44.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.99
Rate for Payer: Cigna Commercial	$74.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.70
Rate for Payer: Oxford Commercial	$29.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.35
Rate for Payer: UnitedHealthcare Commercial	$29.80
Rate for Payer: UnitedHealthcare Community & State	$3.59
Rate for Payer: Wellpoint Medicaid Managed Care	$3.95

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC

Facility

$81,134.66

Service Code	MSDRG 327
Min. Negotiated Rate	$24,704.47
Max. Negotiated Rate	$81,134.66
Rate for Payer: Aetna Commercial	$56,006.09
Rate for Payer: Aetna Medicare Advantage	$81,134.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58,152.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58,152.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26,004.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58,152.50
Rate for Payer: Cigna Commercial	$45,740.76
Rate for Payer: Cigna Medicare Advantage	$26,004.70
Rate for Payer: Clover Medicare Advantage	$24,704.47
Rate for Payer: EmblemHealth Commercial	$78,014.10
Rate for Payer: Humana Medicare Advantage	$26,784.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26,004.70
Rate for Payer: Oxford Commercial	$32,874.49
Rate for Payer: UnitedHealthcare Commercial	$57,646.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$26,004.70
Rate for Payer: Wellcare Medicare Advantage	$26,004.70

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC

Facility

$163,335.12

Service Code	MSDRG 326
Min. Negotiated Rate	$49,733.45
Max. Negotiated Rate	$163,335.12
Rate for Payer: Aetna Commercial	$112,487.18
Rate for Payer: Aetna Medicare Advantage	$163,335.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118,165.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118,165.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$52,351.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118,165.88
Rate for Payer: Cigna Commercial	$93,334.20
Rate for Payer: Cigna Medicare Advantage	$52,351.00
Rate for Payer: Clover Medicare Advantage	$49,733.45
Rate for Payer: EmblemHealth Commercial	$157,053.00
Rate for Payer: Humana Medicare Advantage	$53,921.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$52,351.00
Rate for Payer: Oxford Commercial	$67,080.53
Rate for Payer: UnitedHealthcare Commercial	$117,627.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$52,351.00
Rate for Payer: Wellcare Medicare Advantage	$52,351.00

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC

Facility

$53,923.08

Service Code	MSDRG 328
Min. Negotiated Rate	$16,418.89
Max. Negotiated Rate	$53,923.08
Rate for Payer: Aetna Commercial	$37,308.65
Rate for Payer: Aetna Medicare Advantage	$53,923.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37,217.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37,217.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,283.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37,217.60
Rate for Payer: Cigna Commercial	$29,985.44
Rate for Payer: Cigna Medicare Advantage	$17,283.04
Rate for Payer: Clover Medicare Advantage	$16,418.89
Rate for Payer: EmblemHealth Commercial	$51,849.12
Rate for Payer: Humana Medicare Advantage	$17,801.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,283.04
Rate for Payer: Oxford Commercial	$21,550.94
Rate for Payer: UnitedHealthcare Commercial	$37,790.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,283.04
Rate for Payer: Wellcare Medicare Advantage	$17,283.04

STOMADHESIVE ********

Facility

$131.00

Hospital Charge Code	8001398
Hospital Revenue Code	279
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$49.78
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.30
Rate for Payer: Oxford Commercial	$26.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$26.20
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: Wellpoint Medicaid Managed Care	$3.47

STOMADHESIVE ********

Facility

$131.00

Hospital Charge Code	8001398
Hospital Revenue Code	279
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

STOMA FLEX WAFER 1 1/2

Facility

$27.25

Hospital Charge Code	270303140
Hospital Revenue Code	272
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$13.62
Rate for Payer: Aetna Commercial	$10.36
Rate for Payer: Aetna Medicare Advantage	$8.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.95
Rate for Payer: Cigna Commercial	$13.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.18
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.09
Rate for Payer: UnitedHealthcare Commercial	$5.45
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

STOMA FLEX WAFER 1 1/2

Facility

$27.25

Hospital Charge Code	270303140
Hospital Revenue Code	272
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$4.09
Rate for Payer: Qualcare PPO/HMO/WC	$4.09

STOMA FLEX WAFER 1 3/4

Facility

$27.25

Hospital Charge Code	270303145
Hospital Revenue Code	272
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$13.62
Rate for Payer: Aetna Commercial	$10.36
Rate for Payer: Aetna Medicare Advantage	$8.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.95
Rate for Payer: Cigna Commercial	$13.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.18
Rate for Payer: Oxford Commercial	$5.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.09
Rate for Payer: UnitedHealthcare Commercial	$5.45
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

STOMA FLEX WAFER 1 3/4

Facility

$27.25

Hospital Charge Code	270303145
Hospital Revenue Code	272
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$4.09
Rate for Payer: Qualcare PPO/HMO/WC	$4.09

STOMA FLEX WAFER 2 3/4

Facility

$29.65

Hospital Charge Code	270303150
Hospital Revenue Code	272
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$4.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.45

STOMA FLEX WAFER 2 3/4

Facility

$29.65

Hospital Charge Code	270303150
Hospital Revenue Code	272
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$14.82
Rate for Payer: Aetna Commercial	$11.27
Rate for Payer: Aetna Medicare Advantage	$8.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.56
Rate for Payer: Cigna Commercial	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.89
Rate for Payer: Oxford Commercial	$5.93
Rate for Payer: Qualcare PPO/HMO/WC	$4.45
Rate for Payer: UnitedHealthcare Commercial	$5.93
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

STOMAHESIVE 1.5 2.75 BX *****

Facility

$32.00

Hospital Charge Code	8004426
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

STOMAHESIVE 1.5 2.75 BX *****

Facility

$32.00

Hospital Charge Code	8004426
Hospital Revenue Code	279
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

STOMAHESIVE 4 BX *********

Facility

$174.00

Hospital Charge Code	8001414
Hospital Revenue Code	279
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$66.12
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.20
Rate for Payer: Oxford Commercial	$34.80
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Commercial	$34.80
Rate for Payer: UnitedHealthcare Community & State	$4.19
Rate for Payer: Wellpoint Medicaid Managed Care	$4.61

STOMAHESIVE 4 BX *********

Facility

$174.00

Hospital Charge Code	8001414
Hospital Revenue Code	279
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

Know your out-of-pocket cost for care.

All Charges