Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STOMAHESIVE 4X4 021712

Facility

$28.85

Hospital Charge Code	270649015
Hospital Revenue Code	270
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$4.33
Rate for Payer: Qualcare PPO/HMO/WC	$4.33

STOMAHESIVE 4X4 021712

Facility

$28.85

Hospital Charge Code	270649015
Hospital Revenue Code	270
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$14.43
Rate for Payer: Aetna Commercial	$10.96
Rate for Payer: Aetna Medicare Advantage	$8.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.36
Rate for Payer: Cigna Commercial	$14.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.65
Rate for Payer: Oxford Commercial	$5.77
Rate for Payer: Qualcare PPO/HMO/WC	$4.33
Rate for Payer: UnitedHealthcare Commercial	$5.77
Rate for Payer: UnitedHealthcare Community & State	$0.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

STOMAHESIVE POWDER 1OZ

Facility

$18.00

Hospital Charge Code	270649016
Hospital Revenue Code	270
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Commercial	$6.84
Rate for Payer: Aetna Medicare Advantage	$5.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.59
Rate for Payer: Cigna Commercial	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.40
Rate for Payer: Oxford Commercial	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.70
Rate for Payer: UnitedHealthcare Commercial	$3.60
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

STOMAHESIVE POWDER 1OZ

Facility

$18.00

Hospital Charge Code	270649016
Hospital Revenue Code	270
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.70

STOMATE FLEXIFLO***

Facility

$444.00

Hospital Charge Code	2300754
Hospital Revenue Code	279
Min. Negotiated Rate	$66.60
Max. Negotiated Rate	$66.60
Rate for Payer: Qualcare PPO/HMO/WC	$66.60

STOMATE FLEXIFLO***

Facility

$444.00

Hospital Charge Code	2300754
Hospital Revenue Code	279
Min. Negotiated Rate	$10.70
Max. Negotiated Rate	$222.00
Rate for Payer: Aetna Commercial	$168.72
Rate for Payer: Aetna Medicare Advantage	$133.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.22
Rate for Payer: Cigna Commercial	$222.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.20
Rate for Payer: Oxford Commercial	$88.80
Rate for Payer: Qualcare PPO/HMO/WC	$66.60
Rate for Payer: UnitedHealthcare Commercial	$88.80
Rate for Payer: UnitedHealthcare Community & State	$10.70
Rate for Payer: Wellpoint Medicaid Managed Care	$11.77

STOMATE FLXFLO LRG 22FR 50100

Facility

$1,001.65

Hospital Charge Code	270611261
Hospital Revenue Code	270
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$500.82
Rate for Payer: Aetna Commercial	$380.63
Rate for Payer: Aetna Medicare Advantage	$300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.42
Rate for Payer: Cigna Commercial	$500.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.50
Rate for Payer: Oxford Commercial	$200.33
Rate for Payer: Qualcare PPO/HMO/WC	$150.25
Rate for Payer: UnitedHealthcare Commercial	$200.33
Rate for Payer: UnitedHealthcare Community & State	$24.14
Rate for Payer: Wellpoint Medicaid Managed Care	$26.54

STOMATE FLXFLO LRG 22FR 50100

Facility

$1,001.65

Hospital Charge Code	270611261
Hospital Revenue Code	270
Min. Negotiated Rate	$150.25
Max. Negotiated Rate	$150.25
Rate for Payer: Qualcare PPO/HMO/WC	$150.25

STOMATE FLXFLO MED 22F 50090

Facility

$1,001.65

Hospital Charge Code	270600965
Hospital Revenue Code	270
Min. Negotiated Rate	$150.25
Max. Negotiated Rate	$150.25
Rate for Payer: Qualcare PPO/HMO/WC	$150.25

STOMATE FLXFLO MED 22F 50090

Facility

$1,001.65

Hospital Charge Code	270600965
Hospital Revenue Code	270
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$500.82
Rate for Payer: Aetna Commercial	$380.63
Rate for Payer: Aetna Medicare Advantage	$300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.42
Rate for Payer: Cigna Commercial	$500.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.50
Rate for Payer: Oxford Commercial	$200.33
Rate for Payer: Qualcare PPO/HMO/WC	$150.25
Rate for Payer: UnitedHealthcare Commercial	$200.33
Rate for Payer: UnitedHealthcare Community & State	$24.14
Rate for Payer: Wellpoint Medicaid Managed Care	$26.54

STOMATE FLXFLO SML 22F 50080

Facility

$1,001.65

Hospital Charge Code	270611260
Hospital Revenue Code	270
Min. Negotiated Rate	$150.25
Max. Negotiated Rate	$150.25
Rate for Payer: Qualcare PPO/HMO/WC	$150.25

STOMATE FLXFLO SML 22F 50080

Facility

$1,001.65

Hospital Charge Code	270611260
Hospital Revenue Code	270
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$500.82
Rate for Payer: Aetna Commercial	$380.63
Rate for Payer: Aetna Medicare Advantage	$300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.42
Rate for Payer: Cigna Commercial	$500.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.50
Rate for Payer: Oxford Commercial	$200.33
Rate for Payer: Qualcare PPO/HMO/WC	$150.25
Rate for Payer: UnitedHealthcare Commercial	$200.33
Rate for Payer: UnitedHealthcare Community & State	$24.14
Rate for Payer: Wellpoint Medicaid Managed Care	$26.54

STONE ANALYSIS

Facility

$658.00

Service Code	HCPCS 82365
Hospital Charge Code	38474158
Hospital Revenue Code	301
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$98.70
Rate for Payer: Qualcare PPO/HMO/WC	$98.70

STONE ANALYSIS

Facility

$658.00

Service Code	HCPCS 82365
Hospital Charge Code	38474158
Hospital Revenue Code	301
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$329.00
Rate for Payer: Aetna Commercial	$35.09
Rate for Payer: Aetna Medicare Advantage	$41.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.57
Rate for Payer: Cigna Commercial	$329.00
Rate for Payer: Cigna Medicare Advantage	$12.90
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.70
Rate for Payer: Humana Medicare Advantage	$13.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.40
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$98.70
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.90
Rate for Payer: Wellcare Medicare Advantage	$12.90
Rate for Payer: Wellpoint Medicaid Managed Care	$17.44

STONE ANALYSIS

Facility

$390.00

Service Code	HCPCS 82365
Hospital Charge Code	39900514
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

STONE ANALYSIS

Facility

$390.00

Service Code	HCPCS 82365
Hospital Charge Code	39900514
Hospital Revenue Code	301
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.09
Rate for Payer: Aetna Medicare Advantage	$41.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.57
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.90
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.70
Rate for Payer: Humana Medicare Advantage	$13.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.90
Rate for Payer: Wellcare Medicare Advantage	$12.90
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

STONE ANALYSIS INFRARED SPECT

Facility

$153.65

Service Code	HCPCS 82365
Hospital Charge Code	3004397
Hospital Revenue Code	301
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.09
Rate for Payer: Aetna Medicare Advantage	$41.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.57
Rate for Payer: Cigna Commercial	$76.83
Rate for Payer: Cigna Medicare Advantage	$12.90
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.70
Rate for Payer: Humana Medicare Advantage	$13.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.09
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.90
Rate for Payer: Wellcare Medicare Advantage	$12.90
Rate for Payer: Wellpoint Medicaid Managed Care	$4.07

STONE ANALYSIS INFRARED SPECT

Facility

$153.65

Service Code	HCPCS 82365
Hospital Charge Code	3004397
Hospital Revenue Code	301
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

STONE ANALYSIS, QUAL

Facility

$119.25

Service Code	HCPCS 82355
Hospital Charge Code	3005296
Hospital Revenue Code	301
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$31.50
Rate for Payer: Aetna Medicare Advantage	$37.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.80
Rate for Payer: Cigna Commercial	$59.62
Rate for Payer: Cigna Medicare Advantage	$11.58
Rate for Payer: Clover Medicare Advantage	$11.00
Rate for Payer: EmblemHealth Commercial	$34.74
Rate for Payer: Humana Medicare Advantage	$11.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.77
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.89
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.58
Rate for Payer: Wellcare Medicare Advantage	$11.58
Rate for Payer: Wellpoint Medicaid Managed Care	$3.16

STONE ANALYSIS, QUAL

Facility

$390.00

Service Code	HCPCS 82355
Hospital Charge Code	3005295
Hospital Revenue Code	301
Min. Negotiated Rate	$9.26
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$31.50
Rate for Payer: Aetna Medicare Advantage	$37.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.80
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.58
Rate for Payer: Clover Medicare Advantage	$11.00
Rate for Payer: EmblemHealth Commercial	$34.74
Rate for Payer: Humana Medicare Advantage	$11.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$9.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.58
Rate for Payer: Wellcare Medicare Advantage	$11.58
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

STONE ANALYSIS, QUAL

Facility

$390.00

Service Code	HCPCS 82355
Hospital Charge Code	3005295
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

STONE ANALYSIS, QUAL

Facility

$119.25

Service Code	HCPCS 82355
Hospital Charge Code	3005296
Hospital Revenue Code	301
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$17.89
Rate for Payer: Qualcare PPO/HMO/WC	$17.89

STONE BASKET EXPAND 212 3 FR 9

Facility

$831.95

Hospital Charge Code	270682472
Hospital Revenue Code	272
Min. Negotiated Rate	$124.79
Max. Negotiated Rate	$124.79
Rate for Payer: Qualcare PPO/HMO/WC	$124.79

STONE BASKET EXPAND 212 3 FR 9

Facility

$831.95

Hospital Charge Code	270682472
Hospital Revenue Code	272
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$415.98
Rate for Payer: Aetna Commercial	$316.14
Rate for Payer: Aetna Medicare Advantage	$249.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.15
Rate for Payer: Cigna Commercial	$415.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.59
Rate for Payer: Oxford Commercial	$166.39
Rate for Payer: Qualcare PPO/HMO/WC	$124.79
Rate for Payer: UnitedHealthcare Commercial	$166.39
Rate for Payer: UnitedHealthcare Community & State	$20.05
Rate for Payer: Wellpoint Medicaid Managed Care	$22.05

STONEBASKET G07313

Facility

$2,389.35

Hospital Charge Code	270635185
Hospital Revenue Code	272
Min. Negotiated Rate	$358.40
Max. Negotiated Rate	$358.40
Rate for Payer: Qualcare PPO/HMO/WC	$358.40

Know your out-of-pocket cost for care.

All Charges