Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SURGICAL PATTIES 1X1

Facility

$44.00

Hospital Charge Code	270332417
Hospital Revenue Code	272
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

SURGICEL 1/2 X 2 *******

Facility

$30.00

Hospital Charge Code	1601178
Hospital Revenue Code	272
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

SURGICEL 1/2 X 2 *******

Facility

$30.00

Hospital Charge Code	1601178
Hospital Revenue Code	272
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.00
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

SURGICEL 2 X 14 *******

Facility

$88.00

Hospital Charge Code	1601186
Hospital Revenue Code	272
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

SURGICEL 2 X 14 *******

Facility

$88.00

Hospital Charge Code	1601186
Hospital Revenue Code	272
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$44.00
Rate for Payer: Aetna Commercial	$33.44
Rate for Payer: Aetna Medicare Advantage	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.44
Rate for Payer: Cigna Commercial	$44.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.40
Rate for Payer: Oxford Commercial	$17.60
Rate for Payer: Qualcare PPO/HMO/WC	$13.20
Rate for Payer: UnitedHealthcare Commercial	$17.60
Rate for Payer: UnitedHealthcare Community & State	$2.12
Rate for Payer: Wellpoint Medicaid Managed Care	$2.33

SURGICEL 2X3

Facility

$150.45

Hospital Charge Code	270060852
Hospital Revenue Code	272
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$75.22
Rate for Payer: Aetna Commercial	$57.17
Rate for Payer: Aetna Medicare Advantage	$45.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.36
Rate for Payer: Cigna Commercial	$75.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.13
Rate for Payer: Oxford Commercial	$30.09
Rate for Payer: Qualcare PPO/HMO/WC	$22.57
Rate for Payer: UnitedHealthcare Commercial	$30.09
Rate for Payer: UnitedHealthcare Community & State	$3.63
Rate for Payer: Wellpoint Medicaid Managed Care	$3.99

SURGICEL 2X3

Facility

$245.80

Hospital Charge Code	6006936
Hospital Revenue Code	250
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$122.90
Rate for Payer: Aetna Commercial	$93.40
Rate for Payer: Aetna Medicare Advantage	$73.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.68
Rate for Payer: Cigna Commercial	$122.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.74
Rate for Payer: Oxford Commercial	$49.16
Rate for Payer: Qualcare PPO/HMO/WC	$36.87
Rate for Payer: UnitedHealthcare Commercial	$49.16
Rate for Payer: UnitedHealthcare Community & State	$5.92
Rate for Payer: Wellpoint Medicaid Managed Care	$6.51

SURGICEL 2X3

Facility

$150.45

Hospital Charge Code	270060852
Hospital Revenue Code	272
Min. Negotiated Rate	$22.57
Max. Negotiated Rate	$22.57
Rate for Payer: Qualcare PPO/HMO/WC	$22.57

SURGICEL 2X3

Facility

$245.80

Hospital Charge Code	6006936
Hospital Revenue Code	250
Min. Negotiated Rate	$36.87
Max. Negotiated Rate	$36.87
Rate for Payer: Qualcare PPO/HMO/WC	$36.87

SURGICEL 2x3 3460001953

Facility

$161.25

Hospital Charge Code	270641422
Hospital Revenue Code	272
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$80.62
Rate for Payer: Aetna Commercial	$61.27
Rate for Payer: Aetna Medicare Advantage	$48.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.12
Rate for Payer: Cigna Commercial	$80.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.38
Rate for Payer: Oxford Commercial	$32.25
Rate for Payer: Qualcare PPO/HMO/WC	$24.19
Rate for Payer: UnitedHealthcare Commercial	$32.25
Rate for Payer: UnitedHealthcare Community & State	$3.89
Rate for Payer: Wellpoint Medicaid Managed Care	$4.27

SURGICEL 2x3 3460001953

Facility

$161.25

Hospital Charge Code	270641422
Hospital Revenue Code	272
Min. Negotiated Rate	$24.19
Max. Negotiated Rate	$24.19
Rate for Payer: Qualcare PPO/HMO/WC	$24.19

SURGICEL 2X4

Facility

$228.00

Hospital Charge Code	270060850
Hospital Revenue Code	272
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$86.64
Rate for Payer: Aetna Medicare Advantage	$68.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.14
Rate for Payer: Cigna Commercial	$114.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.40
Rate for Payer: Oxford Commercial	$45.60
Rate for Payer: Qualcare PPO/HMO/WC	$34.20
Rate for Payer: UnitedHealthcare Commercial	$45.60
Rate for Payer: UnitedHealthcare Community & State	$5.49
Rate for Payer: Wellpoint Medicaid Managed Care	$6.04

SURGICEL 2X4

Facility

$228.00

Hospital Charge Code	270060850
Hospital Revenue Code	272
Min. Negotiated Rate	$34.20
Max. Negotiated Rate	$34.20
Rate for Payer: Qualcare PPO/HMO/WC	$34.20

SURGICEL 4 X 8 ********

Facility

$98.00

Hospital Charge Code	1600915
Hospital Revenue Code	272
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

SURGICEL 4 X 8 ********

Facility

$98.00

Hospital Charge Code	1600915
Hospital Revenue Code	272
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.40
Rate for Payer: Oxford Commercial	$19.60
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Commercial	$19.60
Rate for Payer: UnitedHealthcare Community & State	$2.36
Rate for Payer: Wellpoint Medicaid Managed Care	$2.60

SURGICEL 4X8

Facility

$597.57

Hospital Charge Code	270650484
Hospital Revenue Code	272
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$298.79
Rate for Payer: Aetna Commercial	$227.08
Rate for Payer: Aetna Medicare Advantage	$179.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.38
Rate for Payer: Cigna Commercial	$298.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.27
Rate for Payer: Oxford Commercial	$119.51
Rate for Payer: Qualcare PPO/HMO/WC	$89.64
Rate for Payer: UnitedHealthcare Commercial	$119.51
Rate for Payer: UnitedHealthcare Community & State	$14.40
Rate for Payer: Wellpoint Medicaid Managed Care	$15.84

SURGICEL 4X8

Facility

$597.57

Hospital Charge Code	270650484
Hospital Revenue Code	272
Min. Negotiated Rate	$89.64
Max. Negotiated Rate	$89.64
Rate for Payer: Qualcare PPO/HMO/WC	$89.64

SURGICEL 4X8

Facility

$248.00

Hospital Charge Code	270060855
Hospital Revenue Code	272
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$94.24
Rate for Payer: Aetna Medicare Advantage	$74.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.24
Rate for Payer: Cigna Commercial	$124.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.40
Rate for Payer: Oxford Commercial	$49.60
Rate for Payer: Qualcare PPO/HMO/WC	$37.20
Rate for Payer: UnitedHealthcare Commercial	$49.60
Rate for Payer: UnitedHealthcare Community & State	$5.98
Rate for Payer: Wellpoint Medicaid Managed Care	$6.57

SURGICEL 4X8

Facility

$248.00

Hospital Charge Code	270060855
Hospital Revenue Code	272
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$37.20
Rate for Payer: Qualcare PPO/HMO/WC	$37.20

SURGICEL ABSORB HEMOSTAT

Facility

$153.65

Hospital Charge Code	6010185
Hospital Revenue Code	272
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$76.83
Rate for Payer: Aetna Commercial	$58.39
Rate for Payer: Aetna Medicare Advantage	$46.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.18
Rate for Payer: Cigna Commercial	$76.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.09
Rate for Payer: Oxford Commercial	$30.73
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$30.73
Rate for Payer: UnitedHealthcare Community & State	$3.70
Rate for Payer: Wellpoint Medicaid Managed Care	$4.07

SURGICEL ABSORB HEMOSTAT

Facility

$153.65

Hospital Charge Code	6010185
Hospital Revenue Code	272
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

SURGICEL FIB 2X4 HEMOSTAT 1962

Facility

$906.84

Hospital Charge Code	270632664
Hospital Revenue Code	272
Min. Negotiated Rate	$21.85
Max. Negotiated Rate	$453.42
Rate for Payer: Aetna Commercial	$344.60
Rate for Payer: Aetna Medicare Advantage	$272.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.24
Rate for Payer: Cigna Commercial	$453.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.05
Rate for Payer: Oxford Commercial	$181.37
Rate for Payer: Qualcare PPO/HMO/WC	$136.03
Rate for Payer: UnitedHealthcare Commercial	$181.37
Rate for Payer: UnitedHealthcare Community & State	$21.85
Rate for Payer: Wellpoint Medicaid Managed Care	$24.03

SURGICEL FIB 2X4 HEMOSTAT 1962

Facility

$906.84

Hospital Charge Code	270632664
Hospital Revenue Code	272
Min. Negotiated Rate	$136.03
Max. Negotiated Rate	$136.03
Rate for Payer: Qualcare PPO/HMO/WC	$136.03

SURGICEL HEMOSTAT 2 X 0.5

Facility

$6.00

Hospital Charge Code	60634736
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare Advantage	$1.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.53
Rate for Payer: Cigna Commercial	$3.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

SURGICEL HEMOSTAT 2 X 0.5

Facility

$6.00

Hospital Charge Code	60634736
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

Know your out-of-pocket cost for care.

All Charges