Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TAPE ELASTOPLAST 4

Facility

$22.04

Hospital Charge Code	270350150
Hospital Revenue Code	272
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$3.31
Rate for Payer: Qualcare PPO/HMO/WC	$3.31

TAPE ELASTOPLAST 4

Facility

$22.04

Hospital Charge Code	270350150
Hospital Revenue Code	272
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$11.02
Rate for Payer: Aetna Commercial	$8.38
Rate for Payer: Aetna Medicare Advantage	$6.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.62
Rate for Payer: Cigna Commercial	$11.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.61
Rate for Payer: Oxford Commercial	$4.41
Rate for Payer: Qualcare PPO/HMO/WC	$3.31
Rate for Payer: UnitedHealthcare Commercial	$4.41
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.58

TAPE ELASTOPLAST 4*********

Facility

$24.00

Hospital Charge Code	8000697
Hospital Revenue Code	279
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

TAPE ELASTOPLAST 4*********

Facility

$24.00

Hospital Charge Code	8000697
Hospital Revenue Code	279
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$9.12
Rate for Payer: Aetna Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.12
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.20
Rate for Payer: Oxford Commercial	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Commercial	$4.80
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

TAPE EMERGENCY TAPE EDITION A

Facility

$167.00

Hospital Charge Code	270611452
Hospital Revenue Code	280
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$2,789.00
Rate for Payer: Aetna Commercial	$63.46
Rate for Payer: Aetna Medicare Advantage	$50.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.59
Rate for Payer: Cigna Commercial	$83.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.10
Rate for Payer: Oxford Commercial	$1,591.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.05
Rate for Payer: UnitedHealthcare Commercial	$2,789.00
Rate for Payer: UnitedHealthcare Community & State	$4.02
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

TAPE EMERGENCY TAPE EDITION A

Facility

$167.00

Hospital Charge Code	270611452
Hospital Revenue Code	280
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$25.05

TAPE GLOW N TELL STERILE

Facility

$99.90

Hospital Charge Code	2703000877
Hospital Revenue Code	272
Min. Negotiated Rate	$14.98
Max. Negotiated Rate	$14.98
Rate for Payer: Qualcare PPO/HMO/WC	$14.98

TAPE GLOW N TELL STERILE

Facility

$99.90

Hospital Charge Code	2703000877
Hospital Revenue Code	272
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$49.95
Rate for Payer: Aetna Commercial	$37.96
Rate for Payer: Aetna Medicare Advantage	$29.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.47
Rate for Payer: Cigna Commercial	$49.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.97
Rate for Payer: Oxford Commercial	$19.98
Rate for Payer: Qualcare PPO/HMO/WC	$14.98
Rate for Payer: UnitedHealthcare Commercial	$19.98
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

TAPE GLOW & TELL 051492-S20

Facility

$209.75

Hospital Charge Code	270600423
Hospital Revenue Code	270
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$104.88
Rate for Payer: Aetna Commercial	$79.70
Rate for Payer: Aetna Medicare Advantage	$62.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.49
Rate for Payer: Cigna Commercial	$104.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.92
Rate for Payer: Oxford Commercial	$41.95
Rate for Payer: Qualcare PPO/HMO/WC	$31.46
Rate for Payer: UnitedHealthcare Commercial	$41.95
Rate for Payer: UnitedHealthcare Community & State	$5.05
Rate for Payer: Wellpoint Medicaid Managed Care	$5.56

TAPE GLOW & TELL 051492-S20

Facility

$209.75

Hospital Charge Code	270600423
Hospital Revenue Code	270
Min. Negotiated Rate	$31.46
Max. Negotiated Rate	$31.46
Rate for Payer: Qualcare PPO/HMO/WC	$31.46

TAPE LABEL 1.5 MM 36IN

Facility

$350.00

Hospital Charge Code	270667329
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

TAPE LABEL 1.5 MM 36IN

Facility

$350.00

Hospital Charge Code	270667329
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

TAPE MEDIPORE SOFT CLOTH 2862

Facility

$16.58

Hospital Charge Code	270649120
Hospital Revenue Code	272
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$2.49
Rate for Payer: Qualcare PPO/HMO/WC	$2.49

TAPE MEDIPORE SOFT CLOTH 2862

Facility

$16.58

Hospital Charge Code	270649120
Hospital Revenue Code	272
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$8.29
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Aetna Medicare Advantage	$4.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.23
Rate for Payer: Cigna Commercial	$8.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.97
Rate for Payer: Oxford Commercial	$3.32
Rate for Payer: Qualcare PPO/HMO/WC	$2.49
Rate for Payer: UnitedHealthcare Commercial	$3.32
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

TAPE MEDIPORE SOFT CLOTH 3x10

Facility

$25.17

Hospital Charge Code	270649121
Hospital Revenue Code	272
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$3.78
Rate for Payer: Qualcare PPO/HMO/WC	$3.78

TAPE MEDIPORE SOFT CLOTH 3x10

Facility

$25.17

Hospital Charge Code	270649121
Hospital Revenue Code	272
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$12.59
Rate for Payer: Aetna Commercial	$9.56
Rate for Payer: Aetna Medicare Advantage	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.42
Rate for Payer: Cigna Commercial	$12.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.55
Rate for Payer: Oxford Commercial	$5.03
Rate for Payer: Qualcare PPO/HMO/WC	$3.78
Rate for Payer: UnitedHealthcare Commercial	$5.03
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.67

TAPE MERSILENE 5MM 0S-8

Facility

$358.33

Hospital Charge Code	270655648
Hospital Revenue Code	270
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$179.16
Rate for Payer: Aetna Commercial	$136.17
Rate for Payer: Aetna Medicare Advantage	$107.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.37
Rate for Payer: Cigna Commercial	$179.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.50
Rate for Payer: Oxford Commercial	$71.67
Rate for Payer: Qualcare PPO/HMO/WC	$53.75
Rate for Payer: UnitedHealthcare Commercial	$71.67
Rate for Payer: UnitedHealthcare Community & State	$8.64
Rate for Payer: Wellpoint Medicaid Managed Care	$9.50

TAPE MERSILENE 5MM 0S-8

Facility

$358.33

Hospital Charge Code	270655648
Hospital Revenue Code	270
Min. Negotiated Rate	$53.75
Max. Negotiated Rate	$53.75
Rate for Payer: Qualcare PPO/HMO/WC	$53.75

TAPE MERSILENE 5MM OS-8 D9212

Facility

$289.65

Hospital Charge Code	270609130
Hospital Revenue Code	272
Min. Negotiated Rate	$6.98
Max. Negotiated Rate	$144.82
Rate for Payer: Aetna Commercial	$110.07
Rate for Payer: Aetna Medicare Advantage	$86.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.86
Rate for Payer: Cigna Commercial	$144.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$86.89
Rate for Payer: Oxford Commercial	$57.93
Rate for Payer: Qualcare PPO/HMO/WC	$43.45
Rate for Payer: UnitedHealthcare Commercial	$57.93
Rate for Payer: UnitedHealthcare Community & State	$6.98
Rate for Payer: Wellpoint Medicaid Managed Care	$7.68

TAPE MERSILENE 5MM OS-8 D9212

Facility

$289.65

Hospital Charge Code	270609130
Hospital Revenue Code	272
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$43.45
Rate for Payer: Qualcare PPO/HMO/WC	$43.45

TAPE MICRFOAM PATCH ******

Facility

$21.00

Hospital Charge Code	8001117
Hospital Revenue Code	279
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.50
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare Advantage	$6.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.36
Rate for Payer: Cigna Commercial	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.30
Rate for Payer: Oxford Commercial	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.15
Rate for Payer: UnitedHealthcare Commercial	$4.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

TAPE MICRFOAM PATCH ******

Facility

$21.00

Hospital Charge Code	8001117
Hospital Revenue Code	279
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.15
Rate for Payer: Qualcare PPO/HMO/WC	$3.15

TAPE MICRO FOAM 1

Facility

$30.32

Hospital Charge Code	270653207
Hospital Revenue Code	272
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.16
Rate for Payer: Aetna Commercial	$11.52
Rate for Payer: Aetna Medicare Advantage	$9.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.73
Rate for Payer: Cigna Commercial	$15.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.10
Rate for Payer: Oxford Commercial	$6.06
Rate for Payer: Qualcare PPO/HMO/WC	$4.55
Rate for Payer: UnitedHealthcare Commercial	$6.06
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

TAPE MICRO FOAM 1

Facility

$30.32

Hospital Charge Code	270653207
Hospital Revenue Code	272
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$4.55
Rate for Payer: Qualcare PPO/HMO/WC	$4.55

TAPE MICROFOAM 3

Facility

$1.00

Hospital Charge Code	270350255
Hospital Revenue Code	272
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

Know your out-of-pocket cost for care.

All Charges