Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

TAPE MICROFOAM 3

Facility

$1.00

Hospital Charge Code	270350255
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

TAPE MICROFOAM 3 ROLL ******

Facility

$47.00

Hospital Charge Code	8001109
Hospital Revenue Code	279
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$23.50
Rate for Payer: Aetna Commercial	$17.86
Rate for Payer: Aetna Medicare Advantage	$14.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.98
Rate for Payer: Cigna Commercial	$23.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.10
Rate for Payer: Oxford Commercial	$9.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.05
Rate for Payer: UnitedHealthcare Commercial	$9.40
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

TAPE MICROFOAM 3 ROLL ******

Facility

$47.00

Hospital Charge Code	8001109
Hospital Revenue Code	279
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$7.05
Rate for Payer: Qualcare PPO/HMO/WC	$7.05

TAPE MICROFOAM PATCH

Facility

$13.65

Hospital Charge Code	270350235
Hospital Revenue Code	272
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

TAPE MICROFOAM PATCH

Facility

$13.65

Hospital Charge Code	270350235
Hospital Revenue Code	272
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.09
Rate for Payer: Oxford Commercial	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$2.73
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

TAPE MICROPORE 1

Facility

$1.00

Hospital Charge Code	270350240
Hospital Revenue Code	270
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

TAPE MICROPORE 1

Facility

$1.00

Hospital Charge Code	270350240
Hospital Revenue Code	270
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

TAPE MICROPORE 1 ROLL *****

Facility

$2.00

Hospital Charge Code	8001174
Hospital Revenue Code	279
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

TAPE MICROPORE 1 ROLL *****

Facility

$2.00

Hospital Charge Code	8001174
Hospital Revenue Code	279
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

TAPE MICROPORE 2

Facility

$1.00

Hospital Charge Code	270350245
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

TAPE MICROPORE 2

Facility

$1.00

Hospital Charge Code	270350245
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

TAPE MICROPORE 2 ROLL ******

Facility

$5.00

Hospital Charge Code	8001182
Hospital Revenue Code	279
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

TAPE MICROPORE 2 ROLL ******

Facility

$5.00

Hospital Charge Code	8001182
Hospital Revenue Code	279
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TAPER ADAPTER STD NECK

Facility

$635.00

Service Code	HCPCS C1776
Hospital Charge Code	270645467
Hospital Revenue Code	278
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$317.50
Rate for Payer: Aetna Commercial	$241.30
Rate for Payer: Aetna Medicare Advantage	$190.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.93
Rate for Payer: Cigna Commercial	$317.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$139.70
Rate for Payer: Qualcare PPO/HMO/WC	$95.25
Rate for Payer: UnitedHealthcare Community & State	$15.30
Rate for Payer: Wellpoint Medicaid Managed Care	$16.83

TAPER ADAPTER STD NECK

Facility

$635.00

Service Code	HCPCS C1776
Hospital Charge Code	270645467
Hospital Revenue Code	278
Min. Negotiated Rate	$95.25
Max. Negotiated Rate	$153.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$139.70
Rate for Payer: Qualcare PPO/HMO/WC	$95.25

TAPER DELTA C 36 MM -5

Facility

$4,799.25

Service Code	HCPCS C1776
Hospital Charge Code	270691974
Hospital Revenue Code	278
Min. Negotiated Rate	$719.89
Max. Negotiated Rate	$1,161.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$959.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,055.84
Rate for Payer: Qualcare PPO/HMO/WC	$719.89

TAPER DELTA C 36 MM -5

Facility

$4,799.25

Service Code	HCPCS C1776
Hospital Charge Code	270691974
Hospital Revenue Code	278
Min. Negotiated Rate	$115.66
Max. Negotiated Rate	$2,399.62
Rate for Payer: Aetna Commercial	$1,823.71
Rate for Payer: Aetna Medicare Advantage	$1,439.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,223.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,223.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$959.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,223.81
Rate for Payer: Cigna Commercial	$2,399.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,055.84
Rate for Payer: Qualcare PPO/HMO/WC	$719.89
Rate for Payer: UnitedHealthcare Community & State	$115.66
Rate for Payer: Wellpoint Medicaid Managed Care	$127.18

TAPER ECCENTRICAL ADAPTOR +4MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672316
Hospital Revenue Code	278
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$36.15
Rate for Payer: Wellpoint Medicaid Managed Care	$39.75

TAPER ECCENTRICAL ADAPTOR +4MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672316
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$330.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

TAPERED DRILL SIZE 3 AND 4

Facility

$1,375.00

Hospital Charge Code	270656324
Hospital Revenue Code	271
Min. Negotiated Rate	$206.25
Max. Negotiated Rate	$206.25
Rate for Payer: Qualcare PPO/HMO/WC	$206.25

TAPERED DRILL SIZE 3 AND 4

Facility

$1,375.00

Hospital Charge Code	270656324
Hospital Revenue Code	271
Min. Negotiated Rate	$33.14
Max. Negotiated Rate	$687.50
Rate for Payer: Aetna Commercial	$522.50
Rate for Payer: Aetna Medicare Advantage	$412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.62
Rate for Payer: Cigna Commercial	$687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.50
Rate for Payer: Oxford Commercial	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$206.25
Rate for Payer: UnitedHealthcare Commercial	$275.00
Rate for Payer: UnitedHealthcare Community & State	$33.14
Rate for Payer: Wellpoint Medicaid Managed Care	$36.44

TAPERED ROUTER 2.3X22MM

Facility

$395.00

Hospital Charge Code	270691577
Hospital Revenue Code	272
Min. Negotiated Rate	$59.25
Max. Negotiated Rate	$59.25
Rate for Payer: Qualcare PPO/HMO/WC	$59.25

TAPERED ROUTER 2.3X22MM

Facility

$395.00

Hospital Charge Code	270691577
Hospital Revenue Code	272
Min. Negotiated Rate	$9.52
Max. Negotiated Rate	$197.50
Rate for Payer: Aetna Commercial	$150.10
Rate for Payer: Aetna Medicare Advantage	$118.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.72
Rate for Payer: Cigna Commercial	$197.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.50
Rate for Payer: Oxford Commercial	$79.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.25
Rate for Payer: UnitedHealthcare Commercial	$79.00
Rate for Payer: UnitedHealthcare Community & State	$9.52
Rate for Payer: Wellpoint Medicaid Managed Care	$10.47

TAPERED ROUTER D-58 1.7X16MM

Facility

$603.75

Hospital Charge Code	270676208
Hospital Revenue Code	272
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$301.88
Rate for Payer: Aetna Commercial	$229.43
Rate for Payer: Aetna Medicare Advantage	$181.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.96
Rate for Payer: Cigna Commercial	$301.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.12
Rate for Payer: Oxford Commercial	$120.75
Rate for Payer: Qualcare PPO/HMO/WC	$90.56
Rate for Payer: UnitedHealthcare Commercial	$120.75
Rate for Payer: UnitedHealthcare Community & State	$14.55
Rate for Payer: Wellpoint Medicaid Managed Care	$16.00

TAPERED ROUTER D-58 1.7X16MM

Facility

$603.75

Hospital Charge Code	270676208
Hospital Revenue Code	272
Min. Negotiated Rate	$90.56
Max. Negotiated Rate	$90.56
Rate for Payer: Qualcare PPO/HMO/WC	$90.56

Know your out-of-pocket cost for care.

All Charges