Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

ABSORB COLLAGEN HEMOSTAT 1X2

Facility

$88.00

Hospital Charge Code	6016109
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

ABSORB COLLAGEN HEMOST FIBRILL

Facility

$125.63

Service Code	NDC 66977031001
Hospital Charge Code	60627503
Hospital Revenue Code	250
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$18.84
Rate for Payer: Qualcare PPO/HMO/WC	$18.84

ABSORB COLLAGEN HEMOST FIBRILL

Facility

$125.63

Service Code	NDC 66977031001
Hospital Charge Code	60627503
Hospital Revenue Code	250
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$62.81
Rate for Payer: Aetna Commercial	$47.74
Rate for Payer: Aetna Medicare Advantage	$37.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.04
Rate for Payer: Cigna Commercial	$62.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.69
Rate for Payer: Oxford Commercial	$25.13
Rate for Payer: Qualcare PPO/HMO/WC	$18.84
Rate for Payer: UnitedHealthcare Commercial	$25.13
Rate for Payer: UnitedHealthcare Community & State	$3.03
Rate for Payer: Wellpoint Medicaid Managed Care	$3.33

ABSORBENT PAD 23INx40IN

Facility

$52.23

Hospital Charge Code	270665156
Hospital Revenue Code	270
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$7.83
Rate for Payer: Qualcare PPO/HMO/WC	$7.83

ABSORBENT PAD 23INx40IN

Facility

$52.23

Hospital Charge Code	270665156
Hospital Revenue Code	270
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$26.11
Rate for Payer: Aetna Commercial	$19.85
Rate for Payer: Aetna Medicare Advantage	$15.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.32
Rate for Payer: Cigna Commercial	$26.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.67
Rate for Payer: Oxford Commercial	$10.45
Rate for Payer: Qualcare PPO/HMO/WC	$7.83
Rate for Payer: UnitedHealthcare Commercial	$10.45
Rate for Payer: UnitedHealthcare Community & State	$1.26
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

ABSORBENT PAD 46INX72IN

Facility

$175.45

Hospital Charge Code	270665157
Hospital Revenue Code	270
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$26.32
Rate for Payer: Qualcare PPO/HMO/WC	$26.32

ABSORBENT PAD 46INX72IN

Facility

$175.45

Hospital Charge Code	270665157
Hospital Revenue Code	270
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$87.72
Rate for Payer: Aetna Commercial	$66.67
Rate for Payer: Aetna Medicare Advantage	$52.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.74
Rate for Payer: Cigna Commercial	$87.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.63
Rate for Payer: Oxford Commercial	$35.09
Rate for Payer: Qualcare PPO/HMO/WC	$26.32
Rate for Payer: UnitedHealthcare Commercial	$35.09
Rate for Payer: UnitedHealthcare Community & State	$4.23
Rate for Payer: Wellpoint Medicaid Managed Care	$4.65

ABSORB GEL FILM OPHTH

Facility

$82.60

Hospital Charge Code	6005755
Hospital Revenue Code	250
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$41.30
Rate for Payer: Aetna Commercial	$31.39
Rate for Payer: Aetna Medicare Advantage	$24.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.06
Rate for Payer: Cigna Commercial	$41.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.78
Rate for Payer: Oxford Commercial	$16.52
Rate for Payer: Qualcare PPO/HMO/WC	$12.39
Rate for Payer: UnitedHealthcare Commercial	$16.52
Rate for Payer: UnitedHealthcare Community & State	$1.99
Rate for Payer: Wellpoint Medicaid Managed Care	$2.19

ABSORB GEL FILM OPHTH

Facility

$82.60

Hospital Charge Code	6005755
Hospital Revenue Code	250
Min. Negotiated Rate	$12.39
Max. Negotiated Rate	$12.39
Rate for Payer: Qualcare PPO/HMO/WC	$12.39

ABSORB GEL SPNG SZ100

Facility

$53.80

Hospital Charge Code	6005748
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$26.90
Rate for Payer: Aetna Commercial	$20.44
Rate for Payer: Aetna Medicare Advantage	$16.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.72
Rate for Payer: Cigna Commercial	$26.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.14
Rate for Payer: Oxford Commercial	$10.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.07
Rate for Payer: UnitedHealthcare Commercial	$10.76
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

ABSORB GEL SPNG SZ100

Facility

$53.80

Hospital Charge Code	6005748
Hospital Revenue Code	250
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$8.07

ABSORB GEL SPNG SZ12-3

Facility

$37.80

Hospital Charge Code	6005714
Hospital Revenue Code	250
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

ABSORB GEL SPNG SZ12-3

Facility

$37.80

Hospital Charge Code	6005714
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$14.36
Rate for Payer: Aetna Medicare Advantage	$11.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.34
Rate for Payer: Oxford Commercial	$7.56
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$7.56
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

ABSORB GEL SPNG SZ12-7

Facility

$60.37

Service Code	NDC 9034201
Hospital Charge Code	60627526
Hospital Revenue Code	270
Min. Negotiated Rate	$9.06
Max. Negotiated Rate	$9.06
Rate for Payer: Qualcare PPO/HMO/WC	$9.06

ABSORB GEL SPNG SZ12-7

Facility

$34.60

Hospital Charge Code	6005722
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$17.30
Rate for Payer: Aetna Commercial	$13.15
Rate for Payer: Aetna Medicare Advantage	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.82
Rate for Payer: Cigna Commercial	$17.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.38
Rate for Payer: Oxford Commercial	$6.92
Rate for Payer: Qualcare PPO/HMO/WC	$5.19
Rate for Payer: UnitedHealthcare Commercial	$6.92
Rate for Payer: UnitedHealthcare Community & State	$0.83
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

ABSORB GEL SPNG SZ12-7

Facility

$34.60

Hospital Charge Code	6005722
Hospital Revenue Code	250
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$5.19
Rate for Payer: Qualcare PPO/HMO/WC	$5.19

ABSORB GEL SPNG SZ12-7

Facility

$60.37

Service Code	NDC 9034201
Hospital Charge Code	60627526
Hospital Revenue Code	270
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$30.18
Rate for Payer: Aetna Commercial	$22.94
Rate for Payer: Aetna Medicare Advantage	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.39
Rate for Payer: Cigna Commercial	$30.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.11
Rate for Payer: Oxford Commercial	$12.07
Rate for Payer: Qualcare PPO/HMO/WC	$9.06
Rate for Payer: UnitedHealthcare Commercial	$12.07
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.60

ABSORB GEL SPNG SZ 18

Facility

$604.20

Hospital Charge Code	60627527
Hospital Revenue Code	250
Min. Negotiated Rate	$90.63
Max. Negotiated Rate	$90.63
Rate for Payer: Qualcare PPO/HMO/WC	$90.63

ABSORB GEL SPNG SZ 18

Facility

$604.20

Hospital Charge Code	60627527
Hospital Revenue Code	250
Min. Negotiated Rate	$14.56
Max. Negotiated Rate	$302.10
Rate for Payer: Aetna Commercial	$229.60
Rate for Payer: Aetna Medicare Advantage	$181.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.07
Rate for Payer: Cigna Commercial	$302.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.26
Rate for Payer: Oxford Commercial	$120.84
Rate for Payer: Qualcare PPO/HMO/WC	$90.63
Rate for Payer: UnitedHealthcare Commercial	$120.84
Rate for Payer: UnitedHealthcare Community & State	$14.56
Rate for Payer: Wellpoint Medicaid Managed Care	$16.01

ABSORB GEL SPNG SZ 50

Facility

$109.45

Hospital Charge Code	6005730
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$54.73
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$32.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.91
Rate for Payer: Cigna Commercial	$54.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.84
Rate for Payer: Oxford Commercial	$21.89
Rate for Payer: Qualcare PPO/HMO/WC	$16.42
Rate for Payer: UnitedHealthcare Commercial	$21.89
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.90

ABSORB GEL SPNG SZ 50

Facility

$109.45

Hospital Charge Code	6005730
Hospital Revenue Code	250
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$16.42
Rate for Payer: Qualcare PPO/HMO/WC	$16.42

ABSORB STACK 15

Facility

$16,981.90

Hospital Charge Code	270657454
Hospital Revenue Code	278
Min. Negotiated Rate	$2,547.28
Max. Negotiated Rate	$4,109.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,396.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,109.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,736.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,547.28

ABSORB STACK 15

Facility

$16,981.90

Hospital Charge Code	270657454
Hospital Revenue Code	278
Min. Negotiated Rate	$409.26
Max. Negotiated Rate	$8,490.95
Rate for Payer: Aetna Commercial	$6,453.12
Rate for Payer: Aetna Medicare Advantage	$5,094.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,330.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,330.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,396.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,330.38
Rate for Payer: Cigna Commercial	$8,490.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,109.62
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,736.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,547.28
Rate for Payer: UnitedHealthcare Community & State	$409.26
Rate for Payer: Wellpoint Medicaid Managed Care	$450.02

ABSORBTACK 20 TACK SHORT

Facility

$1,944.38

Hospital Charge Code	270657453
Hospital Revenue Code	272
Min. Negotiated Rate	$46.86
Max. Negotiated Rate	$972.19
Rate for Payer: Aetna Commercial	$738.86
Rate for Payer: Aetna Medicare Advantage	$583.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$495.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$495.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$495.82
Rate for Payer: Cigna Commercial	$972.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$583.31
Rate for Payer: Oxford Commercial	$388.88
Rate for Payer: Qualcare PPO/HMO/WC	$291.66
Rate for Payer: UnitedHealthcare Commercial	$388.88
Rate for Payer: UnitedHealthcare Community & State	$46.86
Rate for Payer: Wellpoint Medicaid Managed Care	$51.53

ABSORBTACK 20 TACK SHORT

Facility

$1,944.38

Hospital Charge Code	270657453
Hospital Revenue Code	272
Min. Negotiated Rate	$291.66
Max. Negotiated Rate	$291.66
Rate for Payer: Qualcare PPO/HMO/WC	$291.66

Know your out-of-pocket cost for care.

All Charges