Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DIALYSATE 2 K 3.5 CA SB1003

Facility

$22.45

Hospital Charge Code	270604646
Hospital Revenue Code	272
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.22
Rate for Payer: Aetna Commercial	$8.53
Rate for Payer: Aetna Medicare Advantage	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.72
Rate for Payer: Cigna Commercial	$11.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.74
Rate for Payer: Oxford Commercial	$4.49
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Commercial	$4.49
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

DIALYSATE 2 K 3.5 CA SB1003

Facility

$22.45

Hospital Charge Code	270604646
Hospital Revenue Code	272
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

DIALYSATE CAL-0 K-0 BAT SB1030

Facility

$22.45

Hospital Charge Code	270605244
Hospital Revenue Code	272
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

DIALYSATE CAL-0 K-0 BAT SB1030

Facility

$22.45

Hospital Charge Code	270605244
Hospital Revenue Code	272
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$11.22
Rate for Payer: Aetna Commercial	$8.53
Rate for Payer: Aetna Medicare Advantage	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.72
Rate for Payer: Cigna Commercial	$11.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.74
Rate for Payer: Oxford Commercial	$4.49
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Commercial	$4.49
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

DIALYSATE KIT #3

Facility

$26.45

Hospital Charge Code	8200347
Hospital Revenue Code	279
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$3.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.97

DIALYSATE KIT #3

Facility

$26.45

Hospital Charge Code	8200347
Hospital Revenue Code	279
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$13.22
Rate for Payer: Aetna Commercial	$10.05
Rate for Payer: Aetna Medicare Advantage	$7.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.74
Rate for Payer: Cigna Commercial	$13.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.93
Rate for Payer: Oxford Commercial	$5.29
Rate for Payer: Qualcare PPO/HMO/WC	$3.97
Rate for Payer: UnitedHealthcare Commercial	$5.29
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

DIALYSATE O K 2.5 CAL

Facility

$39.25

Hospital Charge Code	8200255
Hospital Revenue Code	272
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$5.89
Rate for Payer: Qualcare PPO/HMO/WC	$5.89

DIALYSATE O K 2.5 CAL

Facility

$39.25

Hospital Charge Code	8200255
Hospital Revenue Code	272
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$19.62
Rate for Payer: Aetna Commercial	$14.91
Rate for Payer: Aetna Medicare Advantage	$11.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.01
Rate for Payer: Cigna Commercial	$19.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.78
Rate for Payer: Oxford Commercial	$7.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.89
Rate for Payer: UnitedHealthcare Commercial	$7.85
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

DIALYSATE O K 3.5 CAL

Facility

$52.85

Hospital Charge Code	8200263
Hospital Revenue Code	272
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$26.43
Rate for Payer: Aetna Commercial	$20.08
Rate for Payer: Aetna Medicare Advantage	$15.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.48
Rate for Payer: Cigna Commercial	$26.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.86
Rate for Payer: Oxford Commercial	$10.57
Rate for Payer: Qualcare PPO/HMO/WC	$7.93
Rate for Payer: UnitedHealthcare Commercial	$10.57
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.40

DIALYSATE O K 3.5 CAL

Facility

$52.85

Hospital Charge Code	8200263
Hospital Revenue Code	272
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$7.93
Rate for Payer: Qualcare PPO/HMO/WC	$7.93

DIALYSATE SORB 10

Facility

$29.65

Hospital Charge Code	8200107
Hospital Revenue Code	272
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$14.82
Rate for Payer: Aetna Commercial	$11.27
Rate for Payer: Aetna Medicare Advantage	$8.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.56
Rate for Payer: Cigna Commercial	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.89
Rate for Payer: Oxford Commercial	$5.93
Rate for Payer: Qualcare PPO/HMO/WC	$4.45
Rate for Payer: UnitedHealthcare Commercial	$5.93
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

DIALYSATE SORB 10

Facility

$29.65

Hospital Charge Code	8200107
Hospital Revenue Code	272
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$4.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.45

DIALYSIS

Facility

$638.00

Service Code	HCPCS 99333
Hospital Charge Code	8200071
Hospital Revenue Code	841
Min. Negotiated Rate	$95.70
Max. Negotiated Rate	$95.70
Rate for Payer: Qualcare PPO/HMO/WC	$95.70

DIALYSIS

Facility

$3.00

Hospital Charge Code	270615571
Hospital Revenue Code	272
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.90
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

DIALYSIS

Facility

$150.51

Service Code	HCPCS 90999
Hospital Charge Code	8200040R
Hospital Revenue Code	821
Min. Negotiated Rate	$22.58
Max. Negotiated Rate	$22.58
Rate for Payer: Qualcare PPO/HMO/WC	$22.58

DIALYSIS

Facility

$185.00

Hospital Charge Code	270605310
Hospital Revenue Code	270
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

DIALYSIS

Facility

$15.40

Hospital Charge Code	8200321
Hospital Revenue Code	279
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

DIALYSIS

Facility

$615.70

Hospital Charge Code	8200032
Hospital Revenue Code	809
Min. Negotiated Rate	$14.84
Max. Negotiated Rate	$307.85
Rate for Payer: Aetna Commercial	$233.97
Rate for Payer: Aetna Medicare Advantage	$184.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.00
Rate for Payer: Cigna Commercial	$307.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$184.71
Rate for Payer: Oxford Commercial	$123.14
Rate for Payer: Qualcare PPO/HMO/WC	$92.36
Rate for Payer: UnitedHealthcare Commercial	$123.14
Rate for Payer: UnitedHealthcare Community & State	$14.84
Rate for Payer: Wellpoint Medicaid Managed Care	$16.32

DIALYSIS

Facility

$167.00

Hospital Charge Code	270605309
Hospital Revenue Code	270
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$25.05

DIALYSIS

Facility

$96.00

Hospital Charge Code	27059765
Hospital Revenue Code	271
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$14.40

DIALYSIS

Facility

$9.00

Hospital Charge Code	270616286
Hospital Revenue Code	270
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

DIALYSIS

Facility

$1,385.00

Hospital Charge Code	8200057
Hospital Revenue Code	803
Min. Negotiated Rate	$207.75
Max. Negotiated Rate	$207.75
Rate for Payer: Qualcare PPO/HMO/WC	$207.75

DIALYSIS

Facility

$167.00

Hospital Charge Code	270605309
Hospital Revenue Code	270
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$83.50
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	$33.40
Rate for Payer: Qualcare PPO/HMO/WC	$25.05
Rate for Payer: UnitedHealthcare Commercial	$33.40
Rate for Payer: UnitedHealthcare Community & State	$4.02
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

DIALYSIS

Facility

$4,500.00

Service Code	HCPCS 90961
Hospital Charge Code	8200042
Hospital Revenue Code	821
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

DIALYSIS

Facility

$46.25

Hospital Charge Code	260120
Hospital Revenue Code	771
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$17.57
Rate for Payer: Aetna Medicare Advantage	$13.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.79
Rate for Payer: Cigna Commercial	$23.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.88
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.94
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

Know your out-of-pocket cost for care.

All Charges