Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DIALYSIS

Facility

$210.00

Hospital Charge Code	8200149
Hospital Revenue Code	271
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.50

DIALYSIS

Facility

$797.45

Hospital Charge Code	270606376
Hospital Revenue Code	820
Min. Negotiated Rate	$19.22
Max. Negotiated Rate	$4,468.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$203.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$203.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$203.35
Rate for Payer: Cigna Commercial	$398.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$239.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$700.00
Rate for Payer: Oxford Commercial	$2,546.00
Rate for Payer: Qualcare PPO/HMO/WC	$119.62
Rate for Payer: UnitedHealthcare Commercial	$4,468.00
Rate for Payer: UnitedHealthcare Community & State	$19.22
Rate for Payer: Wellpoint Medicaid Managed Care	$21.13

DIALYSIS

Facility

$648.00

Hospital Charge Code	27059772
Hospital Revenue Code	271
Min. Negotiated Rate	$97.20
Max. Negotiated Rate	$97.20
Rate for Payer: Qualcare PPO/HMO/WC	$97.20

DIALYSIS

Facility

$395.55

Hospital Charge Code	270607581
Hospital Revenue Code	809
Min. Negotiated Rate	$59.33
Max. Negotiated Rate	$59.33
Rate for Payer: Qualcare PPO/HMO/WC	$59.33

DIALYSIS

Facility

$207.00

Hospital Charge Code	27059767
Hospital Revenue Code	271
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna Commercial	$78.66
Rate for Payer: Aetna Medicare Advantage	$62.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.78
Rate for Payer: Cigna Commercial	$103.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.10
Rate for Payer: Oxford Commercial	$41.40
Rate for Payer: Qualcare PPO/HMO/WC	$31.05
Rate for Payer: UnitedHealthcare Commercial	$41.40
Rate for Payer: UnitedHealthcare Community & State	$4.99
Rate for Payer: Wellpoint Medicaid Managed Care	$5.49

DIALYSIS

Facility

$988.00

Hospital Charge Code	270607808
Hospital Revenue Code	270
Min. Negotiated Rate	$23.81
Max. Negotiated Rate	$494.00
Rate for Payer: Aetna Commercial	$375.44
Rate for Payer: Aetna Medicare Advantage	$296.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.94
Rate for Payer: Cigna Commercial	$494.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.40
Rate for Payer: Oxford Commercial	$197.60
Rate for Payer: Qualcare PPO/HMO/WC	$148.20
Rate for Payer: UnitedHealthcare Commercial	$197.60
Rate for Payer: UnitedHealthcare Community & State	$23.81
Rate for Payer: Wellpoint Medicaid Managed Care	$26.18

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

$662.00

Hospital Charge Code	27059771
Hospital Revenue Code	271
Min. Negotiated Rate	$99.30
Max. Negotiated Rate	$99.30
Rate for Payer: Qualcare PPO/HMO/WC	$99.30

DIALYSIS

Facility

$1,035.25

Service Code	HCPCS 90920
Hospital Charge Code	8200045
Hospital Revenue Code	821
Min. Negotiated Rate	$155.29
Max. Negotiated Rate	$155.29
Rate for Payer: Qualcare PPO/HMO/WC	$155.29

DIALYSIS

Facility

$821.00

Hospital Charge Code	27059773
Hospital Revenue Code	271
Min. Negotiated Rate	$19.79
Max. Negotiated Rate	$410.50
Rate for Payer: Aetna Commercial	$311.98
Rate for Payer: Aetna Medicare Advantage	$246.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.35
Rate for Payer: Cigna Commercial	$410.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.30
Rate for Payer: Oxford Commercial	$164.20
Rate for Payer: Qualcare PPO/HMO/WC	$123.15
Rate for Payer: UnitedHealthcare Commercial	$164.20
Rate for Payer: UnitedHealthcare Community & State	$19.79
Rate for Payer: Wellpoint Medicaid Managed Care	$21.76

DIALYSIS

Facility

$106.00

Hospital Charge Code	27059766
Hospital Revenue Code	271
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$53.00
Rate for Payer: Aetna Commercial	$40.28
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.80
Rate for Payer: Oxford Commercial	$21.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$21.20
Rate for Payer: UnitedHealthcare Community & State	$2.55
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

DIALYSIS

Facility

$154.00

Hospital Charge Code	8200081
Hospital Revenue Code	272
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$77.00
Rate for Payer: Aetna Commercial	$58.52
Rate for Payer: Aetna Medicare Advantage	$46.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.27
Rate for Payer: Cigna Commercial	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.20
Rate for Payer: Oxford Commercial	$30.80
Rate for Payer: Qualcare PPO/HMO/WC	$23.10
Rate for Payer: UnitedHealthcare Commercial	$30.80
Rate for Payer: UnitedHealthcare Community & State	$3.71
Rate for Payer: Wellpoint Medicaid Managed Care	$4.08

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

$156.00

Hospital Charge Code	270614258
Hospital Revenue Code	270
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$23.40

DIALYSIS

Facility

$46.25

Hospital Charge Code	260120
Hospital Revenue Code	771
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$6.94
Rate for Payer: Qualcare PPO/HMO/WC	$6.94

DIALYSIS

Facility

$1,035.25

Service Code	HCPCS 90920
Hospital Charge Code	8200045
Hospital Revenue Code	821
Min. Negotiated Rate	$24.95
Max. Negotiated Rate	$4,468.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.99
Rate for Payer: Cigna Commercial	$517.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$310.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$700.00
Rate for Payer: Oxford Commercial	$2,546.00
Rate for Payer: Qualcare PPO/HMO/WC	$155.29
Rate for Payer: UnitedHealthcare Commercial	$4,468.00
Rate for Payer: UnitedHealthcare Community & State	$24.95
Rate for Payer: Wellpoint Medicaid Managed Care	$27.43

DIALYSIS

Facility

$262.00

Hospital Charge Code	8200461
Hospital Revenue Code	271
Min. Negotiated Rate	$39.30
Max. Negotiated Rate	$39.30
Rate for Payer: Qualcare PPO/HMO/WC	$39.30

DIALYSIS ACCESS SYSTEM

Facility

$21.40

Service Code	HCPCS C1881
Hospital Charge Code	4800905
Hospital Revenue Code	278
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$10.70
Rate for Payer: Aetna Commercial	$8.13
Rate for Payer: Aetna Medicare Advantage	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.46
Rate for Payer: Cigna Commercial	$10.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4.71
Rate for Payer: Qualcare PPO/HMO/WC	$3.21
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.57

DIALYSIS ACCESS SYSTEM

Facility

$21.40

Service Code	HCPCS C1881
Hospital Charge Code	4800905
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4.71
Rate for Payer: Qualcare PPO/HMO/WC	$3.21

DIALYZER GFS+20

Facility

$150.45

Hospital Charge Code	270605472
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

DIALYZER GFS+20

Facility

$150.45

Hospital Charge Code	270605472
Hospital Revenue Code	272
Min. Negotiated Rate	$22.57
Max. Negotiated Rate	$22.57
Rate for Payer: Qualcare PPO/HMO/WC	$22.57

DIALYZER HIGH FLUX 160

Facility

$47.50

Hospital Charge Code	270639657
Hospital Revenue Code	272
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$7.12

DIALYZER HIGH FLUX 160

Facility

$47.50

Hospital Charge Code	270639657
Hospital Revenue Code	272
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.75
Rate for Payer: Aetna Commercial	$18.05
Rate for Payer: Aetna Medicare Advantage	$14.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.11
Rate for Payer: Cigna Commercial	$23.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.25
Rate for Payer: Oxford Commercial	$9.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.12
Rate for Payer: UnitedHealthcare Commercial	$9.50
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.26

DIALYZER HIGH FLUX 180

Facility

$70.00

Hospital Charge Code	270641822
Hospital Revenue Code	272
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

DIALYZER HIGH FLUX 180

Facility

$70.00

Hospital Charge Code	270641822
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial	$26.60
Rate for Payer: Aetna Medicare Advantage	$21.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.85
Rate for Payer: Cigna Commercial	$35.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.00
Rate for Payer: Oxford Commercial	$14.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.50
Rate for Payer: UnitedHealthcare Commercial	$14.00
Rate for Payer: UnitedHealthcare Community & State	$1.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1.85

Know your out-of-pocket cost for care.

All Charges