Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DIALYZER HIGH FLUX 200

Facility

$64.38

Hospital Charge Code	270647287
Hospital Revenue Code	271
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$9.66
Rate for Payer: Qualcare PPO/HMO/WC	$9.66

DIALYZER HIGH FLUX 200

Facility

$64.38

Hospital Charge Code	270647287
Hospital Revenue Code	271
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$32.19
Rate for Payer: Aetna Commercial	$24.46
Rate for Payer: Aetna Medicare Advantage	$19.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.42
Rate for Payer: Cigna Commercial	$32.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.31
Rate for Payer: Oxford Commercial	$12.88
Rate for Payer: Qualcare PPO/HMO/WC	$9.66
Rate for Payer: UnitedHealthcare Commercial	$12.88
Rate for Payer: UnitedHealthcare Community & State	$1.55
Rate for Payer: Wellpoint Medicaid Managed Care	$1.71

DIALYZER HIGH FLUX F250 OPTIFL

Facility

$72.10

Hospital Charge Code	270678522
Hospital Revenue Code	272
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$36.05
Rate for Payer: Aetna Commercial	$27.40
Rate for Payer: Aetna Medicare Advantage	$21.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.39
Rate for Payer: Cigna Commercial	$36.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.63
Rate for Payer: Oxford Commercial	$14.42
Rate for Payer: Qualcare PPO/HMO/WC	$10.81
Rate for Payer: UnitedHealthcare Commercial	$14.42
Rate for Payer: UnitedHealthcare Community & State	$1.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

DIALYZER HIGH FLUX F250 OPTIFL

Facility

$72.10

Hospital Charge Code	270678522
Hospital Revenue Code	272
Min. Negotiated Rate	$10.81
Max. Negotiated Rate	$10.81
Rate for Payer: Qualcare PPO/HMO/WC	$10.81

DIAMETER HEAD 40mm MINUS 3mm

Facility

$8,160.00

Hospital Charge Code	270664897
Hospital Revenue Code	278
Min. Negotiated Rate	$1,224.00
Max. Negotiated Rate	$1,974.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,632.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,974.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,795.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,224.00

DIAMETER HEAD 40mm MINUS 3mm

Facility

$8,160.00

Hospital Charge Code	270664897
Hospital Revenue Code	278
Min. Negotiated Rate	$196.66
Max. Negotiated Rate	$4,080.00
Rate for Payer: Aetna Commercial	$3,100.80
Rate for Payer: Aetna Medicare Advantage	$2,448.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,080.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,080.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,632.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,080.80
Rate for Payer: Cigna Commercial	$4,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,974.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,795.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,224.00
Rate for Payer: UnitedHealthcare Community & State	$196.66
Rate for Payer: Wellpoint Medicaid Managed Care	$216.24

DIAMONDBACK 360 1.25 MICRO CRO

Facility

$23,975.00

Hospital Charge Code	270666949
Hospital Revenue Code	270
Min. Negotiated Rate	$577.80
Max. Negotiated Rate	$11,987.50
Rate for Payer: Aetna Commercial	$9,110.50
Rate for Payer: Aetna Medicare Advantage	$7,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,113.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,113.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,113.62
Rate for Payer: Cigna Commercial	$11,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,192.50
Rate for Payer: Oxford Commercial	$4,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,596.25
Rate for Payer: UnitedHealthcare Commercial	$4,795.00
Rate for Payer: UnitedHealthcare Community & State	$577.80
Rate for Payer: Wellpoint Medicaid Managed Care	$635.34

DIAMONDBACK 360 1.25 MICRO CRO

Facility

$23,975.00

Hospital Charge Code	270666949
Hospital Revenue Code	270
Min. Negotiated Rate	$3,596.25
Max. Negotiated Rate	$3,596.25
Rate for Payer: Qualcare PPO/HMO/WC	$3,596.25

DIAMONDBACK 360 1.25 SOLID CRO

Facility

$23,975.00

Hospital Charge Code	270666950
Hospital Revenue Code	270
Min. Negotiated Rate	$577.80
Max. Negotiated Rate	$11,987.50
Rate for Payer: Aetna Commercial	$9,110.50
Rate for Payer: Aetna Medicare Advantage	$7,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,113.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,113.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,113.62
Rate for Payer: Cigna Commercial	$11,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,192.50
Rate for Payer: Oxford Commercial	$4,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,596.25
Rate for Payer: UnitedHealthcare Commercial	$4,795.00
Rate for Payer: UnitedHealthcare Community & State	$577.80
Rate for Payer: Wellpoint Medicaid Managed Care	$635.34

DIAMONDBACK 360 1.25 SOLID CRO

Facility

$23,975.00

Hospital Charge Code	270666950
Hospital Revenue Code	270
Min. Negotiated Rate	$3,596.25
Max. Negotiated Rate	$3,596.25
Rate for Payer: Qualcare PPO/HMO/WC	$3,596.25

DIAMONDBCK 360 1.25MM SLD CRWN

Facility

$16,975.00

Service Code	HCPCS C1724
Hospital Charge Code	270677737
Hospital Revenue Code	278
Min. Negotiated Rate	$2,546.25
Max. Negotiated Rate	$4,107.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,107.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,734.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,546.25

DIAMONDBCK 360 1.25MM SLD CRWN

Facility

$16,975.00

Service Code	HCPCS C1724
Hospital Charge Code	270677737
Hospital Revenue Code	278
Min. Negotiated Rate	$409.10
Max. Negotiated Rate	$8,487.50
Rate for Payer: Aetna Commercial	$6,450.50
Rate for Payer: Aetna Medicare Advantage	$5,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,328.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,328.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,328.62
Rate for Payer: Cigna Commercial	$8,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,107.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,734.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,546.25
Rate for Payer: UnitedHealthcare Community & State	$409.10
Rate for Payer: Wellpoint Medicaid Managed Care	$449.84

DIAMOND BURR

Facility

$4,125.00

Hospital Charge Code	270703249
Hospital Revenue Code	272
Min. Negotiated Rate	$99.41
Max. Negotiated Rate	$2,062.50
Rate for Payer: Aetna Commercial	$1,567.50
Rate for Payer: Aetna Medicare Advantage	$1,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.88
Rate for Payer: Cigna Commercial	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,237.50
Rate for Payer: Oxford Commercial	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$618.75
Rate for Payer: UnitedHealthcare Commercial	$825.00
Rate for Payer: UnitedHealthcare Community & State	$99.41
Rate for Payer: Wellpoint Medicaid Managed Care	$109.31

DIAMOND BURR

Facility

$2,275.00

Hospital Charge Code	2707014146
Hospital Revenue Code	272
Min. Negotiated Rate	$341.25
Max. Negotiated Rate	$341.25
Rate for Payer: Qualcare PPO/HMO/WC	$341.25

DIAMOND BURR

Facility

$4,125.00

Hospital Charge Code	270703249
Hospital Revenue Code	272
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$618.75
Rate for Payer: Qualcare PPO/HMO/WC	$618.75

DIAMOND BURR

Facility

$2,275.00

Hospital Charge Code	270704146
Hospital Revenue Code	272
Min. Negotiated Rate	$341.25
Max. Negotiated Rate	$341.25
Rate for Payer: Qualcare PPO/HMO/WC	$341.25

DIAMOND BURR

Facility

$2,275.00

Hospital Charge Code	2707014146
Hospital Revenue Code	272
Min. Negotiated Rate	$54.83
Max. Negotiated Rate	$1,137.50
Rate for Payer: Aetna Commercial	$864.50
Rate for Payer: Aetna Medicare Advantage	$682.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$580.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$580.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$580.12
Rate for Payer: Cigna Commercial	$1,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.50
Rate for Payer: Oxford Commercial	$455.00
Rate for Payer: Qualcare PPO/HMO/WC	$341.25
Rate for Payer: UnitedHealthcare Commercial	$455.00
Rate for Payer: UnitedHealthcare Community & State	$54.83
Rate for Payer: Wellpoint Medicaid Managed Care	$60.29

DIAMOND BURR

Facility

$2,275.00

Hospital Charge Code	270704146
Hospital Revenue Code	272
Min. Negotiated Rate	$54.83
Max. Negotiated Rate	$1,137.50
Rate for Payer: Aetna Commercial	$864.50
Rate for Payer: Aetna Medicare Advantage	$682.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$580.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$580.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$580.12
Rate for Payer: Cigna Commercial	$1,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.50
Rate for Payer: Oxford Commercial	$455.00
Rate for Payer: Qualcare PPO/HMO/WC	$341.25
Rate for Payer: UnitedHealthcare Commercial	$455.00
Rate for Payer: UnitedHealthcare Community & State	$54.83
Rate for Payer: Wellpoint Medicaid Managed Care	$60.29

DIAMOX/125MG/TAB

Facility

$3.00

Hospital Charge Code	60632819
Hospital Revenue Code	250
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

DIAMOX/125MG/TAB

Facility

$3.00

Hospital Charge Code	60632819
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

DIAMOX/250MG/TAB

Facility

$4.00

Hospital Charge Code	60632820
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DIAMOX/250MG/TAB

Facility

$4.00

Hospital Charge Code	60632820
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DIAMOX/500MG

Facility

$166.00

Hospital Charge Code	60632818
Hospital Revenue Code	250
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$83.00
Rate for Payer: Aetna Commercial	$63.08
Rate for Payer: Aetna Medicare Advantage	$49.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.33
Rate for Payer: Cigna Commercial	$83.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.80
Rate for Payer: Oxford Commercial	$33.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.90
Rate for Payer: UnitedHealthcare Commercial	$33.20
Rate for Payer: UnitedHealthcare Community & State	$4.00
Rate for Payer: Wellpoint Medicaid Managed Care	$4.40

DIAMOX/500MG

Facility

$166.00

Hospital Charge Code	60632818
Hospital Revenue Code	250
Min. Negotiated Rate	$24.90
Max. Negotiated Rate	$24.90
Rate for Payer: Qualcare PPO/HMO/WC	$24.90

DIAMOX SEQ 500

Facility

$4.00

Hospital Charge Code	60634751
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

Know your out-of-pocket cost for care.

All Charges