Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FILTERLINE W/O2 CONN F/CPAP/

Facility

$63.22

Hospital Charge Code	270674939
Hospital Revenue Code	272
Min. Negotiated Rate	$9.48
Max. Negotiated Rate	$9.48
Rate for Payer: Qualcare PPO/HMO/WC	$9.48

FILTER LIPID

Facility

$224.60

Hospital Charge Code	270674073
Hospital Revenue Code	272
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$112.30
Rate for Payer: Aetna Commercial	$85.35
Rate for Payer: Aetna Medicare Advantage	$67.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.27
Rate for Payer: Cigna Commercial	$112.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.38
Rate for Payer: Oxford Commercial	$44.92
Rate for Payer: Qualcare PPO/HMO/WC	$33.69
Rate for Payer: UnitedHealthcare Commercial	$44.92
Rate for Payer: UnitedHealthcare Community & State	$5.41
Rate for Payer: Wellpoint Medicaid Managed Care	$5.95

FILTER LIPID

Facility

$224.60

Hospital Charge Code	270674073
Hospital Revenue Code	272
Min. Negotiated Rate	$33.69
Max. Negotiated Rate	$33.69
Rate for Payer: Qualcare PPO/HMO/WC	$33.69

FILTER MEMBRANE DISP

Facility

$85.65

Hospital Charge Code	270607684
Hospital Revenue Code	279
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$42.83
Rate for Payer: Aetna Commercial	$32.55
Rate for Payer: Aetna Medicare Advantage	$25.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.84
Rate for Payer: Cigna Commercial	$42.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.70
Rate for Payer: Oxford Commercial	$17.13
Rate for Payer: Qualcare PPO/HMO/WC	$12.85
Rate for Payer: UnitedHealthcare Commercial	$17.13
Rate for Payer: UnitedHealthcare Community & State	$2.06
Rate for Payer: Wellpoint Medicaid Managed Care	$2.27

FILTER MEMBRANE DISP

Facility

$85.65

Hospital Charge Code	270607684
Hospital Revenue Code	279
Min. Negotiated Rate	$12.85
Max. Negotiated Rate	$12.85
Rate for Payer: Qualcare PPO/HMO/WC	$12.85

FILTER MERIDIAN VENA

Facility

$7,725.00

Hospital Charge Code	270646597C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,158.75
Max. Negotiated Rate	$1,869.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,699.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75

FILTER MERIDIAN VENA

Facility

$7,725.00

Hospital Charge Code	270646597C
Hospital Revenue Code	278
Min. Negotiated Rate	$186.17
Max. Negotiated Rate	$3,862.50
Rate for Payer: Aetna Commercial	$2,935.50
Rate for Payer: Aetna Medicare Advantage	$2,317.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,969.88
Rate for Payer: Cigna Commercial	$3,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,699.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75
Rate for Payer: UnitedHealthcare Community & State	$186.17
Rate for Payer: Wellpoint Medicaid Managed Care	$204.71

FILTER MERIDIAN VENA

Facility

$7,725.00

Service Code	HCPCS C1880
Hospital Charge Code	270646957N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,158.75
Max. Negotiated Rate	$1,869.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,699.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75

FILTER MERIDIAN VENA

Facility

$7,725.00

Service Code	HCPCS C1880
Hospital Charge Code	270646957N
Hospital Revenue Code	278
Min. Negotiated Rate	$186.17
Max. Negotiated Rate	$3,862.50
Rate for Payer: Aetna Commercial	$2,935.50
Rate for Payer: Aetna Medicare Advantage	$2,317.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,969.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,545.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,969.88
Rate for Payer: Cigna Commercial	$3,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,699.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,158.75
Rate for Payer: UnitedHealthcare Community & State	$186.17
Rate for Payer: Wellpoint Medicaid Managed Care	$204.71

FILTER MERIDIAN VENA

Facility

$6,750.00

Service Code	HCPCS C1880
Hospital Charge Code	270646957C
Hospital Revenue Code	278
Min. Negotiated Rate	$162.68
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$162.68
Rate for Payer: Wellpoint Medicaid Managed Care	$178.88

FILTER MERIDIAN VENA

Facility

$6,750.00

Service Code	HCPCS C1880
Hospital Charge Code	270646957C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,485.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

FILTER MICROGUARD PFT DISP

Facility

$15.45

Hospital Charge Code	270647353
Hospital Revenue Code	270
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$2.32
Rate for Payer: Qualcare PPO/HMO/WC	$2.32

FILTER MICROGUARD PFT DISP

Facility

$15.45

Hospital Charge Code	270647353
Hospital Revenue Code	270
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.72
Rate for Payer: Aetna Commercial	$5.87
Rate for Payer: Aetna Medicare Advantage	$4.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.94
Rate for Payer: Cigna Commercial	$7.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.63
Rate for Payer: Oxford Commercial	$3.09
Rate for Payer: Qualcare PPO/HMO/WC	$2.32
Rate for Payer: UnitedHealthcare Commercial	$3.09
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

FILTER MICRON 0.22

Facility

$50.45

Hospital Charge Code	270600852
Hospital Revenue Code	270
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$7.57
Rate for Payer: Qualcare PPO/HMO/WC	$7.57

FILTER MICRON 0.22

Facility

$50.45

Hospital Charge Code	270600852
Hospital Revenue Code	270
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$25.23
Rate for Payer: Aetna Commercial	$19.17
Rate for Payer: Aetna Medicare Advantage	$15.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.86
Rate for Payer: Cigna Commercial	$25.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.13
Rate for Payer: Oxford Commercial	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.57
Rate for Payer: UnitedHealthcare Commercial	$10.09
Rate for Payer: UnitedHealthcare Community & State	$1.22
Rate for Payer: Wellpoint Medicaid Managed Care	$1.34

FILTER MICRON 0.25

Facility

$34.03

Hospital Charge Code	270654296
Hospital Revenue Code	272
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$17.02
Rate for Payer: Aetna Commercial	$12.93
Rate for Payer: Aetna Medicare Advantage	$10.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.68
Rate for Payer: Cigna Commercial	$17.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.21
Rate for Payer: Oxford Commercial	$6.81
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$6.81
Rate for Payer: UnitedHealthcare Community & State	$0.82
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

FILTER MICRON 0.25

Facility

$34.03

Hospital Charge Code	270654296
Hospital Revenue Code	272
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

FILTER MICRON 1.2

Facility

$10.66

Hospital Charge Code	270041075
Hospital Revenue Code	270
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.60

FILTER MICRON 1.2

Facility

$10.66

Hospital Charge Code	270041075
Hospital Revenue Code	270
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.33
Rate for Payer: Aetna Commercial	$4.05
Rate for Payer: Aetna Medicare Advantage	$3.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.72
Rate for Payer: Cigna Commercial	$5.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.20
Rate for Payer: Oxford Commercial	$2.13
Rate for Payer: Qualcare PPO/HMO/WC	$1.60
Rate for Payer: UnitedHealthcare Commercial	$2.13
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

FILTER MONO FUME 5051-05

Facility

$766.45

Hospital Charge Code	270600352
Hospital Revenue Code	270
Min. Negotiated Rate	$18.47
Max. Negotiated Rate	$383.23
Rate for Payer: Aetna Commercial	$291.25
Rate for Payer: Aetna Medicare Advantage	$229.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.44
Rate for Payer: Cigna Commercial	$383.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.94
Rate for Payer: Oxford Commercial	$153.29
Rate for Payer: Qualcare PPO/HMO/WC	$114.97
Rate for Payer: UnitedHealthcare Commercial	$153.29
Rate for Payer: UnitedHealthcare Community & State	$18.47
Rate for Payer: Wellpoint Medicaid Managed Care	$20.31

FILTER MONO FUME 5051-05

Facility

$766.45

Hospital Charge Code	270600352
Hospital Revenue Code	270
Min. Negotiated Rate	$114.97
Max. Negotiated Rate	$114.97
Rate for Payer: Qualcare PPO/HMO/WC	$114.97

FILTER NASAL O2 49125

Facility

$86.45

Hospital Charge Code	270627189
Hospital Revenue Code	272
Min. Negotiated Rate	$12.97
Max. Negotiated Rate	$12.97
Rate for Payer: Qualcare PPO/HMO/WC	$12.97

FILTER NASAL O2 49125

Facility

$86.45

Hospital Charge Code	270627189
Hospital Revenue Code	272
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$43.23
Rate for Payer: Aetna Commercial	$32.85
Rate for Payer: Aetna Medicare Advantage	$25.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.04
Rate for Payer: Cigna Commercial	$43.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.93
Rate for Payer: Oxford Commercial	$17.29
Rate for Payer: Qualcare PPO/HMO/WC	$12.97
Rate for Payer: UnitedHealthcare Commercial	$17.29
Rate for Payer: UnitedHealthcare Community & State	$2.08
Rate for Payer: Wellpoint Medicaid Managed Care	$2.29

FILTER OPTION ELITE 100CM

Facility

$4,625.00

Service Code	HCPCS C1880
Hospital Charge Code	270676626N
Hospital Revenue Code	278
Min. Negotiated Rate	$111.46
Max. Negotiated Rate	$2,312.50
Rate for Payer: Aetna Commercial	$1,757.50
Rate for Payer: Aetna Medicare Advantage	$1,387.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,179.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,179.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,179.38
Rate for Payer: Cigna Commercial	$2,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,119.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,017.50
Rate for Payer: Qualcare PPO/HMO/WC	$693.75
Rate for Payer: UnitedHealthcare Community & State	$111.46
Rate for Payer: Wellpoint Medicaid Managed Care	$122.56

FILTER OPTION ELITE 100CM

Facility

$4,625.00

Service Code	HCPCS C1880
Hospital Charge Code	270676626N
Hospital Revenue Code	278
Min. Negotiated Rate	$693.75
Max. Negotiated Rate	$1,119.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,119.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,017.50
Rate for Payer: Qualcare PPO/HMO/WC	$693.75

Know your out-of-pocket cost for care.

All Charges