Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FILTER OPTION ELITE 100CM

Facility

$4,475.00

Service Code	HCPCS C1880
Hospital Charge Code	270676626
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

FILTER OPTION ELITE 100CM

Facility

$4,475.00

Service Code	HCPCS C1880
Hospital Charge Code	270676626
Hospital Revenue Code	278
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,700.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25
Rate for Payer: UnitedHealthcare Community & State	$107.85
Rate for Payer: Wellpoint Medicaid Managed Care	$118.59

FILTER OPTION ELITE 100CM

Facility

$4,475.00

Service Code	HCPCS C1880
Hospital Charge Code	270676626S
Hospital Revenue Code	278
Min. Negotiated Rate	$671.25
Max. Negotiated Rate	$1,082.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25

FILTER OPTION ELITE 100CM

Facility

$4,475.00

Service Code	HCPCS C1880
Hospital Charge Code	270676626S
Hospital Revenue Code	278
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$2,237.50
Rate for Payer: Aetna Commercial	$1,700.50
Rate for Payer: Aetna Medicare Advantage	$1,342.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,141.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,141.12
Rate for Payer: Cigna Commercial	$2,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,082.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$984.50
Rate for Payer: Qualcare PPO/HMO/WC	$671.25
Rate for Payer: UnitedHealthcare Community & State	$107.85
Rate for Payer: Wellpoint Medicaid Managed Care	$118.59

FILTER PALL RCEZ1T

Facility

$2,759.25

Hospital Charge Code	270612416
Hospital Revenue Code	272
Min. Negotiated Rate	$413.89
Max. Negotiated Rate	$413.89
Rate for Payer: Qualcare PPO/HMO/WC	$413.89

FILTER PALL RCEZ1T

Facility

$2,759.25

Hospital Charge Code	270612416
Hospital Revenue Code	272
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$1,379.62
Rate for Payer: Aetna Commercial	$1,048.52
Rate for Payer: Aetna Medicare Advantage	$827.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$703.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$703.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$703.61
Rate for Payer: Cigna Commercial	$1,379.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$827.77
Rate for Payer: Oxford Commercial	$551.85
Rate for Payer: Qualcare PPO/HMO/WC	$413.89
Rate for Payer: UnitedHealthcare Commercial	$551.85
Rate for Payer: UnitedHealthcare Community & State	$66.50
Rate for Payer: Wellpoint Medicaid Managed Care	$73.12

FILTER PFT KOKO

Facility

$26.00

Hospital Charge Code	270652199
Hospital Revenue Code	270
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Commercial	$9.88
Rate for Payer: Aetna Medicare Advantage	$7.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.63
Rate for Payer: Cigna Commercial	$13.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.80
Rate for Payer: Oxford Commercial	$5.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.90
Rate for Payer: UnitedHealthcare Commercial	$5.20
Rate for Payer: UnitedHealthcare Community & State	$0.63
Rate for Payer: Wellpoint Medicaid Managed Care	$0.69

FILTER PFT KOKO

Facility

$26.00

Hospital Charge Code	270652199
Hospital Revenue Code	270
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$3.90
Rate for Payer: Qualcare PPO/HMO/WC	$3.90

FILTER PFT WHITE PRI757W

Facility

$5.50

Hospital Charge Code	270649462
Hospital Revenue Code	270
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$0.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.83

FILTER PFT WHITE PRI757W

Facility

$5.50

Hospital Charge Code	270649462
Hospital Revenue Code	270
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.75
Rate for Payer: Aetna Commercial	$2.09
Rate for Payer: Aetna Medicare Advantage	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.40
Rate for Payer: Cigna Commercial	$2.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.65
Rate for Payer: Oxford Commercial	$1.10
Rate for Payer: Qualcare PPO/HMO/WC	$0.83
Rate for Payer: UnitedHealthcare Commercial	$1.10
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

FILTER (PLASMA) BLOOD BANK

Facility

$366.45

Hospital Charge Code	3100575
Hospital Revenue Code	272
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$183.22
Rate for Payer: Aetna Commercial	$139.25
Rate for Payer: Aetna Medicare Advantage	$109.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.44
Rate for Payer: Cigna Commercial	$183.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.94
Rate for Payer: Oxford Commercial	$73.29
Rate for Payer: Qualcare PPO/HMO/WC	$54.97
Rate for Payer: UnitedHealthcare Commercial	$73.29
Rate for Payer: UnitedHealthcare Community & State	$8.83
Rate for Payer: Wellpoint Medicaid Managed Care	$9.71

FILTER (PLASMA) BLOOD BANK

Facility

$366.45

Hospital Charge Code	3100575
Hospital Revenue Code	272
Min. Negotiated Rate	$54.97
Max. Negotiated Rate	$54.97
Rate for Payer: Qualcare PPO/HMO/WC	$54.97

FILTER PULMAGUARD 29-7950100

Facility

$10.10

Hospital Charge Code	270636310
Hospital Revenue Code	272
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$5.05
Rate for Payer: Aetna Commercial	$3.84
Rate for Payer: Aetna Medicare Advantage	$3.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.58
Rate for Payer: Cigna Commercial	$5.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.03
Rate for Payer: Oxford Commercial	$2.02
Rate for Payer: Qualcare PPO/HMO/WC	$1.51
Rate for Payer: UnitedHealthcare Commercial	$2.02
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

FILTER PULMAGUARD 29-7950100

Facility

$10.10

Hospital Charge Code	270636310
Hospital Revenue Code	272
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$1.51
Rate for Payer: Qualcare PPO/HMO/WC	$1.51

FILTER PUMP BRAVO

Facility

$475.00

Hospital Charge Code	270691425
Hospital Revenue Code	272
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$71.25
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

FILTER PUMP BRAVO

Facility

$475.00

Hospital Charge Code	270691425
Hospital Revenue Code	272
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.50
Rate for Payer: Oxford Commercial	$95.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Commercial	$95.00
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

FILTER RBC BLOOD BANK EZPF

Facility

$198.45

Hospital Charge Code	3100245
Hospital Revenue Code	272
Min. Negotiated Rate	$4.78
Max. Negotiated Rate	$99.22
Rate for Payer: Aetna Commercial	$75.41
Rate for Payer: Aetna Medicare Advantage	$59.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.60
Rate for Payer: Cigna Commercial	$99.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.53
Rate for Payer: Oxford Commercial	$39.69
Rate for Payer: Qualcare PPO/HMO/WC	$29.77
Rate for Payer: UnitedHealthcare Commercial	$39.69
Rate for Payer: UnitedHealthcare Community & State	$4.78
Rate for Payer: Wellpoint Medicaid Managed Care	$5.26

FILTER RBC BLOOD BANK EZPF

Facility

$198.45

Hospital Charge Code	3100245
Hospital Revenue Code	272
Min. Negotiated Rate	$29.77
Max. Negotiated Rate	$29.77
Rate for Payer: Qualcare PPO/HMO/WC	$29.77

FILTER RBC (PALL)

Facility

$113.65

Hospital Charge Code	3100237
Hospital Revenue Code	272
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$56.83
Rate for Payer: Aetna Commercial	$43.19
Rate for Payer: Aetna Medicare Advantage	$34.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.98
Rate for Payer: Cigna Commercial	$56.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.09
Rate for Payer: Oxford Commercial	$22.73
Rate for Payer: Qualcare PPO/HMO/WC	$17.05
Rate for Payer: UnitedHealthcare Commercial	$22.73
Rate for Payer: UnitedHealthcare Community & State	$2.74
Rate for Payer: Wellpoint Medicaid Managed Care	$3.01

FILTER RBC (PALL)

Facility

$113.65

Hospital Charge Code	3100237
Hospital Revenue Code	272
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$17.05
Rate for Payer: Qualcare PPO/HMO/WC	$17.05

FILTERS 20 X 25 X 2 PERFECT

Facility

$11.60

Hospital Charge Code	270658439
Hospital Revenue Code	270
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$5.80
Rate for Payer: Aetna Commercial	$4.41
Rate for Payer: Aetna Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.96
Rate for Payer: Cigna Commercial	$5.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.48
Rate for Payer: Oxford Commercial	$2.32
Rate for Payer: Qualcare PPO/HMO/WC	$1.74
Rate for Payer: UnitedHealthcare Commercial	$2.32
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

FILTERS 20 X 25 X 2 PERFECT

Facility

$11.60

Hospital Charge Code	270658439
Hospital Revenue Code	270
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$1.74
Rate for Payer: Qualcare PPO/HMO/WC	$1.74

FILTER SET EXT 1.2 MICRON

Facility

$17.90

Hospital Charge Code	270649500
Hospital Revenue Code	272
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.95
Rate for Payer: Aetna Commercial	$6.80
Rate for Payer: Aetna Medicare Advantage	$5.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.56
Rate for Payer: Cigna Commercial	$8.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.37
Rate for Payer: Oxford Commercial	$3.58
Rate for Payer: Qualcare PPO/HMO/WC	$2.69
Rate for Payer: UnitedHealthcare Commercial	$3.58
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

FILTER SET EXT 1.2 MICRON

Facility

$17.90

Hospital Charge Code	270649500
Hospital Revenue Code	272
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.69

FILTER SUBMIC 2 25 10FILTPK02

Facility

$24.00

Hospital Charge Code	270636450C
Hospital Revenue Code	272
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

Know your out-of-pocket cost for care.

All Charges