Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

FILTER SUBMIC 2 25 10FILTPK02

Facility

$24.00

Hospital Charge Code	270636450C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$9.12
Rate for Payer: Aetna Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.12
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.20
Rate for Payer: Oxford Commercial	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Commercial	$4.80
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

FILTER SYSTEM ELITE VENA CAVA

Facility

$4,475.00

Service Code	HCPCS C1880
Hospital Charge Code	270658294N
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 SYSTEM ELITE VENA CAVA

Facility

$4,475.00

Service Code	HCPCS C1880
Hospital Charge Code	270658294N
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 SYSTEM ELITE VENA CAVA

Facility

$3,975.00

Service Code	HCPCS C1880
Hospital Charge Code	270658294
Hospital Revenue Code	278
Min. Negotiated Rate	$95.80
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,510.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$874.50
Rate for Payer: Qualcare PPO/HMO/WC	$596.25
Rate for Payer: UnitedHealthcare Community & State	$95.80
Rate for Payer: Wellpoint Medicaid Managed Care	$105.34

FILTER SYSTEM ELITE VENA CAVA

Facility

$3,975.00

Service Code	HCPCS C1880
Hospital Charge Code	270658294S
Hospital Revenue Code	278
Min. Negotiated Rate	$95.80
Max. Negotiated Rate	$1,987.50
Rate for Payer: Aetna Commercial	$1,510.50
Rate for Payer: Aetna Medicare Advantage	$1,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,013.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,013.62
Rate for Payer: Cigna Commercial	$1,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$874.50
Rate for Payer: Qualcare PPO/HMO/WC	$596.25
Rate for Payer: UnitedHealthcare Community & State	$95.80
Rate for Payer: Wellpoint Medicaid Managed Care	$105.34

FILTER SYSTEM ELITE VENA CAVA

Facility

$3,975.00

Service Code	HCPCS C1880
Hospital Charge Code	270658294S
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$874.50
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

FILTER SYSTEM ELITE VENA CAVA

Facility

$3,975.00

Service Code	HCPCS C1880
Hospital Charge Code	270658294
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$874.50
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

FILTER TRI LUMEN TUBE CHARCOAL

Facility

$2,626.50

Hospital Charge Code	270686722
Hospital Revenue Code	272
Min. Negotiated Rate	$393.98
Max. Negotiated Rate	$393.98
Rate for Payer: Qualcare PPO/HMO/WC	$393.98

FILTER TRI LUMEN TUBE CHARCOAL

Facility

$2,626.50

Hospital Charge Code	270686722
Hospital Revenue Code	272
Min. Negotiated Rate	$63.30
Max. Negotiated Rate	$1,313.25
Rate for Payer: Aetna Commercial	$998.07
Rate for Payer: Aetna Medicare Advantage	$787.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.76
Rate for Payer: Cigna Commercial	$1,313.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.95
Rate for Payer: Oxford Commercial	$525.30
Rate for Payer: Qualcare PPO/HMO/WC	$393.98
Rate for Payer: UnitedHealthcare Commercial	$525.30
Rate for Payer: UnitedHealthcare Community & State	$63.30
Rate for Payer: Wellpoint Medicaid Managed Care	$69.60

FILTER TRIMED IV

Facility

$10.92

Hospital Charge Code	270041080
Hospital Revenue Code	272
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

FILTER TRIMED IV

Facility

$10.92

Hospital Charge Code	270041080
Hospital Revenue Code	272
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$5.46
Rate for Payer: Aetna Commercial	$4.15
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.78
Rate for Payer: Cigna Commercial	$5.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.28
Rate for Payer: Oxford Commercial	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.18
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

FILTER TRT VENA CAVA 466P306A

Facility

$3,125.00

Service Code	HCPCS C1880
Hospital Charge Code	270627443
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$756.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$687.50
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

FILTER TRT VENA CAVA 466P306A

Facility

$3,125.00

Service Code	HCPCS C1880
Hospital Charge Code	270627443
Hospital Revenue Code	278
Min. Negotiated Rate	$75.31
Max. Negotiated Rate	$1,562.50
Rate for Payer: Aetna Commercial	$1,187.50
Rate for Payer: Aetna Medicare Advantage	$937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$756.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$687.50
Rate for Payer: Qualcare PPO/HMO/WC	$468.75
Rate for Payer: UnitedHealthcare Community & State	$75.31
Rate for Payer: Wellpoint Medicaid Managed Care	$82.81

FILTER VACUUM MIX FUME 5049-81

Facility

$215.25

Hospital Charge Code	270600226
Hospital Revenue Code	270
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$107.62
Rate for Payer: Aetna Commercial	$81.80
Rate for Payer: Aetna Medicare Advantage	$64.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.89
Rate for Payer: Cigna Commercial	$107.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.58
Rate for Payer: Oxford Commercial	$43.05
Rate for Payer: Qualcare PPO/HMO/WC	$32.29
Rate for Payer: UnitedHealthcare Commercial	$43.05
Rate for Payer: UnitedHealthcare Community & State	$5.19
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

FILTER VACUUM MIX FUME 5049-81

Facility

$215.25

Hospital Charge Code	270600226
Hospital Revenue Code	270
Min. Negotiated Rate	$32.29
Max. Negotiated Rate	$32.29
Rate for Payer: Qualcare PPO/HMO/WC	$32.29

FILTER VACUUM MIXING FUME*****

Facility

$82.00

Hospital Charge Code	1606250
Hospital Revenue Code	279
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$12.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.30

FILTER VACUUM MIXING FUME*****

Facility

$82.00

Hospital Charge Code	1606250
Hospital Revenue Code	279
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$41.00
Rate for Payer: Aetna Commercial	$31.16
Rate for Payer: Aetna Medicare Advantage	$24.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.91
Rate for Payer: Cigna Commercial	$41.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.60
Rate for Payer: Oxford Commercial	$16.40
Rate for Payer: Qualcare PPO/HMO/WC	$12.30
Rate for Payer: UnitedHealthcare Commercial	$16.40
Rate for Payer: UnitedHealthcare Community & State	$1.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.17

FILTER VENA CAVA FEM 50-501

Facility

$2,252.00

Hospital Charge Code	1608397
Hospital Revenue Code	272
Min. Negotiated Rate	$337.80
Max. Negotiated Rate	$337.80
Rate for Payer: Qualcare PPO/HMO/WC	$337.80

FILTER VENA CAVA FEM 50-501

Facility

$2,252.00

Hospital Charge Code	1608397
Hospital Revenue Code	272
Min. Negotiated Rate	$54.27
Max. Negotiated Rate	$1,126.00
Rate for Payer: Aetna Commercial	$855.76
Rate for Payer: Aetna Medicare Advantage	$675.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$574.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$574.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$574.26
Rate for Payer: Cigna Commercial	$1,126.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$675.60
Rate for Payer: Oxford Commercial	$450.40
Rate for Payer: Qualcare PPO/HMO/WC	$337.80
Rate for Payer: UnitedHealthcare Commercial	$450.40
Rate for Payer: UnitedHealthcare Community & State	$54.27
Rate for Payer: Wellpoint Medicaid Managed Care	$59.68

FILTER VENA CAVA FEMORAL 12FR

Facility

$4,994.50

Service Code	HCPCS C1880
Hospital Charge Code	270601106
Hospital Revenue Code	278
Min. Negotiated Rate	$749.17
Max. Negotiated Rate	$1,208.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,098.79
Rate for Payer: Qualcare PPO/HMO/WC	$749.17

FILTER VENA CAVA FEMORAL 12FR

Facility

$4,994.50

Service Code	HCPCS C1880
Hospital Charge Code	270601106
Hospital Revenue Code	278
Min. Negotiated Rate	$120.37
Max. Negotiated Rate	$2,497.25
Rate for Payer: Aetna Commercial	$1,897.91
Rate for Payer: Aetna Medicare Advantage	$1,498.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,273.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,273.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,273.60
Rate for Payer: Cigna Commercial	$2,497.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,098.79
Rate for Payer: Qualcare PPO/HMO/WC	$749.17
Rate for Payer: UnitedHealthcare Community & State	$120.37
Rate for Payer: Wellpoint Medicaid Managed Care	$132.35

FILTER VENA CAVA JUGLR 50300**

Facility

$4,810.00

Hospital Charge Code	1604685
Hospital Revenue Code	279
Min. Negotiated Rate	$721.50
Max. Negotiated Rate	$721.50
Rate for Payer: Qualcare PPO/HMO/WC	$721.50

FILTER VENA CAVA JUGLR 50300**

Facility

$4,810.00

Hospital Charge Code	1604685
Hospital Revenue Code	279
Min. Negotiated Rate	$115.92
Max. Negotiated Rate	$2,405.00
Rate for Payer: Aetna Commercial	$1,827.80
Rate for Payer: Aetna Medicare Advantage	$1,443.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,226.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,226.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,226.55
Rate for Payer: Cigna Commercial	$2,405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,443.00
Rate for Payer: Oxford Commercial	$962.00
Rate for Payer: Qualcare PPO/HMO/WC	$721.50
Rate for Payer: UnitedHealthcare Commercial	$962.00
Rate for Payer: UnitedHealthcare Community & State	$115.92
Rate for Payer: Wellpoint Medicaid Managed Care	$127.47

FILTER VENA CAVA JUGULAR 12FR

Facility

$4,994.50

Hospital Charge Code	270601105
Hospital Revenue Code	278
Min. Negotiated Rate	$749.17
Max. Negotiated Rate	$1,208.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,098.79
Rate for Payer: Qualcare PPO/HMO/WC	$749.17

FILTER VENA CAVA JUGULAR 12FR

Facility

$4,994.50

Hospital Charge Code	270601105
Hospital Revenue Code	278
Min. Negotiated Rate	$120.37
Max. Negotiated Rate	$2,497.25
Rate for Payer: Aetna Commercial	$1,897.91
Rate for Payer: Aetna Medicare Advantage	$1,498.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,273.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,273.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,273.60
Rate for Payer: Cigna Commercial	$2,497.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.67
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,098.79
Rate for Payer: Qualcare PPO/HMO/WC	$749.17
Rate for Payer: UnitedHealthcare Community & State	$120.37
Rate for Payer: Wellpoint Medicaid Managed Care	$132.35

Know your out-of-pocket cost for care.

All Charges