Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CANISTER ENG PENUMBRA

Facility

$1,800.00

Hospital Charge Code	270685262S
Hospital Revenue Code	272
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$270.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00

CANISTER GUARDIAN 12 LITER

Facility

$89.35

Hospital Charge Code	270651667
Hospital Revenue Code	270
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$44.67
Rate for Payer: Aetna Commercial	$33.95
Rate for Payer: Aetna Medicare Advantage	$26.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.78
Rate for Payer: Cigna Commercial	$44.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.80
Rate for Payer: Oxford Commercial	$17.87
Rate for Payer: Qualcare PPO/HMO/WC	$13.40
Rate for Payer: UnitedHealthcare Commercial	$17.87
Rate for Payer: UnitedHealthcare Community & State	$2.15
Rate for Payer: Wellpoint Medicaid Managed Care	$2.37

CANISTER GUARDIAN 12 LITER

Facility

$89.35

Hospital Charge Code	270651667
Hospital Revenue Code	270
Min. Negotiated Rate	$13.40
Max. Negotiated Rate	$13.40
Rate for Payer: Qualcare PPO/HMO/WC	$13.40

CANISTER INVIA 300ML FOR NPWT

Facility

$77.60

Hospital Charge Code	270687287
Hospital Revenue Code	270
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$38.80
Rate for Payer: Aetna Commercial	$29.49
Rate for Payer: Aetna Medicare Advantage	$23.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.79
Rate for Payer: Cigna Commercial	$38.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.28
Rate for Payer: Oxford Commercial	$15.52
Rate for Payer: Qualcare PPO/HMO/WC	$11.64
Rate for Payer: UnitedHealthcare Commercial	$15.52
Rate for Payer: UnitedHealthcare Community & State	$1.87
Rate for Payer: Wellpoint Medicaid Managed Care	$2.06

CANISTER INVIA 300ML FOR NPWT

Facility

$77.60

Hospital Charge Code	270687287
Hospital Revenue Code	270
Min. Negotiated Rate	$11.64
Max. Negotiated Rate	$11.64
Rate for Payer: Qualcare PPO/HMO/WC	$11.64

CANISTER INVIA 800ML W SOLIDE

Facility

$111.55

Hospital Charge Code	270687288
Hospital Revenue Code	271
Min. Negotiated Rate	$16.73
Max. Negotiated Rate	$16.73
Rate for Payer: Qualcare PPO/HMO/WC	$16.73

CANISTER INVIA 800ML W SOLIDE

Facility

$111.55

Hospital Charge Code	270687288
Hospital Revenue Code	271
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$55.77
Rate for Payer: Aetna Commercial	$42.39
Rate for Payer: Aetna Medicare Advantage	$33.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.45
Rate for Payer: Cigna Commercial	$55.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.47
Rate for Payer: Oxford Commercial	$22.31
Rate for Payer: Qualcare PPO/HMO/WC	$16.73
Rate for Payer: UnitedHealthcare Commercial	$22.31
Rate for Payer: UnitedHealthcare Community & State	$2.69
Rate for Payer: Wellpoint Medicaid Managed Care	$2.96

CANISTER NO. 2 NC-2

Facility

$248.00

Hospital Charge Code	270634521
Hospital Revenue Code	272
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$94.24
Rate for Payer: Aetna Medicare Advantage	$74.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.24
Rate for Payer: Cigna Commercial	$124.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.40
Rate for Payer: Oxford Commercial	$49.60
Rate for Payer: Qualcare PPO/HMO/WC	$37.20
Rate for Payer: UnitedHealthcare Commercial	$49.60
Rate for Payer: UnitedHealthcare Community & State	$5.98
Rate for Payer: Wellpoint Medicaid Managed Care	$6.57

CANISTER NO. 2 NC-2

Facility

$248.00

Hospital Charge Code	270634521
Hospital Revenue Code	272
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$37.20
Rate for Payer: Qualcare PPO/HMO/WC	$37.20

Canister Penumbra MAX

Facility

$1,850.00

Hospital Charge Code	270681132N
Hospital Revenue Code	272
Min. Negotiated Rate	$44.59
Max. Negotiated Rate	$925.00
Rate for Payer: Aetna Commercial	$703.00
Rate for Payer: Aetna Medicare Advantage	$555.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$471.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$471.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$471.75
Rate for Payer: Cigna Commercial	$925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$555.00
Rate for Payer: Oxford Commercial	$370.00
Rate for Payer: Qualcare PPO/HMO/WC	$277.50
Rate for Payer: UnitedHealthcare Commercial	$370.00
Rate for Payer: UnitedHealthcare Community & State	$44.59
Rate for Payer: Wellpoint Medicaid Managed Care	$49.02

Canister Penumbra MAX

Facility

$1,850.00

Hospital Charge Code	270681132O
Hospital Revenue Code	272
Min. Negotiated Rate	$44.59
Max. Negotiated Rate	$925.00
Rate for Payer: Aetna Commercial	$703.00
Rate for Payer: Aetna Medicare Advantage	$555.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$471.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$471.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$471.75
Rate for Payer: Cigna Commercial	$925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$555.00
Rate for Payer: Oxford Commercial	$370.00
Rate for Payer: Qualcare PPO/HMO/WC	$277.50
Rate for Payer: UnitedHealthcare Commercial	$370.00
Rate for Payer: UnitedHealthcare Community & State	$44.59
Rate for Payer: Wellpoint Medicaid Managed Care	$49.02

Canister Penumbra MAX

Facility

$1,850.00

Hospital Charge Code	270681132O
Hospital Revenue Code	272
Min. Negotiated Rate	$277.50
Max. Negotiated Rate	$277.50
Rate for Payer: Qualcare PPO/HMO/WC	$277.50

Canister Penumbra MAX

Facility

$1,850.00

Hospital Charge Code	270681132N
Hospital Revenue Code	272
Min. Negotiated Rate	$277.50
Max. Negotiated Rate	$277.50
Rate for Payer: Qualcare PPO/HMO/WC	$277.50

CANISTER PENUMBRA MAX

Facility

$1,825.00

Hospital Charge Code	270681132
Hospital Revenue Code	272
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$273.75
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

CANISTER PENUMBRA MAX

Facility

$1,850.00

Hospital Charge Code	270681132S
Hospital Revenue Code	272
Min. Negotiated Rate	$277.50
Max. Negotiated Rate	$277.50
Rate for Payer: Qualcare PPO/HMO/WC	$277.50

CANISTER PENUMBRA MAX

Facility

$1,825.00

Hospital Charge Code	270681132
Hospital Revenue Code	272
Min. Negotiated Rate	$43.98
Max. Negotiated Rate	$912.50
Rate for Payer: Aetna Commercial	$693.50
Rate for Payer: Aetna Medicare Advantage	$547.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.38
Rate for Payer: Cigna Commercial	$912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$547.50
Rate for Payer: Oxford Commercial	$365.00
Rate for Payer: Qualcare PPO/HMO/WC	$273.75
Rate for Payer: UnitedHealthcare Commercial	$365.00
Rate for Payer: UnitedHealthcare Community & State	$43.98
Rate for Payer: Wellpoint Medicaid Managed Care	$48.36

CANISTER PENUMBRA MAX

Facility

$1,850.00

Hospital Charge Code	270681132S
Hospital Revenue Code	272
Min. Negotiated Rate	$44.59
Max. Negotiated Rate	$925.00
Rate for Payer: Aetna Commercial	$703.00
Rate for Payer: Aetna Medicare Advantage	$555.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$471.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$471.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$471.75
Rate for Payer: Cigna Commercial	$925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$555.00
Rate for Payer: Oxford Commercial	$370.00
Rate for Payer: Qualcare PPO/HMO/WC	$277.50
Rate for Payer: UnitedHealthcare Commercial	$370.00
Rate for Payer: UnitedHealthcare Community & State	$44.59
Rate for Payer: Wellpoint Medicaid Managed Care	$49.02

CANISTER PRO-1

Facility

$40.00

Hospital Charge Code	270647394
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

CANISTER PRO-1

Facility

$40.00

Hospital Charge Code	270647394
Hospital Revenue Code	272
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

CANISTER PUMP

Facility

$1,825.00

Hospital Charge Code	270685330
Hospital Revenue Code	272
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$273.75
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

CANISTER PUMP

Facility

$1,825.00

Hospital Charge Code	270685330
Hospital Revenue Code	272
Min. Negotiated Rate	$43.98
Max. Negotiated Rate	$912.50
Rate for Payer: Aetna Commercial	$693.50
Rate for Payer: Aetna Medicare Advantage	$547.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.38
Rate for Payer: Cigna Commercial	$912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$547.50
Rate for Payer: Oxford Commercial	$365.00
Rate for Payer: Qualcare PPO/HMO/WC	$273.75
Rate for Payer: UnitedHealthcare Commercial	$365.00
Rate for Payer: UnitedHealthcare Community & State	$43.98
Rate for Payer: Wellpoint Medicaid Managed Care	$48.36

CANISTER RENASYS GO

Facility

$201.75

Hospital Charge Code	270648964
Hospital Revenue Code	272
Min. Negotiated Rate	$30.26
Max. Negotiated Rate	$30.26
Rate for Payer: Qualcare PPO/HMO/WC	$30.26

CANISTER RENASYS GO

Facility

$201.75

Hospital Charge Code	270648964
Hospital Revenue Code	272
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$100.88
Rate for Payer: Aetna Commercial	$76.67
Rate for Payer: Aetna Medicare Advantage	$60.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.45
Rate for Payer: Cigna Commercial	$100.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.52
Rate for Payer: Oxford Commercial	$40.35
Rate for Payer: Qualcare PPO/HMO/WC	$30.26
Rate for Payer: UnitedHealthcare Commercial	$40.35
Rate for Payer: UnitedHealthcare Community & State	$4.86
Rate for Payer: Wellpoint Medicaid Managed Care	$5.35

CANISTER RENASYS GO LARGE

Facility

$265.00

Hospital Charge Code	270648961
Hospital Revenue Code	272
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$132.50
Rate for Payer: Aetna Commercial	$100.70
Rate for Payer: Aetna Medicare Advantage	$79.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.58
Rate for Payer: Cigna Commercial	$132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.50
Rate for Payer: Oxford Commercial	$53.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.75
Rate for Payer: UnitedHealthcare Commercial	$53.00
Rate for Payer: UnitedHealthcare Community & State	$6.39
Rate for Payer: Wellpoint Medicaid Managed Care	$7.02

CANISTER RENASYS GO LARGE

Facility

$265.00

Hospital Charge Code	270648961
Hospital Revenue Code	272
Min. Negotiated Rate	$39.75
Max. Negotiated Rate	$39.75
Rate for Payer: Qualcare PPO/HMO/WC	$39.75

Know your out-of-pocket cost for care.

All Charges