Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH HEMOSPLIT STD KIT 19CM

Facility

$1,525.00

Service Code	HCPCS C1750
Hospital Charge Code	270642139
Hospital Revenue Code	278
Min. Negotiated Rate	$228.75
Max. Negotiated Rate	$369.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$335.50
Rate for Payer: Qualcare PPO/HMO/WC	$228.75

CATH HEMOSPLIT STD KIT 19CM

Facility

$1,525.00

Service Code	HCPCS C1750
Hospital Charge Code	270642139
Hospital Revenue Code	278
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$762.50
Rate for Payer: Aetna Commercial	$579.50
Rate for Payer: Aetna Medicare Advantage	$457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$388.88
Rate for Payer: Cigna Commercial	$762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$335.50
Rate for Payer: Qualcare PPO/HMO/WC	$228.75
Rate for Payer: UnitedHealthcare Community & State	$36.75
Rate for Payer: Wellpoint Medicaid Managed Care	$40.41

CATH HICKM 45CM 13.5 60045-2

Facility

$2,119.25

Hospital Charge Code	270601092
Hospital Revenue Code	278
Min. Negotiated Rate	$51.07
Max. Negotiated Rate	$1,059.62
Rate for Payer: Aetna Commercial	$805.32
Rate for Payer: Aetna Medicare Advantage	$635.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$540.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$540.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$423.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$540.41
Rate for Payer: Cigna Commercial	$1,059.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$512.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$466.24
Rate for Payer: Qualcare PPO/HMO/WC	$317.89
Rate for Payer: UnitedHealthcare Community & State	$51.07
Rate for Payer: Wellpoint Medicaid Managed Care	$56.16

CATH HICKM 45CM 13.5 60045-2

Facility

$2,119.25

Hospital Charge Code	270601092
Hospital Revenue Code	278
Min. Negotiated Rate	$317.89
Max. Negotiated Rate	$512.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$423.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$512.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$466.24
Rate for Payer: Qualcare PPO/HMO/WC	$317.89

CATH HICKMAN DUAL PED 28CM

Facility

$1,005.00

Hospital Charge Code	270655420
Hospital Revenue Code	278
Min. Negotiated Rate	$24.22
Max. Negotiated Rate	$502.50
Rate for Payer: Aetna Commercial	$381.90
Rate for Payer: Aetna Medicare Advantage	$301.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.27
Rate for Payer: Cigna Commercial	$502.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$221.10
Rate for Payer: Qualcare PPO/HMO/WC	$150.75
Rate for Payer: UnitedHealthcare Community & State	$24.22
Rate for Payer: Wellpoint Medicaid Managed Care	$26.63

CATH HICKMAN DUAL PED 28CM

Facility

$1,005.00

Hospital Charge Code	270655420
Hospital Revenue Code	278
Min. Negotiated Rate	$150.75
Max. Negotiated Rate	$243.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$221.10
Rate for Payer: Qualcare PPO/HMO/WC	$150.75

CATH HICKMAN DUAL W/VITA CUFF

Facility

$830.00

Service Code	HCPCS C1750
Hospital Charge Code	270655422
Hospital Revenue Code	278
Min. Negotiated Rate	$124.50
Max. Negotiated Rate	$200.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$182.60
Rate for Payer: Qualcare PPO/HMO/WC	$124.50

CATH HICKMAN DUAL W/VITA CUFF

Facility

$830.00

Service Code	HCPCS C1750
Hospital Charge Code	270655422
Hospital Revenue Code	278
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$415.00
Rate for Payer: Aetna Commercial	$315.40
Rate for Payer: Aetna Medicare Advantage	$249.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$166.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.65
Rate for Payer: Cigna Commercial	$415.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$182.60
Rate for Payer: Qualcare PPO/HMO/WC	$124.50
Rate for Payer: UnitedHealthcare Community & State	$20.00
Rate for Payer: Wellpoint Medicaid Managed Care	$22.00

CATH HICKM DUAL 13.5 60069-2

Facility

$2,119.25

Hospital Charge Code	270602964
Hospital Revenue Code	272
Min. Negotiated Rate	$51.07
Max. Negotiated Rate	$1,059.62
Rate for Payer: Aetna Commercial	$805.32
Rate for Payer: Aetna Medicare Advantage	$635.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$540.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$540.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$540.41
Rate for Payer: Cigna Commercial	$1,059.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$635.77
Rate for Payer: Oxford Commercial	$423.85
Rate for Payer: Qualcare PPO/HMO/WC	$317.89
Rate for Payer: UnitedHealthcare Commercial	$423.85
Rate for Payer: UnitedHealthcare Community & State	$51.07
Rate for Payer: Wellpoint Medicaid Managed Care	$56.16

CATH HICKM DUAL 13.5 60069-2

Facility

$2,119.25

Hospital Charge Code	270602964
Hospital Revenue Code	272
Min. Negotiated Rate	$317.89
Max. Negotiated Rate	$317.89
Rate for Payer: Qualcare PPO/HMO/WC	$317.89

CATH HICKM DUAL VTCF 60066-2

Facility

$2,016.00

Hospital Charge Code	270601090
Hospital Revenue Code	278
Min. Negotiated Rate	$48.59
Max. Negotiated Rate	$1,008.00
Rate for Payer: Aetna Commercial	$766.08
Rate for Payer: Aetna Medicare Advantage	$604.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$514.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$514.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$403.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$514.08
Rate for Payer: Cigna Commercial	$1,008.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$443.52
Rate for Payer: Qualcare PPO/HMO/WC	$302.40
Rate for Payer: UnitedHealthcare Community & State	$48.59
Rate for Payer: Wellpoint Medicaid Managed Care	$53.42

CATH HICKM DUAL VTCF 60066-2

Facility

$2,016.00

Hospital Charge Code	270601090
Hospital Revenue Code	278
Min. Negotiated Rate	$302.40
Max. Negotiated Rate	$487.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$403.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$443.52
Rate for Payer: Qualcare PPO/HMO/WC	$302.40

CATH HICKM DUAL VTCF 60662-2

Facility

$2,026.45

Hospital Charge Code	270601091
Hospital Revenue Code	278
Min. Negotiated Rate	$48.84
Max. Negotiated Rate	$1,013.23
Rate for Payer: Aetna Commercial	$770.05
Rate for Payer: Aetna Medicare Advantage	$607.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$516.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$516.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$516.74
Rate for Payer: Cigna Commercial	$1,013.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$445.82
Rate for Payer: Qualcare PPO/HMO/WC	$303.97
Rate for Payer: UnitedHealthcare Community & State	$48.84
Rate for Payer: Wellpoint Medicaid Managed Care	$53.70

CATH HICKM DUAL VTCF 60662-2

Facility

$2,026.45

Hospital Charge Code	270601091
Hospital Revenue Code	278
Min. Negotiated Rate	$303.97
Max. Negotiated Rate	$490.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$445.82
Rate for Payer: Qualcare PPO/HMO/WC	$303.97

CATH HICKM MRI 1.6MM 602640

Facility

$3,604.85

Hospital Charge Code	270601093
Hospital Revenue Code	278
Min. Negotiated Rate	$86.88
Max. Negotiated Rate	$1,802.42
Rate for Payer: Aetna Commercial	$1,369.84
Rate for Payer: Aetna Medicare Advantage	$1,081.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$919.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$919.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$720.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$919.24
Rate for Payer: Cigna Commercial	$1,802.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$872.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$793.07
Rate for Payer: Qualcare PPO/HMO/WC	$540.73
Rate for Payer: UnitedHealthcare Community & State	$86.88
Rate for Payer: Wellpoint Medicaid Managed Care	$95.53

CATH HICKM MRI 1.6MM 602640

Facility

$3,604.85

Hospital Charge Code	270601093
Hospital Revenue Code	278
Min. Negotiated Rate	$540.73
Max. Negotiated Rate	$872.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$720.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$872.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$793.07
Rate for Payer: Qualcare PPO/HMO/WC	$540.73

CATH HICKM PERIT 14.3 60300

Facility

$955.00

Service Code	HCPCS C1788
Hospital Charge Code	270605601
Hospital Revenue Code	278
Min. Negotiated Rate	$23.02
Max. Negotiated Rate	$477.50
Rate for Payer: Aetna Commercial	$362.90
Rate for Payer: Aetna Medicare Advantage	$286.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.53
Rate for Payer: Cigna Commercial	$477.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$210.10
Rate for Payer: Qualcare PPO/HMO/WC	$143.25
Rate for Payer: UnitedHealthcare Community & State	$23.02
Rate for Payer: Wellpoint Medicaid Managed Care	$25.31

CATH HICKM PERIT 14.3 60300

Facility

$955.00

Service Code	HCPCS C1788
Hospital Charge Code	270605601
Hospital Revenue Code	278
Min. Negotiated Rate	$143.25
Max. Negotiated Rate	$231.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$210.10
Rate for Payer: Qualcare PPO/HMO/WC	$143.25

CATH HICKM SINGL *******

Facility

$1,959.00

Hospital Charge Code	1604287
Hospital Revenue Code	264
Min. Negotiated Rate	$47.21
Max. Negotiated Rate	$979.50
Rate for Payer: Aetna Commercial	$744.42
Rate for Payer: Aetna Medicare Advantage	$587.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$499.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$499.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$499.55
Rate for Payer: Cigna Commercial	$979.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$587.70
Rate for Payer: Oxford Commercial	$391.80
Rate for Payer: Qualcare PPO/HMO/WC	$293.85
Rate for Payer: UnitedHealthcare Commercial	$391.80
Rate for Payer: UnitedHealthcare Community & State	$47.21
Rate for Payer: Wellpoint Medicaid Managed Care	$51.91

CATH HICKM SINGL *******

Facility

$1,959.00

Hospital Charge Code	1604287
Hospital Revenue Code	264
Min. Negotiated Rate	$293.85
Max. Negotiated Rate	$293.85
Rate for Payer: Qualcare PPO/HMO/WC	$293.85

CATH HICKM SINGL MRI 10F 60266

Facility

$3,221.65

Hospital Charge Code	270604622
Hospital Revenue Code	278
Min. Negotiated Rate	$77.64
Max. Negotiated Rate	$1,610.83
Rate for Payer: Aetna Commercial	$1,224.23
Rate for Payer: Aetna Medicare Advantage	$966.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$821.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$821.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$644.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$821.52
Rate for Payer: Cigna Commercial	$1,610.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$779.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$708.76
Rate for Payer: Qualcare PPO/HMO/WC	$483.25
Rate for Payer: UnitedHealthcare Community & State	$77.64
Rate for Payer: Wellpoint Medicaid Managed Care	$85.37

CATH HICKM SINGL MRI 10F 60266

Facility

$3,221.65

Hospital Charge Code	270604622
Hospital Revenue Code	278
Min. Negotiated Rate	$483.25
Max. Negotiated Rate	$779.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$644.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$779.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$708.76
Rate for Payer: Qualcare PPO/HMO/WC	$483.25

CATH HICKM VEN MRI PORT 60261

Facility

$2,936.85

Hospital Charge Code	270606032
Hospital Revenue Code	278
Min. Negotiated Rate	$440.53
Max. Negotiated Rate	$710.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$587.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$710.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$646.11
Rate for Payer: Qualcare PPO/HMO/WC	$440.53

CATH HICKM VEN MRI PORT 60261

Facility

$2,936.85

Hospital Charge Code	270606032
Hospital Revenue Code	278
Min. Negotiated Rate	$70.78
Max. Negotiated Rate	$1,468.42
Rate for Payer: Aetna Commercial	$1,116.00
Rate for Payer: Aetna Medicare Advantage	$881.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$748.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$748.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$587.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$748.90
Rate for Payer: Cigna Commercial	$1,468.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$710.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$646.11
Rate for Payer: Qualcare PPO/HMO/WC	$440.53
Rate for Payer: UnitedHealthcare Community & State	$70.78
Rate for Payer: Wellpoint Medicaid Managed Care	$77.83

CATH HN5

Facility

$200.85

Hospital Charge Code	270677005
Hospital Revenue Code	272
Min. Negotiated Rate	$30.13
Max. Negotiated Rate	$30.13
Rate for Payer: Qualcare PPO/HMO/WC	$30.13

Know your out-of-pocket cost for care.

All Charges