Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH MRI LO PROF 7 SNG 0603870

Facility

$2,182.45

Hospital Charge Code	270630250
Hospital Revenue Code	278
Min. Negotiated Rate	$327.37
Max. Negotiated Rate	$528.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$436.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$528.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$480.14
Rate for Payer: Qualcare PPO/HMO/WC	$327.37

CATH MRI LO PROF 7 SNG 0603870

Facility

$2,182.45

Hospital Charge Code	270630250
Hospital Revenue Code	278
Min. Negotiated Rate	$52.60
Max. Negotiated Rate	$1,091.22
Rate for Payer: Aetna Commercial	$829.33
Rate for Payer: Aetna Medicare Advantage	$654.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$556.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$556.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$436.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$556.52
Rate for Payer: Cigna Commercial	$1,091.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$528.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$480.14
Rate for Payer: Qualcare PPO/HMO/WC	$327.37
Rate for Payer: UnitedHealthcare Community & State	$52.60
Rate for Payer: Wellpoint Medicaid Managed Care	$57.83

CATH MRI POWER PORT 8F 1LUMEN

Facility

$3,050.00

Service Code	HCPCS C1788
Hospital Charge Code	270644422
Hospital Revenue Code	278
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$1,525.00
Rate for Payer: Aetna Commercial	$1,159.00
Rate for Payer: Aetna Medicare Advantage	$915.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$777.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$777.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$777.75
Rate for Payer: Cigna Commercial	$1,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$738.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$671.00
Rate for Payer: Qualcare PPO/HMO/WC	$457.50
Rate for Payer: UnitedHealthcare Community & State	$73.50
Rate for Payer: Wellpoint Medicaid Managed Care	$80.83

CATH MRI POWER PORT 8F 1LUMEN

Facility

$3,050.00

Service Code	HCPCS C1788
Hospital Charge Code	270644422
Hospital Revenue Code	278
Min. Negotiated Rate	$457.50
Max. Negotiated Rate	$738.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$610.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$738.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$671.00
Rate for Payer: Qualcare PPO/HMO/WC	$457.50

CATH MRI POWER PORT 8fr

Facility

$1.00

Hospital Charge Code	270644422C
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.22
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

CATH MRI POWER PORT 8fr

Facility

$1.00

Hospital Charge Code	270644422C
Hospital Revenue Code	278
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.22
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

CATH MT BALLN DIL 5.3F 19-421

Facility

$1,336.85

Hospital Charge Code	270623797
Hospital Revenue Code	272
Min. Negotiated Rate	$32.22
Max. Negotiated Rate	$668.42
Rate for Payer: Aetna Commercial	$508.00
Rate for Payer: Aetna Medicare Advantage	$401.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$340.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$340.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$340.90
Rate for Payer: Cigna Commercial	$668.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$401.06
Rate for Payer: Oxford Commercial	$267.37
Rate for Payer: Qualcare PPO/HMO/WC	$200.53
Rate for Payer: UnitedHealthcare Commercial	$267.37
Rate for Payer: UnitedHealthcare Community & State	$32.22
Rate for Payer: Wellpoint Medicaid Managed Care	$35.43

CATH MT BALLN DIL 5.3F 19-421

Facility

$1,336.85

Hospital Charge Code	270623797
Hospital Revenue Code	272
Min. Negotiated Rate	$200.53
Max. Negotiated Rate	$200.53
Rate for Payer: Qualcare PPO/HMO/WC	$200.53

CATH MT BALLN DIL 5.8F 12-722

Facility

$1,368.00

Hospital Charge Code	270623798
Hospital Revenue Code	272
Min. Negotiated Rate	$205.20
Max. Negotiated Rate	$205.20
Rate for Payer: Qualcare PPO/HMO/WC	$205.20

CATH MT BALLN DIL 5.8F 12-722

Facility

$1,368.00

Hospital Charge Code	270623798
Hospital Revenue Code	272
Min. Negotiated Rate	$32.97
Max. Negotiated Rate	$684.00
Rate for Payer: Aetna Commercial	$519.84
Rate for Payer: Aetna Medicare Advantage	$410.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$348.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$348.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$348.84
Rate for Payer: Cigna Commercial	$684.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$410.40
Rate for Payer: Oxford Commercial	$273.60
Rate for Payer: Qualcare PPO/HMO/WC	$205.20
Rate for Payer: UnitedHealthcare Commercial	$273.60
Rate for Payer: UnitedHealthcare Community & State	$32.97
Rate for Payer: Wellpoint Medicaid Managed Care	$36.25

CATH MT BALLN DIL XXLG 14-510

Facility

$1,623.25

Hospital Charge Code	270623292V
Hospital Revenue Code	278
Min. Negotiated Rate	$243.49
Max. Negotiated Rate	$392.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.12
Rate for Payer: Qualcare PPO/HMO/WC	$243.49

CATH MT BALLN DIL XXLG 14-510

Facility

$1,623.25

Hospital Charge Code	270623292V
Hospital Revenue Code	278
Min. Negotiated Rate	$39.12
Max. Negotiated Rate	$811.62
Rate for Payer: Aetna Commercial	$616.84
Rate for Payer: Aetna Medicare Advantage	$486.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$413.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$413.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$324.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$413.93
Rate for Payer: Cigna Commercial	$811.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.12
Rate for Payer: Qualcare PPO/HMO/WC	$243.49
Rate for Payer: UnitedHealthcare Community & State	$39.12
Rate for Payer: Wellpoint Medicaid Managed Care	$43.02

CATH MT BALLN DIL XXLG 14-552

Facility

$1,652.00

Hospital Charge Code	270624070V
Hospital Revenue Code	278
Min. Negotiated Rate	$247.80
Max. Negotiated Rate	$399.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$363.44
Rate for Payer: Qualcare PPO/HMO/WC	$247.80

CATH MT BALLN DIL XXLG 14-552

Facility

$1,652.00

Hospital Charge Code	270624070V
Hospital Revenue Code	278
Min. Negotiated Rate	$39.81
Max. Negotiated Rate	$826.00
Rate for Payer: Aetna Commercial	$627.76
Rate for Payer: Aetna Medicare Advantage	$495.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$421.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$421.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$421.26
Rate for Payer: Cigna Commercial	$826.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$363.44
Rate for Payer: Qualcare PPO/HMO/WC	$247.80
Rate for Payer: UnitedHealthcare Community & State	$39.81
Rate for Payer: Wellpoint Medicaid Managed Care	$43.78

CATH MT BALLN MARSHAL 17-881

Facility

$1,064.00

Hospital Charge Code	270624313
Hospital Revenue Code	272
Min. Negotiated Rate	$159.60
Max. Negotiated Rate	$159.60
Rate for Payer: Qualcare PPO/HMO/WC	$159.60

CATH MT BALLN MARSHAL 17-881

Facility

$1,064.00

Hospital Charge Code	270624313
Hospital Revenue Code	272
Min. Negotiated Rate	$25.64
Max. Negotiated Rate	$532.00
Rate for Payer: Aetna Commercial	$404.32
Rate for Payer: Aetna Medicare Advantage	$319.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$271.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$271.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$271.32
Rate for Payer: Cigna Commercial	$532.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$319.20
Rate for Payer: Oxford Commercial	$212.80
Rate for Payer: Qualcare PPO/HMO/WC	$159.60
Rate for Payer: UnitedHealthcare Commercial	$212.80
Rate for Payer: UnitedHealthcare Community & State	$25.64
Rate for Payer: Wellpoint Medicaid Managed Care	$28.20

CATH MT BALLN USQ/5-4 225121

Facility

$1,287.25

Service Code	HCPCS C1725
Hospital Charge Code	270624347
Hospital Revenue Code	278
Min. Negotiated Rate	$193.09
Max. Negotiated Rate	$311.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$257.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$311.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$283.19
Rate for Payer: Qualcare PPO/HMO/WC	$193.09

CATH MT BALLN USQ/5-4 225121

Facility

$1,287.25

Service Code	HCPCS C1725
Hospital Charge Code	270624347
Hospital Revenue Code	278
Min. Negotiated Rate	$31.02
Max. Negotiated Rate	$643.62
Rate for Payer: Aetna Commercial	$489.15
Rate for Payer: Aetna Medicare Advantage	$386.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$328.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$328.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$257.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$328.25
Rate for Payer: Cigna Commercial	$643.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$311.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$283.19
Rate for Payer: Qualcare PPO/HMO/WC	$193.09
Rate for Payer: UnitedHealthcare Community & State	$31.02
Rate for Payer: Wellpoint Medicaid Managed Care	$34.11

CATH MT BALLN XXL 6 18 14-559

Facility

$1,544.85

Hospital Charge Code	270626888
Hospital Revenue Code	278
Min. Negotiated Rate	$231.73
Max. Negotiated Rate	$373.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$339.87
Rate for Payer: Qualcare PPO/HMO/WC	$231.73

CATH MT BALLN XXL 6 18 14-559

Facility

$1,544.85

Hospital Charge Code	270626888
Hospital Revenue Code	278
Min. Negotiated Rate	$37.23
Max. Negotiated Rate	$772.42
Rate for Payer: Aetna Commercial	$587.04
Rate for Payer: Aetna Medicare Advantage	$463.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$393.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$393.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$308.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$393.94
Rate for Payer: Cigna Commercial	$772.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$339.87
Rate for Payer: Qualcare PPO/HMO/WC	$231.73
Rate for Payer: UnitedHealthcare Community & State	$37.23
Rate for Payer: Wellpoint Medicaid Managed Care	$40.94

CATH MT BALN UT DILA ********

Facility

$1,096.00

Hospital Charge Code	1604552
Hospital Revenue Code	272
Min. Negotiated Rate	$26.41
Max. Negotiated Rate	$548.00
Rate for Payer: Aetna Commercial	$416.48
Rate for Payer: Aetna Medicare Advantage	$328.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.48
Rate for Payer: Cigna Commercial	$548.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$328.80
Rate for Payer: Oxford Commercial	$219.20
Rate for Payer: Qualcare PPO/HMO/WC	$164.40
Rate for Payer: UnitedHealthcare Commercial	$219.20
Rate for Payer: UnitedHealthcare Community & State	$26.41
Rate for Payer: Wellpoint Medicaid Managed Care	$29.04

CATH MT BALN UT DILA ********

Facility

$1,096.00

Hospital Charge Code	1604552
Hospital Revenue Code	272
Min. Negotiated Rate	$164.40
Max. Negotiated Rate	$164.40
Rate for Payer: Qualcare PPO/HMO/WC	$164.40

CATH MT BLMX 6/4/5.8 12-531

Facility

$2,119.25

Hospital Charge Code	270601088
Hospital Revenue Code	272
Min. Negotiated Rate	$317.89
Max. Negotiated Rate	$317.89
Rate for Payer: Qualcare PPO/HMO/WC	$317.89

CATH MT BLMX 6/4/5.8 12-531

Facility

$2,119.25

Hospital Charge Code	270601088
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 MT BLMX 8/4/5.8 12-239

Facility

$2,404.00

Hospital Charge Code	270601083
Hospital Revenue Code	272
Min. Negotiated Rate	$360.60
Max. Negotiated Rate	$360.60
Rate for Payer: Qualcare PPO/HMO/WC	$360.60

Know your out-of-pocket cost for care.

All Charges