Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH OCCLUS TRANSFORM C 4X10MM

Facility

$7,876.00

Service Code	HCPCS C2628
Hospital Charge Code	270699938S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,181.40
Max. Negotiated Rate	$1,905.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,732.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.40

CATH OCCLUS TRANSFORM C 4X10MM

Facility

$7,876.00

Service Code	HCPCS C2628
Hospital Charge Code	270699938S
Hospital Revenue Code	278
Min. Negotiated Rate	$189.81
Max. Negotiated Rate	$3,938.00
Rate for Payer: Aetna Commercial	$2,992.88
Rate for Payer: Aetna Medicare Advantage	$2,362.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,008.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,008.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,008.38
Rate for Payer: Cigna Commercial	$3,938.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.99
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,732.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.40
Rate for Payer: UnitedHealthcare Community & State	$189.81
Rate for Payer: Wellpoint Medicaid Managed Care	$208.71

CATH OCELOT MVRX 6FR 110CM

Facility

$12,475.00

Service Code	HCPCS C1725
Hospital Charge Code	270675458N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,871.25
Max. Negotiated Rate	$3,018.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,018.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,744.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,871.25

CATH OCELOT MVRX 6FR 110CM

Facility

$12,475.00

Service Code	HCPCS C1725
Hospital Charge Code	270675458
Hospital Revenue Code	278
Min. Negotiated Rate	$1,871.25
Max. Negotiated Rate	$3,018.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,018.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,744.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,871.25

CATH OCELOT MVRX 6FR 110CM

Facility

$12,475.00

Service Code	HCPCS C1725
Hospital Charge Code	270675458N
Hospital Revenue Code	278
Min. Negotiated Rate	$300.65
Max. Negotiated Rate	$6,237.50
Rate for Payer: Aetna Commercial	$4,740.50
Rate for Payer: Aetna Medicare Advantage	$3,742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,181.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,181.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,181.12
Rate for Payer: Cigna Commercial	$6,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,018.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,744.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,871.25
Rate for Payer: UnitedHealthcare Community & State	$300.65
Rate for Payer: Wellpoint Medicaid Managed Care	$330.59

CATH OCELOT MVRX 6FR 110CM

Facility

$12,475.00

Service Code	HCPCS C1725
Hospital Charge Code	270675458
Hospital Revenue Code	278
Min. Negotiated Rate	$300.65
Max. Negotiated Rate	$6,237.50
Rate for Payer: Aetna Commercial	$4,740.50
Rate for Payer: Aetna Medicare Advantage	$3,742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,181.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,181.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,181.12
Rate for Payer: Cigna Commercial	$6,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,018.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,744.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,871.25
Rate for Payer: UnitedHealthcare Community & State	$300.65
Rate for Payer: Wellpoint Medicaid Managed Care	$330.59

CATH OM FLUSH 5F 7603-D1

Facility

$52.00

Hospital Charge Code	270623733
Hospital Revenue Code	278
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$12.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.44
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

CATH OM FLUSH 5F 7603-D1

Facility

$52.00

Hospital Charge Code	270623733
Hospital Revenue Code	278
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$19.76
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.44
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

CATH OMNIFLUSH 5F 90c 10732202

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270624375
Hospital Revenue Code	278
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

CATH OMNIFLUSH 5F 90c 10732202

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270624375
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$21.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CATH OMNI-FLUSH 5FR 70cm .035

Facility

$750.00

Service Code	HCPCS C1887
Hospital Charge Code	270637241
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

CATH OMNI-FLUSH 5FR 70cm .035

Facility

$750.00

Service Code	HCPCS C1887
Hospital Charge Code	270637241S
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

CATH OMNI-FLUSH 5FR 70cm .035

Facility

$750.00

Service Code	HCPCS C1887
Hospital Charge Code	270637241S
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

CATH OMNI-FLUSH 5FR 70cm .035

Facility

$750.00

Service Code	HCPCS C1887
Hospital Charge Code	270637241
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

CATH OMNI-FLUSH 5FR 70CM .035

Facility

$750.00

Service Code	HCPCS C1887
Hospital Charge Code	270637241C
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

CATH OMNI-FLUSH 5FR 70CM .035

Facility

$750.00

Service Code	HCPCS C1887
Hospital Charge Code	270637241C
Hospital Revenue Code	278
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

CATH OMNI-FLUSH 5FR 70CM .035

Facility

$550.00

Service Code	HCPCS C1887
Hospital Charge Code	270637241N
Hospital Revenue Code	278
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

CATH OMNI-FLUSH 5FR 70CM .035

Facility

$550.00

Service Code	HCPCS C1887
Hospital Charge Code	270637241N
Hospital Revenue Code	278
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

CATH OP JAK RAD 3 5 5FR 405021

Facility

$275.00

Hospital Charge Code	270643742S
Hospital Revenue Code	272
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Oxford Commercial	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Commercial	$55.00
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

CATH OP JAK RAD 3 5 5FR 405021

Facility

$225.00

Hospital Charge Code	270643742
Hospital Revenue Code	272
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.50
Rate for Payer: Oxford Commercial	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$45.00
Rate for Payer: UnitedHealthcare Community & State	$5.42
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

CATH OP JAK RAD 3 5 5FR 405021

Facility

$225.00

Hospital Charge Code	270643742
Hospital Revenue Code	272
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

CATH OP JAK RAD 3 5 5FR 405021

Facility

$275.00

Hospital Charge Code	270643742S
Hospital Revenue Code	272
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CATH OP JAK RAD 3 5 5FR 405021

Facility

$275.00

Hospital Charge Code	270643742N
Hospital Revenue Code	272
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Oxford Commercial	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Commercial	$55.00
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

CATH OP JAK RAD 3 5 5FR 405021

Facility

$275.00

Hospital Charge Code	270643742N
Hospital Revenue Code	272
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CATH OPTI JACKY RADIAL 3.5 5FR

Facility

$275.00

Hospital Charge Code	270645658
Hospital Revenue Code	278
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$66.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

Know your out-of-pocket cost for care.

All Charges