Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH OTW XK 19 ST SPLT 5913190

Facility

$1,825.00

Hospital Charge Code	270661422
Hospital Revenue Code	272
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$273.75
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

CATH OTW XK 19 ST SPLT 5913190

Facility

$1,925.00

Hospital Charge Code	270661422N
Hospital Revenue Code	272
Min. Negotiated Rate	$46.39
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$731.50
Rate for Payer: Aetna Medicare Advantage	$577.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$577.50
Rate for Payer: Oxford Commercial	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Commercial	$385.00
Rate for Payer: UnitedHealthcare Community & State	$46.39
Rate for Payer: Wellpoint Medicaid Managed Care	$51.01

CATH OTW XK 19 ST SPLT 5913190

Facility

$1,825.00

Hospital Charge Code	270661422S
Hospital Revenue Code	272
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$273.75
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

CATH OTW XK 19 ST SPLT 5913190

Facility

$1,825.00

Hospital Charge Code	270661422S
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

CATH OTW,XK,23CM SPLIT KIT

Facility

$1,925.00

Hospital Charge Code	2709006965
Hospital Revenue Code	272
Min. Negotiated Rate	$46.39
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$731.50
Rate for Payer: Aetna Medicare Advantage	$577.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$577.50
Rate for Payer: Oxford Commercial	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Commercial	$385.00
Rate for Payer: UnitedHealthcare Community & State	$46.39
Rate for Payer: Wellpoint Medicaid Managed Care	$51.01

CATH OTW,XK,23CM SPLIT KIT

Facility

$1,925.00

Hospital Charge Code	2709006965
Hospital Revenue Code	272
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$288.75
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

CATH OTW,XK/27CM SPLIT KIT

Facility

$1,925.00

Hospital Charge Code	2709006966
Hospital Revenue Code	272
Min. Negotiated Rate	$46.39
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$731.50
Rate for Payer: Aetna Medicare Advantage	$577.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$577.50
Rate for Payer: Oxford Commercial	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Commercial	$385.00
Rate for Payer: UnitedHealthcare Community & State	$46.39
Rate for Payer: Wellpoint Medicaid Managed Care	$51.01

CATH OTW,XK/27CM SPLIT KIT

Facility

$1,925.00

Hospital Charge Code	2709006966
Hospital Revenue Code	272
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$288.75
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

CATH OTW,XK/31CM SPLIT KIT

Facility

$1,925.00

Hospital Charge Code	2709006967
Hospital Revenue Code	272
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$288.75
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

CATH OTW,XK/31CM SPLIT KIT

Facility

$1,925.00

Hospital Charge Code	2709006967
Hospital Revenue Code	272
Min. Negotiated Rate	$46.39
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$731.50
Rate for Payer: Aetna Medicare Advantage	$577.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$577.50
Rate for Payer: Oxford Commercial	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Commercial	$385.00
Rate for Payer: UnitedHealthcare Community & State	$46.39
Rate for Payer: Wellpoint Medicaid Managed Care	$51.01

CATH OUTBACK

Facility

$10,500.00

Service Code	HCPCS C2628
Hospital Charge Code	270637755S
Hospital Revenue Code	278
Min. Negotiated Rate	$253.05
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$253.05
Rate for Payer: Wellpoint Medicaid Managed Care	$278.25

CATH OUTBACK

Facility

$10,500.00

Service Code	HCPCS C2628
Hospital Charge Code	270637755S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

CATH OUTBACK

Facility

$10,685.70

Service Code	HCPCS C2628
Hospital Charge Code	270637755O
Hospital Revenue Code	278
Min. Negotiated Rate	$257.53
Max. Negotiated Rate	$5,342.85
Rate for Payer: Aetna Commercial	$4,060.57
Rate for Payer: Aetna Medicare Advantage	$3,205.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,724.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,724.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,137.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,724.85
Rate for Payer: Cigna Commercial	$5,342.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,585.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,350.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,602.86
Rate for Payer: UnitedHealthcare Community & State	$257.53
Rate for Payer: Wellpoint Medicaid Managed Care	$283.17

CATH OUTBACK

Facility

$8,750.00

Service Code	HCPCS C2628
Hospital Charge Code	270637755C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

CATH OUTBACK

Facility

$10,685.70

Service Code	HCPCS C2628
Hospital Charge Code	270637755O
Hospital Revenue Code	278
Min. Negotiated Rate	$1,602.86
Max. Negotiated Rate	$2,585.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,137.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,585.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,350.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,602.86

CATH OUTBACK

Facility

$8,750.00

Service Code	HCPCS C2628
Hospital Charge Code	270637755C
Hospital Revenue Code	278
Min. Negotiated Rate	$210.88
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$3,325.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50
Rate for Payer: UnitedHealthcare Community & State	$210.88
Rate for Payer: Wellpoint Medicaid Managed Care	$231.88

CATH OUTBACK 120 CM RE-ENTRY

Facility

$8,775.00

Hospital Charge Code	270637755
Hospital Revenue Code	279
Min. Negotiated Rate	$211.48
Max. Negotiated Rate	$4,387.50
Rate for Payer: Aetna Commercial	$3,334.50
Rate for Payer: Aetna Medicare Advantage	$2,632.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,237.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,237.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,237.62
Rate for Payer: Cigna Commercial	$4,387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,632.50
Rate for Payer: Oxford Commercial	$1,755.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,316.25
Rate for Payer: UnitedHealthcare Commercial	$1,755.00
Rate for Payer: UnitedHealthcare Community & State	$211.48
Rate for Payer: Wellpoint Medicaid Managed Care	$232.54

CATH OUTBACK 120 CM RE-ENTRY

Facility

$8,775.00

Hospital Charge Code	270637755
Hospital Revenue Code	279
Min. Negotiated Rate	$1,316.25
Max. Negotiated Rate	$1,316.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,316.25

CATH OUTBACK 80 CM RE-ENTRY

Facility

$875.00

Hospital Charge Code	270705293
Hospital Revenue Code	279
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

CATH OUTBACK 80 CM RE-ENTRY

Facility

$875.00

Hospital Charge Code	270705293
Hospital Revenue Code	279
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$21.09
Rate for Payer: Wellpoint Medicaid Managed Care	$23.19

CATH PACE PORT 7.5F 93A931H7.5

Facility

$514.45

Hospital Charge Code	270110030
Hospital Revenue Code	272
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$257.23
Rate for Payer: Aetna Commercial	$195.49
Rate for Payer: Aetna Medicare Advantage	$154.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.18
Rate for Payer: Cigna Commercial	$257.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.34
Rate for Payer: Oxford Commercial	$102.89
Rate for Payer: Qualcare PPO/HMO/WC	$77.17
Rate for Payer: UnitedHealthcare Commercial	$102.89
Rate for Payer: UnitedHealthcare Community & State	$12.40
Rate for Payer: Wellpoint Medicaid Managed Care	$13.63

CATH PACE PORT 7.5F 93A931H7.5

Facility

$514.45

Hospital Charge Code	270110030
Hospital Revenue Code	272
Min. Negotiated Rate	$77.17
Max. Negotiated Rate	$77.17
Rate for Payer: Qualcare PPO/HMO/WC	$77.17

CATH PACING GD RIGHTSITE 43CM

Facility

$2,200.00

Service Code	HCPCS C1887
Hospital Charge Code	270699656C
Hospital Revenue Code	278
Min. Negotiated Rate	$53.02
Max. Negotiated Rate	$1,100.00
Rate for Payer: Aetna Commercial	$836.00
Rate for Payer: Aetna Medicare Advantage	$660.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$561.00
Rate for Payer: Cigna Commercial	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$532.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$330.00
Rate for Payer: UnitedHealthcare Community & State	$53.02
Rate for Payer: Wellpoint Medicaid Managed Care	$58.30

CATH PACING GD RIGHTSITE 43CM

Facility

$2,200.00

Service Code	HCPCS C1887
Hospital Charge Code	270699656C
Hospital Revenue Code	278
Min. Negotiated Rate	$330.00
Max. Negotiated Rate	$532.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$532.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$330.00

CATH PACING SSPC2 .035 8FX40CM

Facility

$2,475.00

Service Code	HCPCS C1887
Hospital Charge Code	270695977S
Hospital Revenue Code	272
Min. Negotiated Rate	$59.65
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$742.50
Rate for Payer: Oxford Commercial	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Commercial	$495.00
Rate for Payer: UnitedHealthcare Community & State	$59.65
Rate for Payer: Wellpoint Medicaid Managed Care	$65.59

Know your out-of-pocket cost for care.

All Charges