Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH PTA LUTONIX 70x40x130cm

Facility

$8,250.00

Service Code	HCPCS C2623
Hospital Charge Code	270678937
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

CATH PTA LUTONIX 7.0x60x130cm

Facility

$8,250.00

Service Code	HCPCS C2623
Hospital Charge Code	270678946
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

CATH PTA LUTONIX 7.0x60x130cm

Facility

$8,250.00

Service Code	HCPCS C2623
Hospital Charge Code	270678946
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

CATH PTA SAILOR PLUS 6x120x13

Facility

$1,767.00

Hospital Charge Code	270635527
Hospital Revenue Code	272
Min. Negotiated Rate	$265.05
Max. Negotiated Rate	$265.05
Rate for Payer: Qualcare PPO/HMO/WC	$265.05

CATH PTA SAILOR PLUS 6x120x13

Facility

$1,767.00

Hospital Charge Code	270635527
Hospital Revenue Code	272
Min. Negotiated Rate	$42.58
Max. Negotiated Rate	$883.50
Rate for Payer: Aetna Commercial	$671.46
Rate for Payer: Aetna Medicare Advantage	$530.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.58
Rate for Payer: Cigna Commercial	$883.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$530.10
Rate for Payer: Oxford Commercial	$353.40
Rate for Payer: Qualcare PPO/HMO/WC	$265.05
Rate for Payer: UnitedHealthcare Commercial	$353.40
Rate for Payer: UnitedHealthcare Community & State	$42.58
Rate for Payer: Wellpoint Medicaid Managed Care	$46.83

CATH PUNUMB 5MAX DISTAL 115CM

Facility

$7,450.00

Service Code	HCPCS C1757
Hospital Charge Code	270696885S
Hospital Revenue Code	278
Min. Negotiated Rate	$179.54
Max. Negotiated Rate	$3,725.00
Rate for Payer: Aetna Commercial	$2,831.00
Rate for Payer: Aetna Medicare Advantage	$2,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,899.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,899.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,899.75
Rate for Payer: Cigna Commercial	$3,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,802.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,639.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.50
Rate for Payer: UnitedHealthcare Community & State	$179.54
Rate for Payer: Wellpoint Medicaid Managed Care	$197.43

CATH PUNUMB 5MAX DISTAL 115CM

Facility

$7,450.00

Service Code	HCPCS C1757
Hospital Charge Code	270696885S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,117.50
Max. Negotiated Rate	$1,802.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,802.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,639.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.50

CATH PWERFLEX 5x4 80c 4205040S

Facility

$1,314.45

Hospital Charge Code	270630176
Hospital Revenue Code	278
Min. Negotiated Rate	$31.68
Max. Negotiated Rate	$657.23
Rate for Payer: Aetna Commercial	$499.49
Rate for Payer: Aetna Medicare Advantage	$394.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$335.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$335.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$262.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$335.18
Rate for Payer: Cigna Commercial	$657.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$289.18
Rate for Payer: Qualcare PPO/HMO/WC	$197.17
Rate for Payer: UnitedHealthcare Community & State	$31.68
Rate for Payer: Wellpoint Medicaid Managed Care	$34.83

CATH PWERFLEX 5x4 80c 4205040S

Facility

$1,325.00

Hospital Charge Code	270630176V
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$320.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.50
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

CATH PWERFLEX 5x4 80c 4205040S

Facility

$1,314.45

Hospital Charge Code	270630176
Hospital Revenue Code	278
Min. Negotiated Rate	$197.17
Max. Negotiated Rate	$318.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$262.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$318.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$289.18
Rate for Payer: Qualcare PPO/HMO/WC	$197.17

CATH PWERFLEX 5x4 80c 4205040S

Facility

$1,325.00

Hospital Charge Code	270630176V
Hospital Revenue Code	278
Min. Negotiated Rate	$31.93
Max. Negotiated Rate	$662.50
Rate for Payer: Aetna Commercial	$503.50
Rate for Payer: Aetna Medicare Advantage	$397.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.88
Rate for Payer: Cigna Commercial	$662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.50
Rate for Payer: Qualcare PPO/HMO/WC	$198.75
Rate for Payer: UnitedHealthcare Community & State	$31.93
Rate for Payer: Wellpoint Medicaid Managed Care	$35.11

CATH QUICKCROSS .014 135CM

Facility

$985.00

Service Code	HCPCS C1725
Hospital Charge Code	270636734N
Hospital Revenue Code	278
Min. Negotiated Rate	$23.74
Max. Negotiated Rate	$492.50
Rate for Payer: Aetna Commercial	$374.30
Rate for Payer: Aetna Medicare Advantage	$295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.18
Rate for Payer: Cigna Commercial	$492.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$216.70
Rate for Payer: Qualcare PPO/HMO/WC	$147.75
Rate for Payer: UnitedHealthcare Community & State	$23.74
Rate for Payer: Wellpoint Medicaid Managed Care	$26.10

CATH QUICKCROSS .014 135CM

Facility

$985.00

Service Code	HCPCS C1725
Hospital Charge Code	270636734N
Hospital Revenue Code	278
Min. Negotiated Rate	$147.75
Max. Negotiated Rate	$238.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$216.70
Rate for Payer: Qualcare PPO/HMO/WC	$147.75

CATH QUICKCROSS .014 135CM

Facility

$985.00

Service Code	HCPCS C1725
Hospital Charge Code	270636734C
Hospital Revenue Code	278
Min. Negotiated Rate	$23.74
Max. Negotiated Rate	$492.50
Rate for Payer: Aetna Commercial	$374.30
Rate for Payer: Aetna Medicare Advantage	$295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.18
Rate for Payer: Cigna Commercial	$492.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$216.70
Rate for Payer: Qualcare PPO/HMO/WC	$147.75
Rate for Payer: UnitedHealthcare Community & State	$23.74
Rate for Payer: Wellpoint Medicaid Managed Care	$26.10

CATH QUICKCROSS .014 135CM

Facility

$985.00

Service Code	HCPCS C1725
Hospital Charge Code	270636734C
Hospital Revenue Code	278
Min. Negotiated Rate	$147.75
Max. Negotiated Rate	$238.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$216.70
Rate for Payer: Qualcare PPO/HMO/WC	$147.75

CATH QUICK-CROSS .014 150cm

Facility

$835.00

Hospital Charge Code	270640493C
Hospital Revenue Code	278
Min. Negotiated Rate	$125.25
Max. Negotiated Rate	$202.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$167.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.70
Rate for Payer: Qualcare PPO/HMO/WC	$125.25

CATH QUICK-CROSS .014 150cm

Facility

$835.00

Hospital Charge Code	270640493C
Hospital Revenue Code	278
Min. Negotiated Rate	$20.12
Max. Negotiated Rate	$417.50
Rate for Payer: Aetna Commercial	$317.30
Rate for Payer: Aetna Medicare Advantage	$250.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$167.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.93
Rate for Payer: Cigna Commercial	$417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.70
Rate for Payer: Qualcare PPO/HMO/WC	$125.25
Rate for Payer: UnitedHealthcare Community & State	$20.12
Rate for Payer: Wellpoint Medicaid Managed Care	$22.13

CATH QUICK-CROSS .018 150cm

Facility

$835.00

Hospital Charge Code	270642211C
Hospital Revenue Code	278
Min. Negotiated Rate	$125.25
Max. Negotiated Rate	$202.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$167.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.70
Rate for Payer: Qualcare PPO/HMO/WC	$125.25

CATH QUICK-CROSS .018 150cm

Facility

$835.00

Hospital Charge Code	270642211C
Hospital Revenue Code	278
Min. Negotiated Rate	$20.12
Max. Negotiated Rate	$417.50
Rate for Payer: Aetna Commercial	$317.30
Rate for Payer: Aetna Medicare Advantage	$250.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$167.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.93
Rate for Payer: Cigna Commercial	$417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.70
Rate for Payer: Qualcare PPO/HMO/WC	$125.25
Rate for Payer: UnitedHealthcare Community & State	$20.12
Rate for Payer: Wellpoint Medicaid Managed Care	$22.13

CATH QUICKCROSS .018 X 135MM

Facility

$985.00

Service Code	HCPCS C1725
Hospital Charge Code	270646752C
Hospital Revenue Code	278
Min. Negotiated Rate	$147.75
Max. Negotiated Rate	$238.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$216.70
Rate for Payer: Qualcare PPO/HMO/WC	$147.75

CATH QUICKCROSS .018 X 135MM

Facility

$985.00

Service Code	HCPCS C1725
Hospital Charge Code	270646752C
Hospital Revenue Code	278
Min. Negotiated Rate	$23.74
Max. Negotiated Rate	$492.50
Rate for Payer: Aetna Commercial	$374.30
Rate for Payer: Aetna Medicare Advantage	$295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.18
Rate for Payer: Cigna Commercial	$492.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$216.70
Rate for Payer: Qualcare PPO/HMO/WC	$147.75
Rate for Payer: UnitedHealthcare Community & State	$23.74
Rate for Payer: Wellpoint Medicaid Managed Care	$26.10

CATH QUICKCROSS .018 X 135MM

Facility

$985.00

Service Code	HCPCS C1725
Hospital Charge Code	270646752N
Hospital Revenue Code	278
Min. Negotiated Rate	$23.74
Max. Negotiated Rate	$492.50
Rate for Payer: Aetna Commercial	$374.30
Rate for Payer: Aetna Medicare Advantage	$295.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$251.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$251.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$251.18
Rate for Payer: Cigna Commercial	$492.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$216.70
Rate for Payer: Qualcare PPO/HMO/WC	$147.75
Rate for Payer: UnitedHealthcare Community & State	$23.74
Rate for Payer: Wellpoint Medicaid Managed Care	$26.10

CATH QUICKCROSS .018 X 135MM

Facility

$985.00

Service Code	HCPCS C1725
Hospital Charge Code	270646752N
Hospital Revenue Code	278
Min. Negotiated Rate	$147.75
Max. Negotiated Rate	$238.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$197.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$216.70
Rate for Payer: Qualcare PPO/HMO/WC	$147.75

CATH QUICK CROSS .035 150CM

Facility

$835.00

Hospital Charge Code	270642212C
Hospital Revenue Code	278
Min. Negotiated Rate	$125.25
Max. Negotiated Rate	$202.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$167.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.70
Rate for Payer: Qualcare PPO/HMO/WC	$125.25

CATH QUICK CROSS .035 150CM

Facility

$835.00

Hospital Charge Code	270642212C
Hospital Revenue Code	278
Min. Negotiated Rate	$20.12
Max. Negotiated Rate	$417.50
Rate for Payer: Aetna Commercial	$317.30
Rate for Payer: Aetna Medicare Advantage	$250.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$167.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.93
Rate for Payer: Cigna Commercial	$417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$183.70
Rate for Payer: Qualcare PPO/HMO/WC	$125.25
Rate for Payer: UnitedHealthcare Community & State	$20.12
Rate for Payer: Wellpoint Medicaid Managed Care	$22.13

Know your out-of-pocket cost for care.

All Charges