Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH ROBERT W/COATING 5FR 90CM

Facility

$1,625.00

Service Code	HCPCS C1876
Hospital Charge Code	270634650C
Hospital Revenue Code	278
Min. Negotiated Rate	$39.16
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Community & State	$39.16
Rate for Payer: Wellpoint Medicaid Managed Care	$43.06

CATH ROBERT W/COATING 5FR 90CM

Facility

$1,625.00

Service Code	HCPCS C1876
Hospital Charge Code	270634650C
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$393.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

CATH ROYAL FLUSH 5FR

Facility

$74.30

Hospital Charge Code	270677002
Hospital Revenue Code	272
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$37.15
Rate for Payer: Aetna Commercial	$28.23
Rate for Payer: Aetna Medicare Advantage	$22.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.95
Rate for Payer: Cigna Commercial	$37.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.29
Rate for Payer: Oxford Commercial	$14.86
Rate for Payer: Qualcare PPO/HMO/WC	$11.14
Rate for Payer: UnitedHealthcare Commercial	$14.86
Rate for Payer: UnitedHealthcare Community & State	$1.79
Rate for Payer: Wellpoint Medicaid Managed Care	$1.97

CATH ROYAL FLUSH 5FR

Facility

$74.30

Hospital Charge Code	270677002
Hospital Revenue Code	272
Min. Negotiated Rate	$11.14
Max. Negotiated Rate	$11.14
Rate for Payer: Qualcare PPO/HMO/WC	$11.14

CATH SA 5x120x130 SAE050120130

Facility

$1,413.65

Hospital Charge Code	270635524V
Hospital Revenue Code	278
Min. Negotiated Rate	$34.07
Max. Negotiated Rate	$706.83
Rate for Payer: Aetna Commercial	$537.19
Rate for Payer: Aetna Medicare Advantage	$424.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$360.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$360.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$360.48
Rate for Payer: Cigna Commercial	$706.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$311.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.05
Rate for Payer: UnitedHealthcare Community & State	$34.07
Rate for Payer: Wellpoint Medicaid Managed Care	$37.46

CATH SA 5x120x130 SAE050120130

Facility

$1,413.65

Hospital Charge Code	270635524V
Hospital Revenue Code	278
Min. Negotiated Rate	$212.05
Max. Negotiated Rate	$342.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$311.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.05

CATH SA 5x120x130 SAE050120130

Facility

$1,413.65

Hospital Charge Code	270635524
Hospital Revenue Code	278
Min. Negotiated Rate	$212.05
Max. Negotiated Rate	$342.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$311.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.05

CATH SA 5x120x130 SAE050120130

Facility

$1,413.65

Hospital Charge Code	270635524
Hospital Revenue Code	278
Min. Negotiated Rate	$34.07
Max. Negotiated Rate	$706.83
Rate for Payer: Aetna Commercial	$537.19
Rate for Payer: Aetna Medicare Advantage	$424.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$360.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$360.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$360.48
Rate for Payer: Cigna Commercial	$706.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$311.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.05
Rate for Payer: UnitedHealthcare Community & State	$34.07
Rate for Payer: Wellpoint Medicaid Managed Care	$37.46

CATH SAIL 5x80x130 SAE05080130

Facility

$1,413.65

Hospital Charge Code	270636533V
Hospital Revenue Code	278
Min. Negotiated Rate	$34.07
Max. Negotiated Rate	$706.83
Rate for Payer: Aetna Commercial	$537.19
Rate for Payer: Aetna Medicare Advantage	$424.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$360.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$360.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$360.48
Rate for Payer: Cigna Commercial	$706.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$311.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.05
Rate for Payer: UnitedHealthcare Community & State	$34.07
Rate for Payer: Wellpoint Medicaid Managed Care	$37.46

CATH SAIL 5x80x130 SAE05080130

Facility

$1,767.00

Hospital Charge Code	270636533
Hospital Revenue Code	272
Min. Negotiated Rate	$265.05
Max. Negotiated Rate	$265.05
Rate for Payer: Qualcare PPO/HMO/WC	$265.05

CATH SAIL 5x80x130 SAE05080130

Facility

$1,767.00

Hospital Charge Code	270636533
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 SAIL 5x80x130 SAE05080130

Facility

$1,413.65

Hospital Charge Code	270636533V
Hospital Revenue Code	278
Min. Negotiated Rate	$212.05
Max. Negotiated Rate	$342.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$311.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.05

CATH SAL 6x120x13 SAE060120130

Facility

$1,413.65

Hospital Charge Code	270635527V
Hospital Revenue Code	278
Min. Negotiated Rate	$212.05
Max. Negotiated Rate	$342.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$311.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.05

CATH SAL 6x120x13 SAE060120130

Facility

$1,413.65

Hospital Charge Code	270635527V
Hospital Revenue Code	278
Min. Negotiated Rate	$34.07
Max. Negotiated Rate	$706.83
Rate for Payer: Aetna Commercial	$537.19
Rate for Payer: Aetna Medicare Advantage	$424.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$360.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$360.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$282.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$360.48
Rate for Payer: Cigna Commercial	$706.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$311.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.05
Rate for Payer: UnitedHealthcare Community & State	$34.07
Rate for Payer: Wellpoint Medicaid Managed Care	$37.46

CATH SCHON D/LUMEN 20cm

Facility

$475.00

Service Code	HCPCS C1752
Hospital Charge Code	270635645
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

CATH SCHON D/LUMEN 20cm

Facility

$475.00

Service Code	HCPCS C1752
Hospital Charge Code	270635645S
Hospital Revenue Code	278
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

CATH SCHON D/LUMEN 20cm

Facility

$475.00

Service Code	HCPCS C1752
Hospital Charge Code	270635645S
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

CATH SCHON D/LUMEN 20cm

Facility

$699.95

Service Code	HCPCS C1752
Hospital Charge Code	270635645N
Hospital Revenue Code	278
Min. Negotiated Rate	$104.99
Max. Negotiated Rate	$169.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$153.99
Rate for Payer: Qualcare PPO/HMO/WC	$104.99

CATH SCHON D/LUMEN 20cm

Facility

$475.00

Service Code	HCPCS C1752
Hospital Charge Code	270635645
Hospital Revenue Code	278
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

CATH SCHON D/LUMEN 20cm

Facility

$699.95

Service Code	HCPCS C1752
Hospital Charge Code	270635645N
Hospital Revenue Code	278
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$349.98
Rate for Payer: Aetna Commercial	$265.98
Rate for Payer: Aetna Medicare Advantage	$209.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.49
Rate for Payer: Cigna Commercial	$349.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$153.99
Rate for Payer: Qualcare PPO/HMO/WC	$104.99
Rate for Payer: UnitedHealthcare Community & State	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$18.55

CATH SCULP 2.5x100mm 155cm BTK

Facility

$6,000.00

Service Code	HCPCS C1725
Hospital Charge Code	270665654S
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

CATH SCULP 2.5x100mm 155cm BTK

Facility

$6,000.00

Service Code	HCPCS C1725
Hospital Charge Code	270665654
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

CATH SCULP 2.5x100mm 155cm BTK

Facility

$6,000.00

Service Code	HCPCS C1725
Hospital Charge Code	270665654
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

CATH SCULP 2.5x100mm 155cm BTK

Facility

$6,000.00

Service Code	HCPCS C1725
Hospital Charge Code	270665654S
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

CATH SCULP 2x100mm 155cm BTK

Facility

$6,000.00

Service Code	HCPCS C1725
Hospital Charge Code	270665653S
Hospital Revenue Code	278
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,320.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

Know your out-of-pocket cost for care.

All Charges