Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH SOS OMNI SEL2 5Fx80CM

Facility

$105.00

Service Code	HCPCS C1887
Hospital Charge Code	270673388
Hospital Revenue Code	272
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

CATH SOS OMNI SEL(3) 5FRx80CM

Facility

$105.00

Hospital Charge Code	270624913N
Hospital Revenue Code	272
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

CATH SOS OMNI SEL(3) 5FRx80CM

Facility

$105.00

Hospital Charge Code	270624913
Hospital Revenue Code	272
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.50
Rate for Payer: Oxford Commercial	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

CATH SOS OMNI SEL(3) 5FRx80CM

Facility

$105.00

Hospital Charge Code	270624913N
Hospital Revenue Code	272
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

CATH SOS OMNI SEL(3) 5FRx80CM

Facility

$105.00

Hospital Charge Code	270624913
Hospital Revenue Code	272
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

CATH SP 17GA 3.5 TUOHY 185A001

Facility

$129.00

Hospital Charge Code	270636103
Hospital Revenue Code	272
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$19.35
Rate for Payer: Qualcare PPO/HMO/WC	$19.35

CATH SP 17GA 3.5 TUOHY 185A001

Facility

$129.00

Hospital Charge Code	270636103
Hospital Revenue Code	272
Min. Negotiated Rate	$3.11
Max. Negotiated Rate	$64.50
Rate for Payer: Aetna Commercial	$49.02
Rate for Payer: Aetna Medicare Advantage	$38.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.90
Rate for Payer: Cigna Commercial	$64.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.70
Rate for Payer: Oxford Commercial	$25.80
Rate for Payer: Qualcare PPO/HMO/WC	$19.35
Rate for Payer: UnitedHealthcare Commercial	$25.80
Rate for Payer: UnitedHealthcare Community & State	$3.11
Rate for Payer: Wellpoint Medicaid Managed Care	$3.42

CATH SPY SCOPE DS ACCESS/DELIV

Facility

$13,250.00

Hospital Charge Code	270675498
Hospital Revenue Code	272
Min. Negotiated Rate	$319.32
Max. Negotiated Rate	$6,625.00
Rate for Payer: Aetna Commercial	$5,035.00
Rate for Payer: Aetna Medicare Advantage	$3,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,378.75
Rate for Payer: Cigna Commercial	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,975.00
Rate for Payer: Oxford Commercial	$2,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50
Rate for Payer: UnitedHealthcare Commercial	$2,650.00
Rate for Payer: UnitedHealthcare Community & State	$319.32
Rate for Payer: Wellpoint Medicaid Managed Care	$351.12

CATH SPY SCOPE DS ACCESS/DELIV

Facility

$13,250.00

Hospital Charge Code	270675498
Hospital Revenue Code	272
Min. Negotiated Rate	$1,987.50
Max. Negotiated Rate	$1,987.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50

CATH SRC 6FR 533-639T

Facility

$244.85

Hospital Charge Code	270600707
Hospital Revenue Code	272
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$122.42
Rate for Payer: Aetna Commercial	$93.04
Rate for Payer: Aetna Medicare Advantage	$73.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.44
Rate for Payer: Cigna Commercial	$122.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.45
Rate for Payer: Oxford Commercial	$48.97
Rate for Payer: Qualcare PPO/HMO/WC	$36.73
Rate for Payer: UnitedHealthcare Commercial	$48.97
Rate for Payer: UnitedHealthcare Community & State	$5.90
Rate for Payer: Wellpoint Medicaid Managed Care	$6.49

CATH SRC 6FR 533-639T

Facility

$244.85

Hospital Charge Code	270600707
Hospital Revenue Code	272
Min. Negotiated Rate	$36.73
Max. Negotiated Rate	$36.73
Rate for Payer: Qualcare PPO/HMO/WC	$36.73

CATH STEALTH 1.25 MICRO 60

Facility

$18,975.00

Hospital Charge Code	270671186
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

CATH STEALTH 1.25 MICRO 60

Facility

$18,975.00

Hospital Charge Code	270671186
Hospital Revenue Code	278
Min. Negotiated Rate	$457.30
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$7,210.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25
Rate for Payer: UnitedHealthcare Community & State	$457.30
Rate for Payer: Wellpoint Medicaid Managed Care	$502.84

CATH STEALTH 1.25 SOLID 60

Facility

$18,970.00

Service Code	HCPCS C1724
Hospital Charge Code	270671187
Hospital Revenue Code	278
Min. Negotiated Rate	$2,845.50
Max. Negotiated Rate	$4,590.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,794.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,590.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,173.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,845.50

CATH STEALTH 1.25 SOLID 60

Facility

$18,970.00

Service Code	HCPCS C1724
Hospital Charge Code	270671187
Hospital Revenue Code	278
Min. Negotiated Rate	$457.18
Max. Negotiated Rate	$9,485.00
Rate for Payer: Aetna Commercial	$7,208.60
Rate for Payer: Aetna Medicare Advantage	$5,691.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,837.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,837.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,794.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,837.35
Rate for Payer: Cigna Commercial	$9,485.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,590.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,173.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,845.50
Rate for Payer: UnitedHealthcare Community & State	$457.18
Rate for Payer: Wellpoint Medicaid Managed Care	$502.70

CATH STEALTH 1.25 SOLID 60

Facility

$18,970.00

Service Code	HCPCS C1724
Hospital Charge Code	270671187N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,845.50
Max. Negotiated Rate	$4,590.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,794.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,590.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,173.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,845.50

CATH STEALTH 1.25 SOLID 60

Facility

$18,970.00

Service Code	HCPCS C1724
Hospital Charge Code	270671187N
Hospital Revenue Code	278
Min. Negotiated Rate	$457.18
Max. Negotiated Rate	$9,485.00
Rate for Payer: Aetna Commercial	$7,208.60
Rate for Payer: Aetna Medicare Advantage	$5,691.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,837.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,837.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,794.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,837.35
Rate for Payer: Cigna Commercial	$9,485.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,590.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4,173.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,845.50
Rate for Payer: UnitedHealthcare Community & State	$457.18
Rate for Payer: Wellpoint Medicaid Managed Care	$502.70

CATH STEALTH DMNDBK DBE-150

Facility

$16,975.00

Service Code	HCPCS C1714
Hospital Charge Code	270647202N
Hospital Revenue Code	278
Min. Negotiated Rate	$409.10
Max. Negotiated Rate	$8,487.50
Rate for Payer: Aetna Commercial	$6,450.50
Rate for Payer: Aetna Medicare Advantage	$5,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,328.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,328.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,328.62
Rate for Payer: Cigna Commercial	$8,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,107.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,734.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,546.25
Rate for Payer: UnitedHealthcare Community & State	$409.10
Rate for Payer: Wellpoint Medicaid Managed Care	$449.84

CATH STEALTH DMNDBK DBE-150

Facility

$16,975.00

Service Code	HCPCS C1714
Hospital Charge Code	270647202C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,546.25
Max. Negotiated Rate	$4,107.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,107.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,734.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,546.25

CATH STEALTH DMNDBK DBE-150

Facility

$16,975.00

Service Code	HCPCS C1714
Hospital Charge Code	270647202C
Hospital Revenue Code	278
Min. Negotiated Rate	$409.10
Max. Negotiated Rate	$8,487.50
Rate for Payer: Aetna Commercial	$6,450.50
Rate for Payer: Aetna Medicare Advantage	$5,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,328.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,328.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,328.62
Rate for Payer: Cigna Commercial	$8,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,107.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,734.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,546.25
Rate for Payer: UnitedHealthcare Community & State	$409.10
Rate for Payer: Wellpoint Medicaid Managed Care	$449.84

CATH STEALTH DMNDBK DBE-150

Facility

$16,975.00

Service Code	HCPCS C1714
Hospital Charge Code	270647202N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,546.25
Max. Negotiated Rate	$4,107.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,107.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,734.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,546.25

CATH STEALTH DMNDBK DBE-200

Facility

$16,975.00

Service Code	HCPCS C1714
Hospital Charge Code	270647204C
Hospital Revenue Code	278
Min. Negotiated Rate	$409.10
Max. Negotiated Rate	$8,487.50
Rate for Payer: Aetna Commercial	$6,450.50
Rate for Payer: Aetna Medicare Advantage	$5,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,328.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,328.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,328.62
Rate for Payer: Cigna Commercial	$8,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,107.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,734.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,546.25
Rate for Payer: UnitedHealthcare Community & State	$409.10
Rate for Payer: Wellpoint Medicaid Managed Care	$449.84

CATH STEALTH DMNDBK DBE-200

Facility

$16,975.00

Service Code	HCPCS C1714
Hospital Charge Code	270647204C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,546.25
Max. Negotiated Rate	$4,107.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,107.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,734.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,546.25

CATH STEALTH PRDR PRD-SC30-125

Facility

$16,975.00

Service Code	HCPCS C1714
Hospital Charge Code	270647205C
Hospital Revenue Code	278
Min. Negotiated Rate	$409.10
Max. Negotiated Rate	$8,487.50
Rate for Payer: Aetna Commercial	$6,450.50
Rate for Payer: Aetna Medicare Advantage	$5,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,328.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,328.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,328.62
Rate for Payer: Cigna Commercial	$8,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,107.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,734.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,546.25
Rate for Payer: UnitedHealthcare Community & State	$409.10
Rate for Payer: Wellpoint Medicaid Managed Care	$449.84

CATH STEALTH PRDR PRD-SC30-125

Facility

$16,975.00

Service Code	HCPCS C1714
Hospital Charge Code	270647205C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,546.25
Max. Negotiated Rate	$4,107.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,107.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,734.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,546.25

Know your out-of-pocket cost for care.

All Charges