Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

CATH STEALTH PRDR PRD-SC30-200

Facility

$16,975.00

Service Code	HCPCS C1714
Hospital Charge Code	270647207C
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-SC30-200

Facility

$16,975.00

Service Code	HCPCS C1714
Hospital Charge Code	270647207N
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-SC30-200

Facility

$16,975.00

Service Code	HCPCS C1714
Hospital Charge Code	270647207C
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-SC30-200

Facility

$16,975.00

Service Code	HCPCS C1714
Hospital Charge Code	270647207N
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-SC30-150

Facility

$16,975.00

Service Code	HCPCS C1874
Hospital Charge Code	270647206C
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-SC30-150

Facility

$16,975.00

Service Code	HCPCS C1874
Hospital Charge Code	270647206C
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 STM AHS SPLIT 14F ASPC40

Facility

$2,050.00

Hospital Charge Code	270624359
Hospital Revenue Code	272
Min. Negotiated Rate	$49.41
Max. Negotiated Rate	$1,025.00
Rate for Payer: Aetna Commercial	$779.00
Rate for Payer: Aetna Medicare Advantage	$615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.75
Rate for Payer: Cigna Commercial	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$615.00
Rate for Payer: Oxford Commercial	$410.00
Rate for Payer: Qualcare PPO/HMO/WC	$307.50
Rate for Payer: UnitedHealthcare Commercial	$410.00
Rate for Payer: UnitedHealthcare Community & State	$49.41
Rate for Payer: Wellpoint Medicaid Managed Care	$54.33

CATH STM AHS SPLIT 14F ASPC40

Facility

$2,050.00

Hospital Charge Code	270624359
Hospital Revenue Code	272
Min. Negotiated Rate	$307.50
Max. Negotiated Rate	$307.50
Rate for Payer: Qualcare PPO/HMO/WC	$307.50

CATH STONE BALLOON***

Facility

$637.00

Hospital Charge Code	2300531
Hospital Revenue Code	279
Min. Negotiated Rate	$95.55
Max. Negotiated Rate	$95.55
Rate for Payer: Qualcare PPO/HMO/WC	$95.55

CATH STONE BALLOON***

Facility

$637.00

Hospital Charge Code	2300531
Hospital Revenue Code	279
Min. Negotiated Rate	$15.35
Max. Negotiated Rate	$318.50
Rate for Payer: Aetna Commercial	$242.06
Rate for Payer: Aetna Medicare Advantage	$191.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.44
Rate for Payer: Cigna Commercial	$318.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.10
Rate for Payer: Oxford Commercial	$127.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.55
Rate for Payer: UnitedHealthcare Commercial	$127.40
Rate for Payer: UnitedHealthcare Community & State	$15.35
Rate for Payer: Wellpoint Medicaid Managed Care	$16.88

CATH STRAP ******

Facility

$15.00

Hospital Charge Code	8000390
Hospital Revenue Code	279
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.50
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

CATH STRAP ******

Facility

$15.00

Hospital Charge Code	8000390
Hospital Revenue Code	279
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

CATH STR RED RUBBER 10F

Facility

$12.85

Hospital Charge Code	270300516
Hospital Revenue Code	272
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.42
Rate for Payer: Aetna Commercial	$4.88
Rate for Payer: Aetna Medicare Advantage	$3.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.28
Rate for Payer: Cigna Commercial	$6.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.85
Rate for Payer: Oxford Commercial	$2.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.93
Rate for Payer: UnitedHealthcare Commercial	$2.57
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

CATH STR RED RUBBER 10F

Facility

$12.85

Hospital Charge Code	270300516
Hospital Revenue Code	272
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.93

CATH STR RED RUBBER 12F

Facility

$9.65

Hospital Charge Code	270300520
Hospital Revenue Code	272
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

CATH STR RED RUBBER 12F

Facility

$9.65

Hospital Charge Code	270300520
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.90
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

CATH STR RED RUBBER 14F

Facility

$11.25

Hospital Charge Code	270300525
Hospital Revenue Code	272
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

CATH STR RED RUBBER 14F

Facility

$11.25

Hospital Charge Code	270300525
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

CATH STR RED RUBBER 16-18F****

Facility

$5.00

Hospital Charge Code	8000374
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

CATH STR RED RUBBER 16-18F****

Facility

$5.00

Hospital Charge Code	8000374
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

CATH STR RED RUBBER 16F

Facility

$11.25

Hospital Charge Code	270300530
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

CATH STR RED RUBBER 16F

Facility

$11.25

Hospital Charge Code	270300530
Hospital Revenue Code	272
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

CATH STR RED RUBBER 18F

Facility

$13.65

Hospital Charge Code	270300535
Hospital Revenue Code	272
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

Know your out-of-pocket cost for care.

All Charges