Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH TENCKHOFF

Facility

$578.00

Hospital Charge Code	1603133
Hospital Revenue Code	272
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$86.70
Rate for Payer: Qualcare PPO/HMO/WC	$86.70

CATH TENCKHOFF

Facility

$578.00

Hospital Charge Code	1603133
Hospital Revenue Code	272
Min. Negotiated Rate	$13.93
Max. Negotiated Rate	$289.00
Rate for Payer: Aetna Commercial	$219.64
Rate for Payer: Aetna Medicare Advantage	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.39
Rate for Payer: Cigna Commercial	$289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.40
Rate for Payer: Oxford Commercial	$115.60
Rate for Payer: Qualcare PPO/HMO/WC	$86.70
Rate for Payer: UnitedHealthcare Commercial	$115.60
Rate for Payer: UnitedHealthcare Community & State	$13.93
Rate for Payer: Wellpoint Medicaid Managed Care	$15.32

CATH TENCKHOFF

Facility

$288.00

Hospital Charge Code	1608165
Hospital Revenue Code	272
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$43.20
Rate for Payer: Qualcare PPO/HMO/WC	$43.20

CATH TENCKHOFF PERITONL 60087

Facility

$739.25

Hospital Charge Code	270608944
Hospital Revenue Code	272
Min. Negotiated Rate	$17.82
Max. Negotiated Rate	$369.62
Rate for Payer: Aetna Commercial	$280.92
Rate for Payer: Aetna Medicare Advantage	$221.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.51
Rate for Payer: Cigna Commercial	$369.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.78
Rate for Payer: Oxford Commercial	$147.85
Rate for Payer: Qualcare PPO/HMO/WC	$110.89
Rate for Payer: UnitedHealthcare Commercial	$147.85
Rate for Payer: UnitedHealthcare Community & State	$17.82
Rate for Payer: Wellpoint Medicaid Managed Care	$19.59

CATH TENCKHOFF PERITONL 60087

Facility

$739.25

Hospital Charge Code	270608944
Hospital Revenue Code	272
Min. Negotiated Rate	$110.89
Max. Negotiated Rate	$110.89
Rate for Payer: Qualcare PPO/HMO/WC	$110.89

CATH TESIO LEFT SIDE 11FR 52CM

Facility

$1,505.00

Service Code	HCPCS C1750
Hospital Charge Code	270620402
Hospital Revenue Code	278
Min. Negotiated Rate	$225.75
Max. Negotiated Rate	$364.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$301.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$364.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$331.10
Rate for Payer: Qualcare PPO/HMO/WC	$225.75

CATH TESIO LEFT SIDE 11FR 52CM

Facility

$1,505.00

Service Code	HCPCS C1750
Hospital Charge Code	270620402
Hospital Revenue Code	278
Min. Negotiated Rate	$36.27
Max. Negotiated Rate	$752.50
Rate for Payer: Aetna Commercial	$571.90
Rate for Payer: Aetna Medicare Advantage	$451.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$383.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$383.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$301.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$383.77
Rate for Payer: Cigna Commercial	$752.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$364.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$331.10
Rate for Payer: Qualcare PPO/HMO/WC	$225.75
Rate for Payer: UnitedHealthcare Community & State	$36.27
Rate for Payer: Wellpoint Medicaid Managed Care	$39.88

CATH TESIO RIGHT BFR-6

Facility

$380.85

Hospital Charge Code	270621660
Hospital Revenue Code	272
Min. Negotiated Rate	$9.18
Max. Negotiated Rate	$190.43
Rate for Payer: Aetna Commercial	$144.72
Rate for Payer: Aetna Medicare Advantage	$114.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.12
Rate for Payer: Cigna Commercial	$190.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.25
Rate for Payer: Oxford Commercial	$76.17
Rate for Payer: Qualcare PPO/HMO/WC	$57.13
Rate for Payer: UnitedHealthcare Commercial	$76.17
Rate for Payer: UnitedHealthcare Community & State	$9.18
Rate for Payer: Wellpoint Medicaid Managed Care	$10.09

CATH TESIO RIGHT BFR-6

Facility

$380.85

Hospital Charge Code	270621660
Hospital Revenue Code	272
Min. Negotiated Rate	$57.13
Max. Negotiated Rate	$57.13
Rate for Payer: Qualcare PPO/HMO/WC	$57.13

CATH TESIO RT W/6F INTRO/TUNNE

Facility

$1,775.00

Service Code	HCPCS C1750
Hospital Charge Code	270658136
Hospital Revenue Code	278
Min. Negotiated Rate	$42.78
Max. Negotiated Rate	$887.50
Rate for Payer: Aetna Commercial	$674.50
Rate for Payer: Aetna Medicare Advantage	$532.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$452.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$452.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$452.62
Rate for Payer: Cigna Commercial	$887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$390.50
Rate for Payer: Qualcare PPO/HMO/WC	$266.25
Rate for Payer: UnitedHealthcare Community & State	$42.78
Rate for Payer: Wellpoint Medicaid Managed Care	$47.04

CATH TESIO RT W/6F INTRO/TUNNE

Facility

$1,775.00

Service Code	HCPCS C1750
Hospital Charge Code	270658136
Hospital Revenue Code	278
Min. Negotiated Rate	$266.25
Max. Negotiated Rate	$429.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$355.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$390.50
Rate for Payer: Qualcare PPO/HMO/WC	$266.25

CATH TESSIO 10 70 BFR-1070KD-A

Facility

$2,169.65

Hospital Charge Code	270620664
Hospital Revenue Code	272
Min. Negotiated Rate	$325.45
Max. Negotiated Rate	$325.45
Rate for Payer: Qualcare PPO/HMO/WC	$325.45

CATH TESSIO 10 70 BFR-1070KD-A

Facility

$2,169.65

Hospital Charge Code	270620664
Hospital Revenue Code	272
Min. Negotiated Rate	$52.29
Max. Negotiated Rate	$1,084.83
Rate for Payer: Aetna Commercial	$824.47
Rate for Payer: Aetna Medicare Advantage	$650.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$553.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$553.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$553.26
Rate for Payer: Cigna Commercial	$1,084.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$650.89
Rate for Payer: Oxford Commercial	$433.93
Rate for Payer: Qualcare PPO/HMO/WC	$325.45
Rate for Payer: UnitedHealthcare Commercial	$433.93
Rate for Payer: UnitedHealthcare Community & State	$52.29
Rate for Payer: Wellpoint Medicaid Managed Care	$57.50

CATH TESSIO DUAL L 6FR MBL6

Facility

$2,812.85

Hospital Charge Code	270601076
Hospital Revenue Code	272
Min. Negotiated Rate	$67.79
Max. Negotiated Rate	$1,406.42
Rate for Payer: Aetna Commercial	$1,068.88
Rate for Payer: Aetna Medicare Advantage	$843.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$717.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$717.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$717.28
Rate for Payer: Cigna Commercial	$1,406.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$843.86
Rate for Payer: Oxford Commercial	$562.57
Rate for Payer: Qualcare PPO/HMO/WC	$421.93
Rate for Payer: UnitedHealthcare Commercial	$562.57
Rate for Payer: UnitedHealthcare Community & State	$67.79
Rate for Payer: Wellpoint Medicaid Managed Care	$74.54

CATH TESSIO DUAL L 6FR MBL6

Facility

$2,812.85

Hospital Charge Code	270601076
Hospital Revenue Code	272
Min. Negotiated Rate	$421.93
Max. Negotiated Rate	$421.93
Rate for Payer: Qualcare PPO/HMO/WC	$421.93

CATH TESSIO KIT MCTC1035KD-A-1

Facility

$2,700.85

Hospital Charge Code	270605149
Hospital Revenue Code	278
Min. Negotiated Rate	$65.09
Max. Negotiated Rate	$1,350.42
Rate for Payer: Aetna Commercial	$1,026.32
Rate for Payer: Aetna Medicare Advantage	$810.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$540.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.72
Rate for Payer: Cigna Commercial	$1,350.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$653.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$594.19
Rate for Payer: Qualcare PPO/HMO/WC	$405.13
Rate for Payer: UnitedHealthcare Community & State	$65.09
Rate for Payer: Wellpoint Medicaid Managed Care	$71.57

CATH TESSIO KIT MCTC1035KD-A-1

Facility

$2,700.85

Hospital Charge Code	270605149
Hospital Revenue Code	278
Min. Negotiated Rate	$405.13
Max. Negotiated Rate	$653.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$540.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$653.61
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$594.19
Rate for Payer: Qualcare PPO/HMO/WC	$405.13

CATH TESSIO KIT MCTC1035KDA1**

Facility

$792.00

Hospital Charge Code	1608454
Hospital Revenue Code	272
Min. Negotiated Rate	$118.80
Max. Negotiated Rate	$118.80
Rate for Payer: Qualcare PPO/HMO/WC	$118.80

CATH TESSIO KIT MCTC1035KDA1**

Facility

$792.00

Hospital Charge Code	1608454
Hospital Revenue Code	272
Min. Negotiated Rate	$19.09
Max. Negotiated Rate	$396.00
Rate for Payer: Aetna Commercial	$300.96
Rate for Payer: Aetna Medicare Advantage	$237.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.96
Rate for Payer: Cigna Commercial	$396.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.60
Rate for Payer: Oxford Commercial	$158.40
Rate for Payer: Qualcare PPO/HMO/WC	$118.80
Rate for Payer: UnitedHealthcare Commercial	$158.40
Rate for Payer: UnitedHealthcare Community & State	$19.09
Rate for Payer: Wellpoint Medicaid Managed Care	$20.99

CATH TESSIO MBL6*******

Facility

$550.00

Hospital Charge Code	1608355
Hospital Revenue Code	272
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.00
Rate for Payer: Oxford Commercial	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$110.00
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

CATH TESSIO MBL6*******

Facility

$550.00

Hospital Charge Code	1608355
Hospital Revenue Code	272
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

CATH TEXAS EXTERNAL

Facility

$9.65

Hospital Charge Code	270300600
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 TEXAS EXTERNAL

Facility

$20.00

Hospital Charge Code	8001711
Hospital Revenue Code	279
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare Advantage	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.10
Rate for Payer: Cigna Commercial	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.00
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$4.00
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

CATH TEXAS EXTERNAL

Facility

$9.65

Hospital Charge Code	270300600
Hospital Revenue Code	272
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

CATH TEXAS EXTERNAL

Facility

$20.00

Hospital Charge Code	8001711
Hospital Revenue Code	279
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

Know your out-of-pocket cost for care.

All Charges