Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH TRAILBLZR 35CM .035

Facility

$744.80

Service Code	HCPCS C1887
Hospital Charge Code	270643851
Hospital Revenue Code	278
Min. Negotiated Rate	$111.72
Max. Negotiated Rate	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.86
Rate for Payer: Qualcare PPO/HMO/WC	$111.72

CATH TRAILBLZR 35CM .035

Facility

$744.80

Service Code	HCPCS C1887
Hospital Charge Code	270643851
Hospital Revenue Code	278
Min. Negotiated Rate	$17.95
Max. Negotiated Rate	$372.40
Rate for Payer: Aetna Commercial	$283.02
Rate for Payer: Aetna Medicare Advantage	$223.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.92
Rate for Payer: Cigna Commercial	$372.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.86
Rate for Payer: Qualcare PPO/HMO/WC	$111.72
Rate for Payer: UnitedHealthcare Community & State	$17.95
Rate for Payer: Wellpoint Medicaid Managed Care	$19.74

CATH TRAILBLZR 35CM .035

Facility

$4,042.50

Service Code	HCPCS C1887
Hospital Charge Code	270643851N
Hospital Revenue Code	278
Min. Negotiated Rate	$606.38
Max. Negotiated Rate	$978.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$808.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$978.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$889.35
Rate for Payer: Qualcare PPO/HMO/WC	$606.38

CATH TRAILBLZR 35CM .035

Facility

$4,042.50

Service Code	HCPCS C1887
Hospital Charge Code	270643851N
Hospital Revenue Code	278
Min. Negotiated Rate	$97.42
Max. Negotiated Rate	$2,021.25
Rate for Payer: Aetna Commercial	$1,536.15
Rate for Payer: Aetna Medicare Advantage	$1,212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,030.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,030.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$808.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,030.84
Rate for Payer: Cigna Commercial	$2,021.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$978.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$889.35
Rate for Payer: Qualcare PPO/HMO/WC	$606.38
Rate for Payer: UnitedHealthcare Community & State	$97.42
Rate for Payer: Wellpoint Medicaid Managed Care	$107.13

CATH TRAILBZ 018 150 SC0181150

Facility

$744.80

Service Code	HCPCS C1725
Hospital Charge Code	270643850C
Hospital Revenue Code	278
Min. Negotiated Rate	$17.95
Max. Negotiated Rate	$372.40
Rate for Payer: Aetna Commercial	$283.02
Rate for Payer: Aetna Medicare Advantage	$223.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.92
Rate for Payer: Cigna Commercial	$372.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.86
Rate for Payer: Qualcare PPO/HMO/WC	$111.72
Rate for Payer: UnitedHealthcare Community & State	$17.95
Rate for Payer: Wellpoint Medicaid Managed Care	$19.74

CATH TRAILBZ 018 150 SC0181150

Facility

$744.80

Service Code	HCPCS C1725
Hospital Charge Code	270643850C
Hospital Revenue Code	278
Min. Negotiated Rate	$111.72
Max. Negotiated Rate	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$163.86
Rate for Payer: Qualcare PPO/HMO/WC	$111.72

CATH TRANSFORM OCCLUS 4X20MM

Facility

$8,323.50

Service Code	HCPCS C2628
Hospital Charge Code	270693898S
Hospital Revenue Code	278
Min. Negotiated Rate	$200.60
Max. Negotiated Rate	$4,161.75
Rate for Payer: Aetna Commercial	$3,162.93
Rate for Payer: Aetna Medicare Advantage	$2,497.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,122.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,122.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,664.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,122.49
Rate for Payer: Cigna Commercial	$4,161.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,014.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,831.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,248.53
Rate for Payer: UnitedHealthcare Community & State	$200.60
Rate for Payer: Wellpoint Medicaid Managed Care	$220.57

CATH TRANSFORM OCCLUS 4X20MM

Facility

$8,323.50

Service Code	HCPCS C2628
Hospital Charge Code	270693898S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,248.53
Max. Negotiated Rate	$2,014.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,664.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,014.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,831.17
Rate for Payer: Qualcare PPO/HMO/WC	$1,248.53

CATH TRATTNER DBL BALLOON 20FR

Facility

$718.45

Hospital Charge Code	270607519
Hospital Revenue Code	272
Min. Negotiated Rate	$17.31
Max. Negotiated Rate	$359.23
Rate for Payer: Aetna Commercial	$273.01
Rate for Payer: Aetna Medicare Advantage	$215.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$183.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$183.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$183.20
Rate for Payer: Cigna Commercial	$359.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.53
Rate for Payer: Oxford Commercial	$143.69
Rate for Payer: Qualcare PPO/HMO/WC	$107.77
Rate for Payer: UnitedHealthcare Commercial	$143.69
Rate for Payer: UnitedHealthcare Community & State	$17.31
Rate for Payer: Wellpoint Medicaid Managed Care	$19.04

CATH TRATTNER DBL BALLOON 20FR

Facility

$718.45

Hospital Charge Code	270607519
Hospital Revenue Code	272
Min. Negotiated Rate	$107.77
Max. Negotiated Rate	$107.77
Rate for Payer: Qualcare PPO/HMO/WC	$107.77

CATH TRAUMA VENTRIC 3.3x1.9MM

Facility

$1,350.00

Service Code	HCPCS C1729
Hospital Charge Code	270695019
Hospital Revenue Code	278
Min. Negotiated Rate	$32.53
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna Commercial	$513.00
Rate for Payer: Aetna Medicare Advantage	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$344.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$344.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$344.25
Rate for Payer: Cigna Commercial	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$326.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$297.00
Rate for Payer: Qualcare PPO/HMO/WC	$202.50
Rate for Payer: UnitedHealthcare Community & State	$32.53
Rate for Payer: Wellpoint Medicaid Managed Care	$35.77

CATH TRAUMA VENTRIC 3.3x1.9MM

Facility

$1,350.00

Service Code	HCPCS C1729
Hospital Charge Code	270695019
Hospital Revenue Code	278
Min. Negotiated Rate	$202.50
Max. Negotiated Rate	$326.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$326.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$297.00
Rate for Payer: Qualcare PPO/HMO/WC	$202.50

CATH TRBHWK 8F THS-LS-C

Facility

$16,975.00

Service Code	HCPCS C1885
Hospital Charge Code	270642993C
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 TRBHWK 8F THS-LS-C

Facility

$16,975.00

Service Code	HCPCS C1885
Hospital Charge Code	270642993C
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

CATHTR BLLN AMPHRN .35X20X130

Facility

$700.00

Service Code	HCPCS C1725
Hospital Charge Code	270657924
Hospital Revenue Code	278
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Community & State	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$18.55

CATHTR BLLN AMPHRN .35X20X130

Facility

$700.00

Service Code	HCPCS C1725
Hospital Charge Code	270657924
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

CATHTR BLLN AMPHRN .35X60X130

Facility

$1,000.00

Hospital Charge Code	270657930
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CATHTR BLLN AMPHRN .35X60X130

Facility

$1,000.00

Hospital Charge Code	270657930
Hospital Revenue Code	278
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$220.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

CATHTR BLLN AMPHRN .35X80X130

Facility

$725.00

Service Code	HCPCS C1725
Hospital Charge Code	270657926
Hospital Revenue Code	278
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$175.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

CATHTR BLLN AMPHRN .35X80X130

Facility

$725.00

Service Code	HCPCS C1725
Hospital Charge Code	270657926
Hospital Revenue Code	278
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Community & State	$17.47
Rate for Payer: Wellpoint Medicaid Managed Care	$19.21

CATH TRBO ELITE OTW 1.7 417152

Facility

$12,500.00

Hospital Charge Code	270638467C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

CATH TRBO ELITE OTW 1.7 417152

Facility

$12,500.00

Hospital Charge Code	270638467C
Hospital Revenue Code	278
Min. Negotiated Rate	$301.25
Max. Negotiated Rate	$6,250.00
Rate for Payer: Aetna Commercial	$4,750.00
Rate for Payer: Aetna Medicare Advantage	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,187.50
Rate for Payer: Cigna Commercial	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00
Rate for Payer: UnitedHealthcare Community & State	$301.25
Rate for Payer: Wellpoint Medicaid Managed Care	$331.25

CATH TRBO ELTE OTW 1.4 414-151

Facility

$12,500.00

Hospital Charge Code	270638466C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

CATH TRBO ELTE OTW 1.4 414-151

Facility

$12,500.00

Hospital Charge Code	270638466C
Hospital Revenue Code	278
Min. Negotiated Rate	$301.25
Max. Negotiated Rate	$6,250.00
Rate for Payer: Aetna Commercial	$4,750.00
Rate for Payer: Aetna Medicare Advantage	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,187.50
Rate for Payer: Cigna Commercial	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00
Rate for Payer: UnitedHealthcare Community & State	$301.25
Rate for Payer: Wellpoint Medicaid Managed Care	$331.25

CATH TREATMENT ROOM***

Facility

$562.00

Service Code	HCPCS 99201
Hospital Charge Code	5100201
Hospital Revenue Code	769
Min. Negotiated Rate	$84.30
Max. Negotiated Rate	$84.30
Rate for Payer: Qualcare PPO/HMO/WC	$84.30

Know your out-of-pocket cost for care.

All Charges