Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

CATH TREK CORON/2.5MMX12MM

Facility

$850.00

Hospital Charge Code	2709007085
Hospital Revenue Code	272
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.00
Rate for Payer: Oxford Commercial	$170.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$170.00
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

CATH TREK CORON/2.5MMX12MM

Facility

$850.00

Hospital Charge Code	2709007085
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

CATH TREK CORON 2.5MMX15MM

Facility

$850.00

Hospital Charge Code	2709007078
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

CATH TREK CORON 2.5MMX15MM

Facility

$850.00

Hospital Charge Code	2709007078
Hospital Revenue Code	272
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.00
Rate for Payer: Oxford Commercial	$170.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$170.00
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

CATH TREK CORON2.5MMX20MM

Facility

$850.00

Hospital Charge Code	2709007079
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

CATH TREK CORON2.5MMX20MM

Facility

$850.00

Hospital Charge Code	2709007079
Hospital Revenue Code	272
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.00
Rate for Payer: Oxford Commercial	$170.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$170.00
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

CATH TREK CORON/2.5MMX30MM

Facility

$850.00

Hospital Charge Code	2709007080
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

CATH TREK CORON/2.5MMX30MM

Facility

$850.00

Hospital Charge Code	2709007080
Hospital Revenue Code	272
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.00
Rate for Payer: Oxford Commercial	$170.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$170.00
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

CATH TREK CORON/3.00MMX20MM

Facility

$850.00

Hospital Charge Code	2709007082
Hospital Revenue Code	272
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.00
Rate for Payer: Oxford Commercial	$170.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$170.00
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

CATH TREK CORON/3.00MMX20MM

Facility

$850.00

Hospital Charge Code	2709007082
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

CATH TREK CORON/3.0MMX12MM

Facility

$850.00

Hospital Charge Code	2709007120
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

CATH TREK CORON/3.0MMX12MM

Facility

$850.00

Hospital Charge Code	2709007120
Hospital Revenue Code	272
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.00
Rate for Payer: Oxford Commercial	$170.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$170.00
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

CATH TREK CORON/3.5MMX15MM

Facility

$850.00

Hospital Charge Code	2709007122
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

CATH TREK CORON/3.5MMX15MM

Facility

$850.00

Hospital Charge Code	2709007122
Hospital Revenue Code	272
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.00
Rate for Payer: Oxford Commercial	$170.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$170.00
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

CATH TRELLIS PERIPHERAL

Facility

$10,475.00

Hospital Charge Code	27064266
Hospital Revenue Code	278
Min. Negotiated Rate	$252.45
Max. Negotiated Rate	$5,237.50
Rate for Payer: Aetna Commercial	$3,980.50
Rate for Payer: Aetna Medicare Advantage	$3,142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,671.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,671.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,671.12
Rate for Payer: Cigna Commercial	$5,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,534.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,304.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,571.25
Rate for Payer: UnitedHealthcare Community & State	$252.45
Rate for Payer: Wellpoint Medicaid Managed Care	$277.59

CATH TRELLIS PERIPHERAL

Facility

$10,475.00

Hospital Charge Code	27064266
Hospital Revenue Code	278
Min. Negotiated Rate	$1,571.25
Max. Negotiated Rate	$2,534.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,534.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,304.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,571.25

CATH TRELLIS PERIPHERAL 80X30

Facility

$10,475.00

Hospital Charge Code	270639940
Hospital Revenue Code	278
Min. Negotiated Rate	$252.45
Max. Negotiated Rate	$5,237.50
Rate for Payer: Aetna Commercial	$3,980.50
Rate for Payer: Aetna Medicare Advantage	$3,142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,671.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,671.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,671.12
Rate for Payer: Cigna Commercial	$5,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,534.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,304.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,571.25
Rate for Payer: UnitedHealthcare Community & State	$252.45
Rate for Payer: Wellpoint Medicaid Managed Care	$277.59

CATH TRELLIS PERIPHERAL 80X30

Facility

$10,475.00

Hospital Charge Code	270639940
Hospital Revenue Code	278
Min. Negotiated Rate	$1,571.25
Max. Negotiated Rate	$2,534.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,534.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,304.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,571.25

CATH TREL PERIP 30x120

Facility

$9,975.00

Hospital Charge Code	270639805
Hospital Revenue Code	272
Min. Negotiated Rate	$240.40
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$3,790.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,992.50
Rate for Payer: Oxford Commercial	$1,995.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25
Rate for Payer: UnitedHealthcare Commercial	$1,995.00
Rate for Payer: UnitedHealthcare Community & State	$240.40
Rate for Payer: Wellpoint Medicaid Managed Care	$264.34

CATH TREL PERIP 30x120

Facility

$9,975.00

Hospital Charge Code	270639805
Hospital Revenue Code	272
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$1,496.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

CATH TRIPLE LM 6 AK-22123-F

Facility

$936.85

Hospital Charge Code	270606228
Hospital Revenue Code	272
Min. Negotiated Rate	$22.58
Max. Negotiated Rate	$468.43
Rate for Payer: Aetna Commercial	$356.00
Rate for Payer: Aetna Medicare Advantage	$281.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$238.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$238.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$238.90
Rate for Payer: Cigna Commercial	$468.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.06
Rate for Payer: Oxford Commercial	$187.37
Rate for Payer: Qualcare PPO/HMO/WC	$140.53
Rate for Payer: UnitedHealthcare Commercial	$187.37
Rate for Payer: UnitedHealthcare Community & State	$22.58
Rate for Payer: Wellpoint Medicaid Managed Care	$24.83

CATH TRIPLE LM 6 AK-22123-F

Facility

$936.85

Hospital Charge Code	270606228
Hospital Revenue Code	272
Min. Negotiated Rate	$140.53
Max. Negotiated Rate	$140.53
Rate for Payer: Qualcare PPO/HMO/WC	$140.53

CATH TRIPLE LM 6 AK-22123-F

Facility

$936.85

Hospital Charge Code	270302228
Hospital Revenue Code	272
Min. Negotiated Rate	$140.53
Max. Negotiated Rate	$140.53
Rate for Payer: Qualcare PPO/HMO/WC	$140.53

CATH TRIPLE LM 6 AK-22123-F

Facility

$936.85

Hospital Charge Code	270302228
Hospital Revenue Code	272
Min. Negotiated Rate	$22.58
Max. Negotiated Rate	$468.43
Rate for Payer: Aetna Commercial	$356.00
Rate for Payer: Aetna Medicare Advantage	$281.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$238.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$238.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$238.90
Rate for Payer: Cigna Commercial	$468.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.06
Rate for Payer: Oxford Commercial	$187.37
Rate for Payer: Qualcare PPO/HMO/WC	$140.53
Rate for Payer: UnitedHealthcare Commercial	$187.37
Rate for Payer: UnitedHealthcare Community & State	$22.58
Rate for Payer: Wellpoint Medicaid Managed Care	$24.83

Know your out-of-pocket cost for care.

All Charges