Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH VIATRAC 14PLUS 6x40 135

Facility

$1,025.00

Service Code	HCPCS C1725
Hospital Charge Code	270644379C
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$248.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

CATH VIATRAC 14PLUS 7x20 135

Facility

$1,025.00

Service Code	HCPCS C1725
Hospital Charge Code	270643950C
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$248.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

CATH VIATRAC 14PLUS 7x20 135

Facility

$1,025.00

Service Code	HCPCS C1725
Hospital Charge Code	270643950C
Hospital Revenue Code	278
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Community & State	$24.70
Rate for Payer: Wellpoint Medicaid Managed Care	$27.16

CATH VIATRAC 14PLUS 7x40 135

Facility

$1,025.00

Service Code	HCPCS C1725
Hospital Charge Code	270643959C
Hospital Revenue Code	278
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Community & State	$24.70
Rate for Payer: Wellpoint Medicaid Managed Care	$27.16

CATH VIATRAC 14PLUS 7x40 135

Facility

$1,025.00

Service Code	HCPCS C1725
Hospital Charge Code	270643959C
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$248.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

CATH VIPERCROSS .014INX150CM

Facility

$900.00

Service Code	HCPCS C1887
Hospital Charge Code	270697808S
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

CATH VIPERCROSS .014INX150CM

Facility

$900.00

Service Code	HCPCS C1887
Hospital Charge Code	270697808S
Hospital Revenue Code	278
Min. Negotiated Rate	$21.69
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Community & State	$21.69
Rate for Payer: Wellpoint Medicaid Managed Care	$23.85

CATH VIPERCROSS .018INX150CM

Facility

$900.00

Service Code	HCPCS C1887
Hospital Charge Code	270697809S
Hospital Revenue Code	278
Min. Negotiated Rate	$21.69
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Community & State	$21.69
Rate for Payer: Wellpoint Medicaid Managed Care	$23.85

CATH VIPERCROSS .018INX150CM

Facility

$900.00

Service Code	HCPCS C1887
Hospital Charge Code	270697809S
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

CATH VIP SWAN-GANZ ******

Facility

$200.00

Hospital Charge Code	8003097
Hospital Revenue Code	279
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

CATH VIP SWAN-GANZ ******

Facility

$200.00

Hospital Charge Code	8003097
Hospital Revenue Code	279
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.00
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$40.00
Rate for Payer: UnitedHealthcare Community & State	$4.82
Rate for Payer: Wellpoint Medicaid Managed Care	$5.30

CATH VITRC 14PLS V1008193-40

Facility

$1,025.00

Service Code	HCPCS C1725
Hospital Charge Code	270644151C
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$248.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

CATH VITRC 14PLS V1008193-40

Facility

$1,025.00

Service Code	HCPCS C1725
Hospital Charge Code	270644151C
Hospital Revenue Code	278
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Community & State	$24.70
Rate for Payer: Wellpoint Medicaid Managed Care	$27.16

CATH VITRC 14PLS V1008193-40

Facility

$1,025.00

Service Code	HCPCS C1725
Hospital Charge Code	270644151S
Hospital Revenue Code	278
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$248.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

CATH VITRC 14PLS V1008193-40

Facility

$1,025.00

Service Code	HCPCS C1725
Hospital Charge Code	270644151S
Hospital Revenue Code	278
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$225.50
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Community & State	$24.70
Rate for Payer: Wellpoint Medicaid Managed Care	$27.16

CATH VON SONEBERG 16F 30 20304

Facility

$587.60

Hospital Charge Code	270630567
Hospital Revenue Code	272
Min. Negotiated Rate	$14.16
Max. Negotiated Rate	$293.80
Rate for Payer: Aetna Commercial	$223.29
Rate for Payer: Aetna Medicare Advantage	$176.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.84
Rate for Payer: Cigna Commercial	$293.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.28
Rate for Payer: Oxford Commercial	$117.52
Rate for Payer: Qualcare PPO/HMO/WC	$88.14
Rate for Payer: UnitedHealthcare Commercial	$117.52
Rate for Payer: UnitedHealthcare Community & State	$14.16
Rate for Payer: Wellpoint Medicaid Managed Care	$15.57

CATH VON SONEBERG 16F 30 20304

Facility

$587.60

Hospital Charge Code	270630567
Hospital Revenue Code	272
Min. Negotiated Rate	$88.14
Max. Negotiated Rate	$88.14
Rate for Payer: Qualcare PPO/HMO/WC	$88.14

CATH VTC NEPHROSTOMY 8FR 25cm

Facility

$489.25

Service Code	HCPCS C1729
Hospital Charge Code	270601331
Hospital Revenue Code	278
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$244.62
Rate for Payer: Aetna Commercial	$185.91
Rate for Payer: Aetna Medicare Advantage	$146.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.76
Rate for Payer: Cigna Commercial	$244.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$107.64
Rate for Payer: Qualcare PPO/HMO/WC	$73.39
Rate for Payer: UnitedHealthcare Community & State	$11.79
Rate for Payer: Wellpoint Medicaid Managed Care	$12.97

CATH VTC NEPHROSTOMY 8FR 25cm

Facility

$489.25

Service Code	HCPCS C1729
Hospital Charge Code	270601331
Hospital Revenue Code	278
Min. Negotiated Rate	$73.39
Max. Negotiated Rate	$118.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$107.64
Rate for Payer: Qualcare PPO/HMO/WC	$73.39

CATH WALRUS BALLOON GD 90CM

Facility

$8,750.00

Service Code	HCPCS C1887
Hospital Charge Code	270694052S
Hospital Revenue Code	278
Min. Negotiated Rate	$210.88
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$3,325.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50
Rate for Payer: UnitedHealthcare Community & State	$210.88
Rate for Payer: Wellpoint Medicaid Managed Care	$231.88

CATH WALRUS BALLOON GD 90CM

Facility

$8,750.00

Service Code	HCPCS C1887
Hospital Charge Code	270694052S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

CATH WC ERCP PEEL AWAY PLA-1-T

Facility

$307.25

Hospital Charge Code	270618518
Hospital Revenue Code	272
Min. Negotiated Rate	$7.40
Max. Negotiated Rate	$153.62
Rate for Payer: Aetna Commercial	$116.75
Rate for Payer: Aetna Medicare Advantage	$92.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.35
Rate for Payer: Cigna Commercial	$153.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.17
Rate for Payer: Oxford Commercial	$61.45
Rate for Payer: Qualcare PPO/HMO/WC	$46.09
Rate for Payer: UnitedHealthcare Commercial	$61.45
Rate for Payer: UnitedHealthcare Community & State	$7.40
Rate for Payer: Wellpoint Medicaid Managed Care	$8.14

CATH WC ERCP PEEL AWAY PLA-1-T

Facility

$307.25

Hospital Charge Code	270618518
Hospital Revenue Code	272
Min. Negotiated Rate	$46.09
Max. Negotiated Rate	$46.09
Rate for Payer: Qualcare PPO/HMO/WC	$46.09

CATH WEDGE BALLON ARR 5FR

Facility

$725.00

Service Code	HCPCS C1726
Hospital Charge Code	270696315
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 WEDGE BALLON ARR 5FR

Facility

$725.00

Service Code	HCPCS C1726
Hospital Charge Code	270696315
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

Know your out-of-pocket cost for care.

All Charges