Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH XB 4.0 SH 6FR 67005700

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270636337
Hospital Revenue Code	278
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

CATH XB 4.0 SH 6FR 67005700

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270636337
Hospital Revenue Code	278
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Community & State	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

CATH XB 4.0 SH 6FR 67005700

Facility

$277.70

Service Code	HCPCS C1887
Hospital Charge Code	270636337N
Hospital Revenue Code	278
Min. Negotiated Rate	$41.66
Max. Negotiated Rate	$67.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.09
Rate for Payer: Qualcare PPO/HMO/WC	$41.66

CATH XB 4.0 SH 6FR 67005700

Facility

$277.70

Service Code	HCPCS C1887
Hospital Charge Code	270636337N
Hospital Revenue Code	278
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$138.85
Rate for Payer: Aetna Commercial	$105.53
Rate for Payer: Aetna Medicare Advantage	$83.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.81
Rate for Payer: Cigna Commercial	$138.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.09
Rate for Payer: Qualcare PPO/HMO/WC	$41.66
Rate for Payer: UnitedHealthcare Community & State	$6.69
Rate for Payer: Wellpoint Medicaid Managed Care	$7.36

CATH XB LAB 4.0 SH 6FR 6706300

Facility

$277.70

Hospital Charge Code	270636341
Hospital Revenue Code	278
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$138.85
Rate for Payer: Aetna Commercial	$105.53
Rate for Payer: Aetna Medicare Advantage	$83.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.81
Rate for Payer: Cigna Commercial	$138.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.09
Rate for Payer: Qualcare PPO/HMO/WC	$41.66
Rate for Payer: UnitedHealthcare Community & State	$6.69
Rate for Payer: Wellpoint Medicaid Managed Care	$7.36

CATH XB LAB 4.0 SH 6FR 6706300

Facility

$277.70

Hospital Charge Code	270636341
Hospital Revenue Code	278
Min. Negotiated Rate	$41.66
Max. Negotiated Rate	$67.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.09
Rate for Payer: Qualcare PPO/HMO/WC	$41.66

CATH XB LAD 3.5 6F

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270636338
Hospital Revenue Code	278
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

CATH XB LAD 3.5 6F

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270636338
Hospital Revenue Code	278
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Community & State	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

CATH XB LAD 3.5 6F

Facility

$56.00

Service Code	HCPCS C1887
Hospital Charge Code	270636338N
Hospital Revenue Code	278
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.32
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

CATH XB LAD 3.5 6F

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270636338S
Hospital Revenue Code	278
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Community & State	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

CATH XB LAD 3.5 6F

Facility

$56.00

Service Code	HCPCS C1887
Hospital Charge Code	270636338N
Hospital Revenue Code	278
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial	$21.28
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.28
Rate for Payer: Cigna Commercial	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.32
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Community & State	$1.35
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

CATH XB LAD 3.5 6F

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270636338S
Hospital Revenue Code	278
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

CATH XB LAD 3.5 7FR 77806100

Facility

$277.70

Hospital Charge Code	270636384
Hospital Revenue Code	278
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$138.85
Rate for Payer: Aetna Commercial	$105.53
Rate for Payer: Aetna Medicare Advantage	$83.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.81
Rate for Payer: Cigna Commercial	$138.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.09
Rate for Payer: Qualcare PPO/HMO/WC	$41.66
Rate for Payer: UnitedHealthcare Community & State	$6.69
Rate for Payer: Wellpoint Medicaid Managed Care	$7.36

CATH XB LAD 3.5 7FR 77806100

Facility

$277.70

Hospital Charge Code	270636384
Hospital Revenue Code	278
Min. Negotiated Rate	$41.66
Max. Negotiated Rate	$67.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.09
Rate for Payer: Qualcare PPO/HMO/WC	$41.66

CATH XB LAD 3.5 SH 6F 67006100

Facility

$279.85

Hospital Charge Code	270636339C
Hospital Revenue Code	278
Min. Negotiated Rate	$6.74
Max. Negotiated Rate	$139.93
Rate for Payer: Aetna Commercial	$106.34
Rate for Payer: Aetna Medicare Advantage	$83.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.36
Rate for Payer: Cigna Commercial	$139.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.57
Rate for Payer: Qualcare PPO/HMO/WC	$41.98
Rate for Payer: UnitedHealthcare Community & State	$6.74
Rate for Payer: Wellpoint Medicaid Managed Care	$7.42

CATH XB LAD 3.5 SH 6F 67006100

Facility

$279.85

Hospital Charge Code	270636339C
Hospital Revenue Code	278
Min. Negotiated Rate	$41.98
Max. Negotiated Rate	$67.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.57
Rate for Payer: Qualcare PPO/HMO/WC	$41.98

CATH.XB.LAD 3.5 SH6FR 67006100

Facility

$277.70

Service Code	HCPCS C1887
Hospital Charge Code	270636339
Hospital Revenue Code	278
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$138.85
Rate for Payer: Aetna Commercial	$105.53
Rate for Payer: Aetna Medicare Advantage	$83.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.81
Rate for Payer: Cigna Commercial	$138.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.09
Rate for Payer: Qualcare PPO/HMO/WC	$41.66
Rate for Payer: UnitedHealthcare Community & State	$6.69
Rate for Payer: Wellpoint Medicaid Managed Care	$7.36

CATH.XB.LAD 3.5 SH6FR 67006100

Facility

$277.70

Service Code	HCPCS C1887
Hospital Charge Code	270636339
Hospital Revenue Code	278
Min. Negotiated Rate	$41.66
Max. Negotiated Rate	$67.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.09
Rate for Payer: Qualcare PPO/HMO/WC	$41.66

CATH XB LAD 4.0 6F

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270636340
Hospital Revenue Code	278
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

CATH XB LAD 4.0 6F

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270636340S
Hospital Revenue Code	278
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

CATH XB LAD 4.0 6F

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270636340
Hospital Revenue Code	278
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Community & State	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

CATH XB LAD 4.0 6F

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270636340S
Hospital Revenue Code	278
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Community & State	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

CATH XB LAD 4.0 7FR

Facility

$277.70

Service Code	HCPCS C1887
Hospital Charge Code	270636385N
Hospital Revenue Code	278
Min. Negotiated Rate	$41.66
Max. Negotiated Rate	$67.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$61.09
Rate for Payer: Qualcare PPO/HMO/WC	$41.66

CATH XB LAD 4.0 7FR

Facility

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	270636385
Hospital Revenue Code	278
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$53.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$48.40
Rate for Payer: Qualcare PPO/HMO/WC	$33.00

CATH XB LAD 4.0 7FR

Facility

$220.00

Service Code	HCPCS C1887
Hospital Charge Code	270636385
Hospital Revenue Code	278
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$110.00
Rate for Payer: Aetna Commercial	$83.60
Rate for Payer: Aetna Medicare Advantage	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.10
Rate for Payer: Cigna Commercial	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$48.40
Rate for Payer: Qualcare PPO/HMO/WC	$33.00
Rate for Payer: UnitedHealthcare Community & State	$5.30
Rate for Payer: Wellpoint Medicaid Managed Care	$5.83

Know your out-of-pocket cost for care.

All Charges