Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DILATOR RX BILIARY 8mx4c 4594

Facility

$1,215.05

Service Code	HCPCS C1876
Hospital Charge Code	270630341
Hospital Revenue Code	278
Min. Negotiated Rate	$182.26
Max. Negotiated Rate	$294.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$267.31
Rate for Payer: Qualcare PPO/HMO/WC	$182.26

DILATOR SAFEOP STIM OVAL

Facility

$5,850.00

Service Code	HCPCS C1889
Hospital Charge Code	270702574
Hospital Revenue Code	278
Min. Negotiated Rate	$140.99
Max. Negotiated Rate	$2,925.00
Rate for Payer: Aetna Commercial	$2,223.00
Rate for Payer: Aetna Medicare Advantage	$1,755.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,491.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,491.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,491.75
Rate for Payer: Cigna Commercial	$2,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,415.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,287.00
Rate for Payer: Qualcare PPO/HMO/WC	$877.50
Rate for Payer: UnitedHealthcare Community & State	$140.99
Rate for Payer: Wellpoint Medicaid Managed Care	$155.03

DILATOR SAFEOP STIM OVAL

Facility

$5,850.00

Service Code	HCPCS C1889
Hospital Charge Code	270702574
Hospital Revenue Code	278
Min. Negotiated Rate	$877.50
Max. Negotiated Rate	$1,415.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,415.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,287.00
Rate for Payer: Qualcare PPO/HMO/WC	$877.50

DILATOR STD 7FR .035

Facility

$42.45

Hospital Charge Code	270677494
Hospital Revenue Code	279
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$6.37
Rate for Payer: Qualcare PPO/HMO/WC	$6.37

DILATOR STD 7FR .035

Facility

$42.45

Hospital Charge Code	270677494
Hospital Revenue Code	279
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$21.23
Rate for Payer: Aetna Commercial	$16.13
Rate for Payer: Aetna Medicare Advantage	$12.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.82
Rate for Payer: Cigna Commercial	$21.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.73
Rate for Payer: Oxford Commercial	$8.49
Rate for Payer: Qualcare PPO/HMO/WC	$6.37
Rate for Payer: UnitedHealthcare Commercial	$8.49
Rate for Payer: UnitedHealthcare Community & State	$1.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

DILATOR STD 8FR .035

Facility

$46.35

Hospital Charge Code	270677495
Hospital Revenue Code	272
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$6.95
Rate for Payer: Qualcare PPO/HMO/WC	$6.95

DILATOR STD 8FR .035

Facility

$46.35

Hospital Charge Code	270677495
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.18
Rate for Payer: Aetna Commercial	$17.61
Rate for Payer: Aetna Medicare Advantage	$13.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.82
Rate for Payer: Cigna Commercial	$23.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.90
Rate for Payer: Oxford Commercial	$9.27
Rate for Payer: Qualcare PPO/HMO/WC	$6.95
Rate for Payer: UnitedHealthcare Commercial	$9.27
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

DILATOR TREK CORONARY 2.5x12mm

Facility

$170.00

Hospital Charge Code	270652086
Hospital Revenue Code	278
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$85.00
Rate for Payer: Aetna Commercial	$64.60
Rate for Payer: Aetna Medicare Advantage	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.35
Rate for Payer: Cigna Commercial	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$37.40
Rate for Payer: Qualcare PPO/HMO/WC	$25.50
Rate for Payer: UnitedHealthcare Community & State	$4.10
Rate for Payer: Wellpoint Medicaid Managed Care	$4.50

DILATOR TREK CORONARY 2.5x12mm

Facility

$170.00

Hospital Charge Code	270652086
Hospital Revenue Code	278
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$41.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$37.40
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

DILATOR TREK CORONARY 2.5x30mm

Facility

$850.00

Hospital Charge Code	270652084
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

DILATOR TREK CORONARY 2.5x30mm

Facility

$850.00

Hospital Charge Code	270652084
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

DILATOR TREK CORONARY 3.0x15mm

Facility

$170.00

Hospital Charge Code	270652096
Hospital Revenue Code	278
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$41.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$37.40
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

DILATOR TREK CORONARY 3.0x15mm

Facility

$170.00

Hospital Charge Code	270652096
Hospital Revenue Code	278
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$85.00
Rate for Payer: Aetna Commercial	$64.60
Rate for Payer: Aetna Medicare Advantage	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.35
Rate for Payer: Cigna Commercial	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$37.40
Rate for Payer: Qualcare PPO/HMO/WC	$25.50
Rate for Payer: UnitedHealthcare Community & State	$4.10
Rate for Payer: Wellpoint Medicaid Managed Care	$4.50

DILATOR TREK MINI 2.00mm

Facility

$850.00

Hospital Charge Code	270652087
Hospital Revenue Code	271
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

DILATOR TREK MINI 2.00mm

Facility

$850.00

Hospital Charge Code	270652087
Hospital Revenue Code	271
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

DILATOR URETHRAL MEATAL

Facility

$43.00

Hospital Charge Code	270676433
Hospital Revenue Code	272
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

DILATOR URETHRAL MEATAL

Facility

$43.00

Hospital Charge Code	270676433
Hospital Revenue Code	272
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$21.50
Rate for Payer: Aetna Commercial	$16.34
Rate for Payer: Aetna Medicare Advantage	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.90
Rate for Payer: Oxford Commercial	$8.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$8.60
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

DILATOR, VASC/FASC

Facility

$62.00

Hospital Charge Code	2008120
Hospital Revenue Code	272
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$31.00
Rate for Payer: Aetna Commercial	$23.56
Rate for Payer: Aetna Medicare Advantage	$18.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.81
Rate for Payer: Cigna Commercial	$31.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.60
Rate for Payer: Oxford Commercial	$12.40
Rate for Payer: Qualcare PPO/HMO/WC	$9.30
Rate for Payer: UnitedHealthcare Commercial	$12.40
Rate for Payer: UnitedHealthcare Community & State	$1.49
Rate for Payer: Wellpoint Medicaid Managed Care	$1.64

DILATOR, VASC/FASC

Facility

$62.00

Hospital Charge Code	2008120
Hospital Revenue Code	272
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$9.30
Rate for Payer: Qualcare PPO/HMO/WC	$9.30

DILATOR VASCULAR

Facility

$325.00

Hospital Charge Code	270650777
Hospital Revenue Code	272
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$48.75
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

DILATOR VASCULAR

Facility

$325.00

Hospital Charge Code	270650777
Hospital Revenue Code	272
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$162.50
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare Advantage	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.88
Rate for Payer: Cigna Commercial	$162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Oxford Commercial	$65.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.75
Rate for Payer: UnitedHealthcare Commercial	$65.00
Rate for Payer: UnitedHealthcare Community & State	$7.83
Rate for Payer: Wellpoint Medicaid Managed Care	$8.61

DILATOR VASCULAR

Facility

$177.45

Hospital Charge Code	270651286
Hospital Revenue Code	270
Min. Negotiated Rate	$26.62
Max. Negotiated Rate	$26.62
Rate for Payer: Qualcare PPO/HMO/WC	$26.62

DILATOR VASCULAR

Facility

$177.45

Hospital Charge Code	270651286
Hospital Revenue Code	270
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$88.72
Rate for Payer: Aetna Commercial	$67.43
Rate for Payer: Aetna Medicare Advantage	$53.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.25
Rate for Payer: Cigna Commercial	$88.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.23
Rate for Payer: Oxford Commercial	$35.49
Rate for Payer: Qualcare PPO/HMO/WC	$26.62
Rate for Payer: UnitedHealthcare Commercial	$35.49
Rate for Payer: UnitedHealthcare Community & State	$4.28
Rate for Payer: Wellpoint Medicaid Managed Care	$4.70

DILATOR VECT TTS 12MM 36F

Facility

$1,615.25

Hospital Charge Code	270600933
Hospital Revenue Code	270
Min. Negotiated Rate	$38.93
Max. Negotiated Rate	$807.62
Rate for Payer: Aetna Commercial	$613.79
Rate for Payer: Aetna Medicare Advantage	$484.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$411.89
Rate for Payer: Cigna Commercial	$807.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.57
Rate for Payer: Oxford Commercial	$323.05
Rate for Payer: Qualcare PPO/HMO/WC	$242.29
Rate for Payer: UnitedHealthcare Commercial	$323.05
Rate for Payer: UnitedHealthcare Community & State	$38.93
Rate for Payer: Wellpoint Medicaid Managed Care	$42.80

DILATOR VECT TTS 12MM 36F

Facility

$1,615.25

Hospital Charge Code	270600933
Hospital Revenue Code	270
Min. Negotiated Rate	$242.29
Max. Negotiated Rate	$242.29
Rate for Payer: Qualcare PPO/HMO/WC	$242.29

Know your out-of-pocket cost for care.

All Charges