Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

DILATOR VESSEL 10FR .038 20cm

Facility

$36.70

Service Code	HCPCS C1725
Hospital Charge Code	270624076
Hospital Revenue Code	278
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$18.35
Rate for Payer: Aetna Commercial	$13.95
Rate for Payer: Aetna Medicare Advantage	$11.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.36
Rate for Payer: Cigna Commercial	$18.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.50
Rate for Payer: UnitedHealthcare Community & State	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

DILATOR VESSEL 10FR .038 20cm

Facility

$36.70

Service Code	HCPCS C1725
Hospital Charge Code	270624076
Hospital Revenue Code	278
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.50

DILATOR VESSEL 12FR .038 20cm

Facility

$36.70

Service Code	HCPCS C1725
Hospital Charge Code	270624077
Hospital Revenue Code	278
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.50

DILATOR VESSEL 12FR .038 20cm

Facility

$36.70

Service Code	HCPCS C1725
Hospital Charge Code	270624077
Hospital Revenue Code	278
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$18.35
Rate for Payer: Aetna Commercial	$13.95
Rate for Payer: Aetna Medicare Advantage	$11.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.36
Rate for Payer: Cigna Commercial	$18.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.50
Rate for Payer: UnitedHealthcare Community & State	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

DILATOR VESSEL 14F .038 20CM

Facility

$36.70

Service Code	HCPCS C1725
Hospital Charge Code	270601491S
Hospital Revenue Code	278
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.50

DILATOR VESSEL 14F .038 20CM

Facility

$36.70

Service Code	HCPCS C1725
Hospital Charge Code	270601491S
Hospital Revenue Code	278
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$18.35
Rate for Payer: Aetna Commercial	$13.95
Rate for Payer: Aetna Medicare Advantage	$11.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.36
Rate for Payer: Cigna Commercial	$18.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.50
Rate for Payer: UnitedHealthcare Community & State	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

DILATOR VESSEL 14FR .038 20cm

Facility

$36.70

Service Code	HCPCS C1725
Hospital Charge Code	270601491
Hospital Revenue Code	278
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$18.35
Rate for Payer: Aetna Commercial	$13.95
Rate for Payer: Aetna Medicare Advantage	$11.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.36
Rate for Payer: Cigna Commercial	$18.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.50
Rate for Payer: UnitedHealthcare Community & State	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

DILATOR VESSEL 14FR .038 20cm

Facility

$36.70

Service Code	HCPCS C1725
Hospital Charge Code	270601491
Hospital Revenue Code	278
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.50

DILATOR VESSEL -4F .035 15c

Facility

$62.45

Hospital Charge Code	270705305
Hospital Revenue Code	279
Min. Negotiated Rate	$9.37
Max. Negotiated Rate	$9.37
Rate for Payer: Qualcare PPO/HMO/WC	$9.37

DILATOR VESSEL -4F .035 15c

Facility

$62.45

Hospital Charge Code	270705305
Hospital Revenue Code	279
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$31.23
Rate for Payer: Aetna Commercial	$23.73
Rate for Payer: Aetna Medicare Advantage	$18.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.92
Rate for Payer: Cigna Commercial	$31.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.73
Rate for Payer: Oxford Commercial	$12.49
Rate for Payer: Qualcare PPO/HMO/WC	$9.37
Rate for Payer: UnitedHealthcare Commercial	$12.49
Rate for Payer: UnitedHealthcare Community & State	$1.51
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

DILATOR VESSEL 4FR- 3339-31

Facility

$260.00

Hospital Charge Code	270677538
Hospital Revenue Code	279
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

DILATOR VESSEL 4FR- 3339-31

Facility

$260.00

Hospital Charge Code	270677538
Hospital Revenue Code	279
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna Medicare Advantage	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.30
Rate for Payer: Cigna Commercial	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.00
Rate for Payer: Oxford Commercial	$52.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Commercial	$52.00
Rate for Payer: UnitedHealthcare Community & State	$6.27
Rate for Payer: Wellpoint Medicaid Managed Care	$6.89

DILATOR VESSEL 5FR .038 20cm

Facility

$39.80

Hospital Charge Code	270624075
Hospital Revenue Code	272
Min. Negotiated Rate	$5.97
Max. Negotiated Rate	$5.97
Rate for Payer: Qualcare PPO/HMO/WC	$5.97

DILATOR VESSEL 5FR .038 20cm

Facility

$39.80

Hospital Charge Code	270624075
Hospital Revenue Code	272
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$19.90
Rate for Payer: Aetna Commercial	$15.12
Rate for Payer: Aetna Medicare Advantage	$11.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.15
Rate for Payer: Cigna Commercial	$19.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.94
Rate for Payer: Oxford Commercial	$7.96
Rate for Payer: Qualcare PPO/HMO/WC	$5.97
Rate for Payer: UnitedHealthcare Commercial	$7.96
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.05

DILATOR VESSEL 5 FR 20 CM

Facility

$42.45

Hospital Charge Code	270682392
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 VESSEL 5 FR 20 CM

Facility

$42.45

Hospital Charge Code	270682392
Hospital Revenue Code	279
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$6.37
Rate for Payer: Qualcare PPO/HMO/WC	$6.37

DILATOR VESSEL 5FR 20CM

Facility

$50.00

Hospital Charge Code	270331443
Hospital Revenue Code	278
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$12.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

DILATOR VESSEL 5FR 20CM

Facility

$50.00

Hospital Charge Code	270331443
Hospital Revenue Code	278
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

DILATOR VESSEL 5FR.22CM

Facility

$52.00

Hospital Charge Code	270331242
Hospital Revenue Code	278
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$19.76
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.44
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

DILATOR VESSEL 5FR.22CM

Facility

$52.00

Hospital Charge Code	270331242
Hospital Revenue Code	278
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$12.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.58
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.44
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

DILATOR VESSEL -6F .038 15c

Facility

$42.45

Hospital Charge Code	270705306
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 VESSEL -6F .038 15c

Facility

$42.45

Hospital Charge Code	270705306
Hospital Revenue Code	279
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$6.37
Rate for Payer: Qualcare PPO/HMO/WC	$6.37

DILATOR VESSEL 6FR .038 20cm

Facility

$36.70

Service Code	HCPCS C1725
Hospital Charge Code	270624073
Hospital Revenue Code	278
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$18.35
Rate for Payer: Aetna Commercial	$13.95
Rate for Payer: Aetna Medicare Advantage	$11.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.36
Rate for Payer: Cigna Commercial	$18.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.50
Rate for Payer: UnitedHealthcare Community & State	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

DILATOR VESSEL 6FR .038 20cm

Facility

$36.70

Service Code	HCPCS C1725
Hospital Charge Code	270624073
Hospital Revenue Code	278
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.50

DILATOR VESSEL 7FR .038 20cm

Facility

$36.70

Service Code	HCPCS C1725
Hospital Charge Code	270605470
Hospital Revenue Code	278
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$18.35
Rate for Payer: Aetna Commercial	$13.95
Rate for Payer: Aetna Medicare Advantage	$11.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.36
Rate for Payer: Cigna Commercial	$18.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.07
Rate for Payer: Qualcare PPO/HMO/WC	$5.50
Rate for Payer: UnitedHealthcare Community & State	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

Know your out-of-pocket cost for care.

All Charges