Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INTRODR GUIDE 8F 55c 4038553A

Facility

$620.00

Service Code	HCPCS C1887
Hospital Charge Code	270624374
Hospital Revenue Code	272
Min. Negotiated Rate	$14.94
Max. Negotiated Rate	$310.00
Rate for Payer: Aetna Commercial	$235.60
Rate for Payer: Aetna Medicare Advantage	$186.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.10
Rate for Payer: Cigna Commercial	$310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.00
Rate for Payer: Oxford Commercial	$124.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.00
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$14.94
Rate for Payer: Wellpoint Medicaid Managed Care	$16.43

INTRODUCER 10mm

Facility

$729.15

Hospital Charge Code	270679215
Hospital Revenue Code	272
Min. Negotiated Rate	$17.57
Max. Negotiated Rate	$364.57
Rate for Payer: Aetna Commercial	$277.08
Rate for Payer: Aetna Medicare Advantage	$218.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$185.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$185.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$185.93
Rate for Payer: Cigna Commercial	$364.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$218.75
Rate for Payer: Oxford Commercial	$145.83
Rate for Payer: Qualcare PPO/HMO/WC	$109.37
Rate for Payer: UnitedHealthcare Commercial	$145.83
Rate for Payer: UnitedHealthcare Community & State	$17.57
Rate for Payer: Wellpoint Medicaid Managed Care	$19.32

INTRODUCER 10mm

Facility

$729.15

Hospital Charge Code	270679215
Hospital Revenue Code	272
Min. Negotiated Rate	$109.37
Max. Negotiated Rate	$109.37
Rate for Payer: Qualcare PPO/HMO/WC	$109.37

INTRODUCER 11 FR 10 CM CURVED

Facility

$52.00

Service Code	HCPCS C1894
Hospital Charge Code	270690726
Hospital Revenue Code	272
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) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$10.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$10.40
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

INTRODUCER 11 FR 10 CM CURVED

Facility

$52.00

Service Code	HCPCS C1894
Hospital Charge Code	270690726
Hospital Revenue Code	272
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

INTRODUCER 12FR X 30CM

Facility

$100.00

Hospital Charge Code	270683374
Hospital Revenue Code	272
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

INTRODUCER 12FR X 30CM

Facility

$100.00

Hospital Charge Code	270683374
Hospital Revenue Code	272
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$20.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

INTRODUCER 3.6-11.5 BEVEL TIP

Facility

$972.33

Hospital Charge Code	270670666
Hospital Revenue Code	272
Min. Negotiated Rate	$145.85
Max. Negotiated Rate	$145.85
Rate for Payer: Qualcare PPO/HMO/WC	$145.85

INTRODUCER 3.6-11.5 BEVEL TIP

Facility

$972.33

Hospital Charge Code	270670666
Hospital Revenue Code	272
Min. Negotiated Rate	$23.43
Max. Negotiated Rate	$486.17
Rate for Payer: Aetna Commercial	$369.49
Rate for Payer: Aetna Medicare Advantage	$291.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$247.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$247.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$247.94
Rate for Payer: Cigna Commercial	$486.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$291.70
Rate for Payer: Oxford Commercial	$194.47
Rate for Payer: Qualcare PPO/HMO/WC	$145.85
Rate for Payer: UnitedHealthcare Commercial	$194.47
Rate for Payer: UnitedHealthcare Community & State	$23.43
Rate for Payer: Wellpoint Medicaid Managed Care	$25.77

INTRODUCER 3.6-11.5 DIAMON TIP

Facility

$972.33

Hospital Charge Code	270670667
Hospital Revenue Code	272
Min. Negotiated Rate	$145.85
Max. Negotiated Rate	$145.85
Rate for Payer: Qualcare PPO/HMO/WC	$145.85

INTRODUCER 3.6-11.5 DIAMON TIP

Facility

$972.33

Hospital Charge Code	270670667
Hospital Revenue Code	272
Min. Negotiated Rate	$23.43
Max. Negotiated Rate	$486.17
Rate for Payer: Aetna Commercial	$369.49
Rate for Payer: Aetna Medicare Advantage	$291.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$247.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$247.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$247.94
Rate for Payer: Cigna Commercial	$486.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$291.70
Rate for Payer: Oxford Commercial	$194.47
Rate for Payer: Qualcare PPO/HMO/WC	$145.85
Rate for Payer: UnitedHealthcare Commercial	$194.47
Rate for Payer: UnitedHealthcare Community & State	$23.43
Rate for Payer: Wellpoint Medicaid Managed Care	$25.77

INTRODUCER 3.6-B BEVEL TIP LNG

Facility

$972.33

Hospital Charge Code	270670670
Hospital Revenue Code	272
Min. Negotiated Rate	$23.43
Max. Negotiated Rate	$486.17
Rate for Payer: Aetna Commercial	$369.49
Rate for Payer: Aetna Medicare Advantage	$291.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$247.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$247.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$247.94
Rate for Payer: Cigna Commercial	$486.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$291.70
Rate for Payer: Oxford Commercial	$194.47
Rate for Payer: Qualcare PPO/HMO/WC	$145.85
Rate for Payer: UnitedHealthcare Commercial	$194.47
Rate for Payer: UnitedHealthcare Community & State	$23.43
Rate for Payer: Wellpoint Medicaid Managed Care	$25.77

INTRODUCER 3.6-B BEVEL TIP LNG

Facility

$972.33

Hospital Charge Code	270670670
Hospital Revenue Code	272
Min. Negotiated Rate	$145.85
Max. Negotiated Rate	$145.85
Rate for Payer: Qualcare PPO/HMO/WC	$145.85

INTRODUCER 3.6-D DMD TIP LNG

Facility

$972.33

Hospital Charge Code	270670671
Hospital Revenue Code	272
Min. Negotiated Rate	$23.43
Max. Negotiated Rate	$486.17
Rate for Payer: Aetna Commercial	$369.49
Rate for Payer: Aetna Medicare Advantage	$291.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$247.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$247.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$247.94
Rate for Payer: Cigna Commercial	$486.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$291.70
Rate for Payer: Oxford Commercial	$194.47
Rate for Payer: Qualcare PPO/HMO/WC	$145.85
Rate for Payer: UnitedHealthcare Commercial	$194.47
Rate for Payer: UnitedHealthcare Community & State	$23.43
Rate for Payer: Wellpoint Medicaid Managed Care	$25.77

INTRODUCER 3.6-D DMD TIP LNG

Facility

$972.33

Hospital Charge Code	270670671
Hospital Revenue Code	272
Min. Negotiated Rate	$145.85
Max. Negotiated Rate	$145.85
Rate for Payer: Qualcare PPO/HMO/WC	$145.85

INTRODUCER 5F 11CM 92500005

Facility

$93.65

Hospital Charge Code	270617165
Hospital Revenue Code	272
Min. Negotiated Rate	$14.05
Max. Negotiated Rate	$14.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.05

INTRODUCER 5F 11CM 92500005

Facility

$93.65

Hospital Charge Code	270617165
Hospital Revenue Code	272
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$46.83
Rate for Payer: Aetna Commercial	$35.59
Rate for Payer: Aetna Medicare Advantage	$28.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.88
Rate for Payer: Cigna Commercial	$46.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.09
Rate for Payer: Oxford Commercial	$18.73
Rate for Payer: Qualcare PPO/HMO/WC	$14.05
Rate for Payer: UnitedHealthcare Commercial	$18.73
Rate for Payer: UnitedHealthcare Community & State	$2.26
Rate for Payer: Wellpoint Medicaid Managed Care	$2.48

INTRODUCER 6F 23CM 504607T

Facility

$91.25

Hospital Charge Code	270621070
Hospital Revenue Code	272
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$45.62
Rate for Payer: Aetna Commercial	$34.67
Rate for Payer: Aetna Medicare Advantage	$27.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.27
Rate for Payer: Cigna Commercial	$45.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.38
Rate for Payer: Oxford Commercial	$18.25
Rate for Payer: Qualcare PPO/HMO/WC	$13.69
Rate for Payer: UnitedHealthcare Commercial	$18.25
Rate for Payer: UnitedHealthcare Community & State	$2.20
Rate for Payer: Wellpoint Medicaid Managed Care	$2.42

INTRODUCER 6F 23CM 504607T

Facility

$91.25

Hospital Charge Code	270621070
Hospital Revenue Code	272
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$13.69
Rate for Payer: Qualcare PPO/HMO/WC	$13.69

INTRODUCER 6FR ULTIMUM

Facility

$40.00

Hospital Charge Code	270663685
Hospital Revenue Code	272
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

INTRODUCER 6FR ULTIMUM

Facility

$40.00

Hospital Charge Code	270663685
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

INTRODUCER 6F SHULE SET 264163

Facility

$580.40

Hospital Charge Code	270629605
Hospital Revenue Code	272
Min. Negotiated Rate	$87.06
Max. Negotiated Rate	$87.06
Rate for Payer: Qualcare PPO/HMO/WC	$87.06

INTRODUCER 6F SHULE SET 264163

Facility

$580.40

Hospital Charge Code	270629605
Hospital Revenue Code	272
Min. Negotiated Rate	$13.99
Max. Negotiated Rate	$290.20
Rate for Payer: Aetna Commercial	$220.55
Rate for Payer: Aetna Medicare Advantage	$174.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.00
Rate for Payer: Cigna Commercial	$290.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.12
Rate for Payer: Oxford Commercial	$116.08
Rate for Payer: Qualcare PPO/HMO/WC	$87.06
Rate for Payer: UnitedHealthcare Commercial	$116.08
Rate for Payer: UnitedHealthcare Community & State	$13.99
Rate for Payer: Wellpoint Medicaid Managed Care	$15.38

INTRODUCER 7F 23CM 504606T

Facility

$109.75

Hospital Charge Code	270621069
Hospital Revenue Code	272
Min. Negotiated Rate	$16.46
Max. Negotiated Rate	$16.46
Rate for Payer: Qualcare PPO/HMO/WC	$16.46

INTRODUCER 7F 23CM 504606T

Facility

$109.75

Hospital Charge Code	270621069
Hospital Revenue Code	272
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$54.88
Rate for Payer: Aetna Commercial	$41.70
Rate for Payer: Aetna Medicare Advantage	$32.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.99
Rate for Payer: Cigna Commercial	$54.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.92
Rate for Payer: Oxford Commercial	$21.95
Rate for Payer: Qualcare PPO/HMO/WC	$16.46
Rate for Payer: UnitedHealthcare Commercial	$21.95
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.91

Know your out-of-pocket cost for care.

All Charges