Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INTRODUCER VIS 7f 55c 4037553H

Facility

$281.85

Hospital Charge Code	270629332
Hospital Revenue Code	272
Min. Negotiated Rate	$42.28
Max. Negotiated Rate	$42.28
Rate for Payer: Qualcare PPO/HMO/WC	$42.28

INTRODUCER V-STICK 5FR STD

Facility

$90.00

Hospital Charge Code	270676898
Hospital Revenue Code	272
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.00
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

INTRODUCER V-STICK 5FR STD

Facility

$90.00

Hospital Charge Code	270676898
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

INTRODUCER V-STICK 5FR STIFF

Facility

$90.00

Hospital Charge Code	270676899
Hospital Revenue Code	272
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.00
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

INTRODUCER V-STICK 5FR STIFF

Facility

$90.00

Hospital Charge Code	270676899
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

INTRODUCER W/STYLET 407253

Facility

$550.00

Hospital Charge Code	270641739
Hospital Revenue Code	278
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

INTRODUCER W/STYLET 407253

Facility

$550.00

Hospital Charge Code	270641739
Hospital Revenue Code	278
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

INTRODUCE SURE SIGHT 9G

Facility

$4,868.75

Hospital Charge Code	270664837
Hospital Revenue Code	270
Min. Negotiated Rate	$117.34
Max. Negotiated Rate	$2,434.38
Rate for Payer: Aetna Commercial	$1,850.12
Rate for Payer: Aetna Medicare Advantage	$1,460.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,241.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,241.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,241.53
Rate for Payer: Cigna Commercial	$2,434.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,460.62
Rate for Payer: Oxford Commercial	$973.75
Rate for Payer: Qualcare PPO/HMO/WC	$730.31
Rate for Payer: UnitedHealthcare Commercial	$973.75
Rate for Payer: UnitedHealthcare Community & State	$117.34
Rate for Payer: Wellpoint Medicaid Managed Care	$129.02

INTRODUCE SURE SIGHT 9G

Facility

$4,868.75

Hospital Charge Code	270664837
Hospital Revenue Code	270
Min. Negotiated Rate	$730.31
Max. Negotiated Rate	$730.31
Rate for Payer: Qualcare PPO/HMO/WC	$730.31

INTRODUCTION NEEDLE AV SHUNT

Facility

$331.55

Service Code	HCPCS 36145
Hospital Charge Code	5100339
Hospital Revenue Code	761
Min. Negotiated Rate	$7.99
Max. Negotiated Rate	$165.78
Rate for Payer: Aetna Commercial	$125.99
Rate for Payer: Aetna Medicare Advantage	$99.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.55
Rate for Payer: Cigna Commercial	$165.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.47
Rate for Payer: Oxford Commercial	$66.31
Rate for Payer: Qualcare PPO/HMO/WC	$49.73
Rate for Payer: UnitedHealthcare Commercial	$66.31
Rate for Payer: UnitedHealthcare Community & State	$7.99
Rate for Payer: Wellpoint Medicaid Managed Care	$8.79

INTRODUCTION NEEDLE AV SHUNT

Facility

$331.55

Service Code	HCPCS 36145
Hospital Charge Code	5100339
Hospital Revenue Code	761
Min. Negotiated Rate	$49.73
Max. Negotiated Rate	$49.73
Rate for Payer: Qualcare PPO/HMO/WC	$49.73

INTRODUCTION OF CATH AORTA

Facility

$414.45

Service Code	HCPCS 36200
Hospital Charge Code	5100310
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

INTRODUCTION OF CATH AORTA

Facility

$414.45

Service Code	HCPCS 36200
Hospital Charge Code	5100310
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

INTRODUCTION OF CATH AORTA

Facility

$414.45

Service Code	HCPCS 36200
Hospital Charge Code	74110036
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

INTRODUCTION OF CATH AORTA

Facility

$414.45

Service Code	HCPCS 36200
Hospital Charge Code	74110036
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

INTRODUCTION OF CATH AORTA

Facility

$414.45

Service Code	HCPCS 36200
Hospital Charge Code	366836200
Hospital Revenue Code	361
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,016.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.33
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$9.99
Rate for Payer: Wellpoint Medicaid Managed Care	$10.98

INTRODUCTION OF CATH AORTA

Facility

$414.45

Service Code	HCPCS 36200
Hospital Charge Code	366836200
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

INTRODUCTION OF NEEDLE/INTCATH

Facility

$300.00

Service Code	HCPCS 36000
Hospital Charge Code	5300140
Hospital Revenue Code	636
Min. Negotiated Rate	$7.23
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Community & State	$7.23
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

INTRODUCTION OF NEEDLE/INTCATH

Facility

$300.00

Service Code	HCPCS 36000
Hospital Charge Code	5300140
Hospital Revenue Code	636
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$72.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

INTROD VISBRIT 8F 55C 4038553H

Facility

$620.00

Service Code	HCPCS C1887
Hospital Charge Code	270624373N
Hospital Revenue Code	278
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) NJ Health	$124.00
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	$150.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$136.40
Rate for Payer: Qualcare PPO/HMO/WC	$93.00
Rate for Payer: UnitedHealthcare Community & State	$14.94
Rate for Payer: Wellpoint Medicaid Managed Care	$16.43

INTROD VISBRIT 8F 55C 4038553H

Facility

$281.85

Service Code	HCPCS C1887
Hospital Charge Code	270624373
Hospital Revenue Code	278
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$140.93
Rate for Payer: Aetna Commercial	$107.10
Rate for Payer: Aetna Medicare Advantage	$84.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.87
Rate for Payer: Cigna Commercial	$140.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$62.01
Rate for Payer: Qualcare PPO/HMO/WC	$42.28
Rate for Payer: UnitedHealthcare Community & State	$6.79
Rate for Payer: Wellpoint Medicaid Managed Care	$7.47

INTROD VISBRIT 8F 55C 4038553H

Facility

$620.00

Service Code	HCPCS C1887
Hospital Charge Code	270624373N
Hospital Revenue Code	278
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$150.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$136.40
Rate for Payer: Qualcare PPO/HMO/WC	$93.00

INTROD VISBRIT 8F 55C 4038553H

Facility

$281.85

Service Code	HCPCS C1887
Hospital Charge Code	270624373
Hospital Revenue Code	278
Min. Negotiated Rate	$42.28
Max. Negotiated Rate	$68.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$62.01
Rate for Payer: Qualcare PPO/HMO/WC	$42.28

INTROD VISTA BRITE 7F 4037553A

Facility

$470.45

Hospital Charge Code	270624008
Hospital Revenue Code	272
Min. Negotiated Rate	$11.34
Max. Negotiated Rate	$235.22
Rate for Payer: Aetna Commercial	$178.77
Rate for Payer: Aetna Medicare Advantage	$141.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.96
Rate for Payer: Cigna Commercial	$235.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.13
Rate for Payer: Oxford Commercial	$94.09
Rate for Payer: Qualcare PPO/HMO/WC	$70.57
Rate for Payer: UnitedHealthcare Commercial	$94.09
Rate for Payer: UnitedHealthcare Community & State	$11.34
Rate for Payer: Wellpoint Medicaid Managed Care	$12.47

INTROD VISTA BRITE 7F 4037553A

Facility

$470.45

Hospital Charge Code	270624008
Hospital Revenue Code	272
Min. Negotiated Rate	$70.57
Max. Negotiated Rate	$70.57
Rate for Payer: Qualcare PPO/HMO/WC	$70.57

Know your out-of-pocket cost for care.

All Charges