Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INTRO GUIDEESHEATH 6FX10

Facility

$247.50

Service Code	HCPCS C1766
Hospital Charge Code	270658268
Hospital Revenue Code	278
Min. Negotiated Rate	$37.12
Max. Negotiated Rate	$59.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$37.12

INTRO GUIDEESHEATH 6FX10

Facility

$247.50

Service Code	HCPCS C1766
Hospital Charge Code	270658268
Hospital Revenue Code	278
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$123.75
Rate for Payer: Aetna Commercial	$94.05
Rate for Payer: Aetna Medicare Advantage	$74.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.11
Rate for Payer: Cigna Commercial	$123.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$37.12
Rate for Payer: UnitedHealthcare Community & State	$5.96
Rate for Payer: Wellpoint Medicaid Managed Care	$6.56

Intro Guidesheath 5fx10

Facility

$247.50

Service Code	HCPCS C1766
Hospital Charge Code	270658270
Hospital Revenue Code	278
Min. Negotiated Rate	$37.12
Max. Negotiated Rate	$59.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$37.12

Intro Guidesheath 5fx10

Facility

$247.50

Service Code	HCPCS C1766
Hospital Charge Code	270658270
Hospital Revenue Code	278
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$123.75
Rate for Payer: Aetna Commercial	$94.05
Rate for Payer: Aetna Medicare Advantage	$74.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.11
Rate for Payer: Cigna Commercial	$123.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$37.12
Rate for Payer: UnitedHealthcare Community & State	$5.96
Rate for Payer: Wellpoint Medicaid Managed Care	$6.56

INTRO KIT MINI STICK 5FRX10M

Facility

$109.20

Service Code	HCPCS C1894
Hospital Charge Code	270686149S
Hospital Revenue Code	278
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$54.60
Rate for Payer: Aetna Commercial	$41.50
Rate for Payer: Aetna Medicare Advantage	$32.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.85
Rate for Payer: Cigna Commercial	$54.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$24.02
Rate for Payer: Qualcare PPO/HMO/WC	$16.38
Rate for Payer: UnitedHealthcare Community & State	$2.63
Rate for Payer: Wellpoint Medicaid Managed Care	$2.89

INTRO KIT MINI STICK 5FRX10M

Facility

$109.20

Service Code	HCPCS C1894
Hospital Charge Code	278686149S
Hospital Revenue Code	278
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$26.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$24.02
Rate for Payer: Qualcare PPO/HMO/WC	$16.38

INTRO KIT MINI STICK 5FRX10M

Facility

$109.20

Service Code	HCPCS C1894
Hospital Charge Code	270686149S
Hospital Revenue Code	278
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$26.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$24.02
Rate for Payer: Qualcare PPO/HMO/WC	$16.38

INTRO KIT MINI STICK 5FRX10M

Facility

$109.20

Service Code	HCPCS C1894
Hospital Charge Code	278686149S
Hospital Revenue Code	278
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$54.60
Rate for Payer: Aetna Commercial	$41.50
Rate for Payer: Aetna Medicare Advantage	$32.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.85
Rate for Payer: Cigna Commercial	$54.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$24.02
Rate for Payer: Qualcare PPO/HMO/WC	$16.38
Rate for Payer: UnitedHealthcare Community & State	$2.63
Rate for Payer: Wellpoint Medicaid Managed Care	$2.89

INTRO KIT PERCUTANEOUS SHEATH

Facility

$157.49

Hospital Charge Code	270649534
Hospital Revenue Code	272
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$23.62
Rate for Payer: Qualcare PPO/HMO/WC	$23.62

INTRO KIT PERCUTANEOUS SHEATH

Facility

$157.49

Hospital Charge Code	270649534
Hospital Revenue Code	272
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna Commercial	$59.85
Rate for Payer: Aetna Medicare Advantage	$47.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.16
Rate for Payer: Cigna Commercial	$78.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.25
Rate for Payer: Oxford Commercial	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$23.62
Rate for Payer: UnitedHealthcare Commercial	$31.50
Rate for Payer: UnitedHealthcare Community & State	$3.80
Rate for Payer: Wellpoint Medicaid Managed Care	$4.17

INTRON A/3MU

Facility

$166.00

Hospital Charge Code	60633187
Hospital Revenue Code	636
Min. Negotiated Rate	$24.90
Max. Negotiated Rate	$40.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.17
Rate for Payer: Qualcare PPO/HMO/WC	$24.90

INTRON A/3MU

Facility

$166.00

Hospital Charge Code	60633187
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$83.00
Rate for Payer: Aetna Commercial	$63.08
Rate for Payer: Aetna Medicare Advantage	$49.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.33
Rate for Payer: Cigna Commercial	$83.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.17
Rate for Payer: Qualcare PPO/HMO/WC	$24.90
Rate for Payer: UnitedHealthcare Community & State	$4.00
Rate for Payer: Wellpoint Medicaid Managed Care	$4.40

INTRO NEEDLE INTO AV SHUN

Facility

$2,092.00

Hospital Charge Code	2009001
Hospital Revenue Code	761
Min. Negotiated Rate	$50.42
Max. Negotiated Rate	$1,046.00
Rate for Payer: Aetna Commercial	$794.96
Rate for Payer: Aetna Medicare Advantage	$627.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.46
Rate for Payer: Cigna Commercial	$1,046.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$627.60
Rate for Payer: Oxford Commercial	$418.40
Rate for Payer: Qualcare PPO/HMO/WC	$313.80
Rate for Payer: UnitedHealthcare Commercial	$418.40
Rate for Payer: UnitedHealthcare Community & State	$50.42
Rate for Payer: Wellpoint Medicaid Managed Care	$55.44

INTRO NEEDLE INTO AV SHUN

Facility

$2,092.00

Hospital Charge Code	2009001
Hospital Revenue Code	761
Min. Negotiated Rate	$313.80
Max. Negotiated Rate	$313.80
Rate for Payer: Qualcare PPO/HMO/WC	$313.80

INTRO OF CATHETER-AORT

Facility

$233.00

Service Code	HCPCS 36200
Hospital Charge Code	7411079
Hospital Revenue Code	361
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$34.95
Rate for Payer: Qualcare PPO/HMO/WC	$34.95

INTRO OF CATHETER-AORT

Facility

$233.00

Service Code	HCPCS 36200
Hospital Charge Code	7411079
Hospital Revenue Code	361
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$88.54
Rate for Payer: Aetna Medicare Advantage	$69.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.41
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	$59.41
Rate for Payer: Cigna Commercial	$116.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.90
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.95
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$5.62
Rate for Payer: Wellpoint Medicaid Managed Care	$6.17

INTRO OF URET STNT-LT

Facility

$2,717.00

Hospital Charge Code	2009325
Hospital Revenue Code	320
Min. Negotiated Rate	$65.48
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,032.46
Rate for Payer: Aetna Medicare Advantage	$815.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$692.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$692.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$692.84
Rate for Payer: Cigna Commercial	$1,358.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$815.10
Rate for Payer: Oxford Commercial	$1,311.00
Rate for Payer: Qualcare PPO/HMO/WC	$407.55
Rate for Payer: UnitedHealthcare Commercial	$1,975.00
Rate for Payer: UnitedHealthcare Community & State	$65.48
Rate for Payer: Wellpoint Medicaid Managed Care	$72.00

INTRO OF URET STNT-LT

Facility

$2,717.00

Hospital Charge Code	2009325
Hospital Revenue Code	320
Min. Negotiated Rate	$407.55
Max. Negotiated Rate	$407.55
Rate for Payer: Qualcare PPO/HMO/WC	$407.55

INTROPIN/80MG/1ML

Facility

$27.40

Service Code	NDC 517190525
Hospital Charge Code	60633188
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$13.70
Rate for Payer: Aetna Commercial	$10.41
Rate for Payer: Aetna Medicare Advantage	$8.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.99
Rate for Payer: Cigna Commercial	$13.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.22
Rate for Payer: Oxford Commercial	$5.48
Rate for Payer: Qualcare PPO/HMO/WC	$4.11
Rate for Payer: UnitedHealthcare Commercial	$5.48
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.73

INTROPIN/80MG/1ML

Facility

$27.40

Service Code	NDC 517190525
Hospital Charge Code	60633188
Hospital Revenue Code	250
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$4.11
Rate for Payer: Qualcare PPO/HMO/WC	$4.11

INTRO TRANSRAD PREL SHEATH

Facility

$32.00

Hospital Charge Code	270658207
Hospital Revenue Code	278
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$7.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7.04
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

INTRO TRANSRAD PREL SHEATH

Facility

$32.00

Hospital Charge Code	270658207
Hospital Revenue Code	278
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.74
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7.04
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Community & State	$0.77
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

INTRO VISTABRIT 7FR 4037553A

Facility

$620.00

Service Code	HCPCS C1887
Hospital Charge Code	270624008C
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

INTRO VISTABRIT 7FR 4037553A

Facility

$620.00

Service Code	HCPCS C1887
Hospital Charge Code	270624008C
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

INTRO VISTABRITE 8FR 403-8553A

Facility

$650.00

Service Code	HCPCS C1887
Hospital Charge Code	270624374N
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

Know your out-of-pocket cost for care.

All Charges