Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PICC DOUBLE LUMEN 5FR

Facility

$3,255.00

Hospital Charge Code	73662011
Hospital Revenue Code	278
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$1,627.50
Rate for Payer: Aetna Commercial	$1,236.90
Rate for Payer: Aetna Medicare Advantage	$976.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$830.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$830.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$651.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$830.02
Rate for Payer: Cigna Commercial	$1,627.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$716.10
Rate for Payer: Qualcare PPO/HMO/WC	$488.25
Rate for Payer: UnitedHealthcare Community & State	$78.45
Rate for Payer: Wellpoint Medicaid Managed Care	$86.26

PICC DOUBLE LUMEN 5FR

Facility

$3,255.00

Hospital Charge Code	73662011
Hospital Revenue Code	278
Min. Negotiated Rate	$488.25
Max. Negotiated Rate	$787.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$651.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$716.10
Rate for Payer: Qualcare PPO/HMO/WC	$488.25

PICC DOUBLE LUMEN 5FR

Facility

$3,255.00

Service Code	HCPCS C1751
Hospital Charge Code	270664038
Hospital Revenue Code	278
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$1,627.50
Rate for Payer: Aetna Commercial	$1,236.90
Rate for Payer: Aetna Medicare Advantage	$976.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$830.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$830.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$651.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$830.02
Rate for Payer: Cigna Commercial	$1,627.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$716.10
Rate for Payer: Qualcare PPO/HMO/WC	$488.25
Rate for Payer: UnitedHealthcare Community & State	$78.45
Rate for Payer: Wellpoint Medicaid Managed Care	$86.26

PICC DOUBLE LUMEN 5FR

Facility

$3,255.00

Service Code	HCPCS C1751
Hospital Charge Code	270664038
Hospital Revenue Code	278
Min. Negotiated Rate	$488.25
Max. Negotiated Rate	$787.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$651.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$716.10
Rate for Payer: Qualcare PPO/HMO/WC	$488.25

PICC INSERTION

Facility

$7,852.40

Service Code	HCPCS 36569
Hospital Charge Code	73662003
Hospital Revenue Code	361
Min. Negotiated Rate	$189.24
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,355.72
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,177.86
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$189.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$208.09

PICC INSERTION

Facility

$7,852.40

Service Code	HCPCS 36569
Hospital Charge Code	73662003
Hospital Revenue Code	361
Min. Negotiated Rate	$1,177.86
Max. Negotiated Rate	$1,177.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,177.86

PICC LINE4FR LUMEN W/70CM WIRE

Facility

$760.50

Hospital Charge Code	2709007029
Hospital Revenue Code	272
Min. Negotiated Rate	$114.08
Max. Negotiated Rate	$114.08
Rate for Payer: Qualcare PPO/HMO/WC	$114.08

PICC LINE4FR LUMEN W/70CM WIRE

Facility

$760.50

Hospital Charge Code	2709007029
Hospital Revenue Code	272
Min. Negotiated Rate	$18.33
Max. Negotiated Rate	$380.25
Rate for Payer: Aetna Commercial	$288.99
Rate for Payer: Aetna Medicare Advantage	$228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.93
Rate for Payer: Cigna Commercial	$380.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.15
Rate for Payer: Oxford Commercial	$152.10
Rate for Payer: Qualcare PPO/HMO/WC	$114.08
Rate for Payer: UnitedHealthcare Commercial	$152.10
Rate for Payer: UnitedHealthcare Community & State	$18.33
Rate for Payer: Wellpoint Medicaid Managed Care	$20.15

PICC LINE 4FR SINGLE LUMEN IR

Facility

$760.50

Hospital Charge Code	270CH0061
Hospital Revenue Code	272
Min. Negotiated Rate	$18.33
Max. Negotiated Rate	$380.25
Rate for Payer: Aetna Commercial	$288.99
Rate for Payer: Aetna Medicare Advantage	$228.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.93
Rate for Payer: Cigna Commercial	$380.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.15
Rate for Payer: Oxford Commercial	$152.10
Rate for Payer: Qualcare PPO/HMO/WC	$114.08
Rate for Payer: UnitedHealthcare Commercial	$152.10
Rate for Payer: UnitedHealthcare Community & State	$18.33
Rate for Payer: Wellpoint Medicaid Managed Care	$20.15

PICC LINE 4FR SINGLE LUMEN IR

Facility

$760.50

Hospital Charge Code	270CH0061
Hospital Revenue Code	272
Min. Negotiated Rate	$114.08
Max. Negotiated Rate	$114.08
Rate for Payer: Qualcare PPO/HMO/WC	$114.08

PICC LINE 6FR LUMEN/70CM WIRE

Facility

$1,305.00

Hospital Charge Code	2709007031
Hospital Revenue Code	272
Min. Negotiated Rate	$195.75
Max. Negotiated Rate	$195.75
Rate for Payer: Qualcare PPO/HMO/WC	$195.75

PICC LINE 6FR LUMEN/70CM WIRE

Facility

$1,305.00

Hospital Charge Code	2709007031
Hospital Revenue Code	272
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$652.50
Rate for Payer: Aetna Commercial	$495.90
Rate for Payer: Aetna Medicare Advantage	$391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$332.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$332.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$332.77
Rate for Payer: Cigna Commercial	$652.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$391.50
Rate for Payer: Oxford Commercial	$261.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.75
Rate for Payer: UnitedHealthcare Commercial	$261.00
Rate for Payer: UnitedHealthcare Community & State	$31.45
Rate for Payer: Wellpoint Medicaid Managed Care	$34.58

PICC LINE 6FR SINGLE LUMEN IR

Facility

$1,305.00

Hospital Charge Code	270CH0062
Hospital Revenue Code	272
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$652.50
Rate for Payer: Aetna Commercial	$495.90
Rate for Payer: Aetna Medicare Advantage	$391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$332.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$332.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$332.77
Rate for Payer: Cigna Commercial	$652.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$391.50
Rate for Payer: Oxford Commercial	$261.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.75
Rate for Payer: UnitedHealthcare Commercial	$261.00
Rate for Payer: UnitedHealthcare Community & State	$31.45
Rate for Payer: Wellpoint Medicaid Managed Care	$34.58

PICC LINE 6FR SINGLE LUMEN IR

Facility

$1,305.00

Hospital Charge Code	270CH0062
Hospital Revenue Code	272
Min. Negotiated Rate	$195.75
Max. Negotiated Rate	$195.75
Rate for Payer: Qualcare PPO/HMO/WC	$195.75

PICC LINE INSERTION <5 YRS OLD

Facility

$4,649.00

Service Code	HCPCS 36568
Hospital Charge Code	83080010
Hospital Revenue Code	361
Min. Negotiated Rate	$697.35
Max. Negotiated Rate	$697.35
Rate for Payer: Qualcare PPO/HMO/WC	$697.35

PICC LINE INSERTION <5 YRS OLD

Facility

$4,649.00

Service Code	HCPCS 36568
Hospital Charge Code	83080010
Hospital Revenue Code	361
Min. Negotiated Rate	$112.04
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,394.70
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$697.35
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$112.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$123.20

PICC LINE INSERTION < 5YRS OLD

Facility

$4,649.00

Service Code	HCPCS 36568
Hospital Charge Code	83090001
Hospital Revenue Code	361
Min. Negotiated Rate	$697.35
Max. Negotiated Rate	$697.35
Rate for Payer: Qualcare PPO/HMO/WC	$697.35

PICC LINE INSERTION < 5YRS OLD

Facility

$4,649.00

Service Code	HCPCS 36568
Hospital Charge Code	83090001
Hospital Revenue Code	361
Min. Negotiated Rate	$112.04
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,394.70
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$697.35
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$112.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$123.20

PICC LINE INSERTION < 5YRS OLD

Facility

$4,649.00

Service Code	HCPCS 36568
Hospital Charge Code	83092010
Hospital Revenue Code	361
Min. Negotiated Rate	$112.04
Max. Negotiated Rate	$6,750.64
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,750.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,750.64
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,394.70
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$697.35
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$112.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$123.20

PICC LINE INSERTION < 5YRS OLD

Facility

$4,649.00

Service Code	HCPCS 36568
Hospital Charge Code	83092010
Hospital Revenue Code	361
Min. Negotiated Rate	$697.35
Max. Negotiated Rate	$697.35
Rate for Payer: Qualcare PPO/HMO/WC	$697.35

PICC LINE VAX DUAL LUM 5 45413

Facility

$510.00

Hospital Charge Code	270624317V
Hospital Revenue Code	278
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$112.20
Rate for Payer: Qualcare PPO/HMO/WC	$76.50

PICC LINE VAX DUAL LUM 5 45413

Facility

$510.00

Hospital Charge Code	270624317V
Hospital Revenue Code	278
Min. Negotiated Rate	$12.29
Max. Negotiated Rate	$255.00
Rate for Payer: Aetna Commercial	$193.80
Rate for Payer: Aetna Medicare Advantage	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.05
Rate for Payer: Cigna Commercial	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$112.20
Rate for Payer: Qualcare PPO/HMO/WC	$76.50
Rate for Payer: UnitedHealthcare Community & State	$12.29
Rate for Payer: Wellpoint Medicaid Managed Care	$13.52

PICC LINE VAX DUAL LUM 5 45413

Facility

$455.75

Hospital Charge Code	270624317
Hospital Revenue Code	278
Min. Negotiated Rate	$10.98
Max. Negotiated Rate	$227.88
Rate for Payer: Aetna Commercial	$173.19
Rate for Payer: Aetna Medicare Advantage	$136.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.22
Rate for Payer: Cigna Commercial	$227.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$100.27
Rate for Payer: Qualcare PPO/HMO/WC	$68.36
Rate for Payer: UnitedHealthcare Community & State	$10.98
Rate for Payer: Wellpoint Medicaid Managed Care	$12.08

PICC LINE VAX DUAL LUM 5 45413

Facility

$455.75

Hospital Charge Code	270624317
Hospital Revenue Code	278
Min. Negotiated Rate	$68.36
Max. Negotiated Rate	$110.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$100.27
Rate for Payer: Qualcare PPO/HMO/WC	$68.36

PICC PERPHRLLY INS CNTRL CAT**

Facility

$163.00

Hospital Charge Code	8003543
Hospital Revenue Code	272
Min. Negotiated Rate	$24.45
Max. Negotiated Rate	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$24.45

Know your out-of-pocket cost for care.

All Charges