Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PICC PERPHRLLY INS CNTRL CAT**

Facility

$163.00

Hospital Charge Code	8003543
Hospital Revenue Code	272
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$81.50
Rate for Payer: Aetna Commercial	$61.94
Rate for Payer: Aetna Medicare Advantage	$48.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.56
Rate for Payer: Cigna Commercial	$81.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.90
Rate for Payer: Oxford Commercial	$32.60
Rate for Payer: Qualcare PPO/HMO/WC	$24.45
Rate for Payer: UnitedHealthcare Commercial	$32.60
Rate for Payer: UnitedHealthcare Community & State	$3.93
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

PICC SINGLE LUMEN 4FR

Facility

$3,150.00

Service Code	HCPCS C1751
Hospital Charge Code	270664037
Hospital Revenue Code	278
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$762.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$693.00
Rate for Payer: Qualcare PPO/HMO/WC	$472.50

PICC SINGLE LUMEN 4FR

Facility

$3,150.00

Service Code	HCPCS C1751
Hospital Charge Code	270664037
Hospital Revenue Code	278
Min. Negotiated Rate	$75.92
Max. Negotiated Rate	$1,575.00
Rate for Payer: Aetna Commercial	$1,197.00
Rate for Payer: Aetna Medicare Advantage	$945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$803.25
Rate for Payer: Cigna Commercial	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$693.00
Rate for Payer: Qualcare PPO/HMO/WC	$472.50
Rate for Payer: UnitedHealthcare Community & State	$75.92
Rate for Payer: Wellpoint Medicaid Managed Care	$83.47

PICC SINGLE LUMEN 4FR

Facility

$3,150.00

Service Code	HCPCS C1751
Hospital Charge Code	73662010
Hospital Revenue Code	278
Min. Negotiated Rate	$75.92
Max. Negotiated Rate	$1,575.00
Rate for Payer: Aetna Commercial	$1,197.00
Rate for Payer: Aetna Medicare Advantage	$945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$803.25
Rate for Payer: Cigna Commercial	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$693.00
Rate for Payer: Qualcare PPO/HMO/WC	$472.50
Rate for Payer: UnitedHealthcare Community & State	$75.92
Rate for Payer: Wellpoint Medicaid Managed Care	$83.47

PICC SINGLE LUMEN 4FR

Facility

$3,150.00

Service Code	HCPCS C1751
Hospital Charge Code	73662010
Hospital Revenue Code	278
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$762.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$693.00
Rate for Payer: Qualcare PPO/HMO/WC	$472.50

PICC SINGLE LUMEN 5FR

Facility

$608.50

Hospital Charge Code	270669641
Hospital Revenue Code	278
Min. Negotiated Rate	$91.28
Max. Negotiated Rate	$147.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$133.87
Rate for Payer: Qualcare PPO/HMO/WC	$91.28

PICC SINGLE LUMEN 5FR

Facility

$608.50

Hospital Charge Code	270669641
Hospital Revenue Code	278
Min. Negotiated Rate	$14.66
Max. Negotiated Rate	$304.25
Rate for Payer: Aetna Commercial	$231.23
Rate for Payer: Aetna Medicare Advantage	$182.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.17
Rate for Payer: Cigna Commercial	$304.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$133.87
Rate for Payer: Qualcare PPO/HMO/WC	$91.28
Rate for Payer: UnitedHealthcare Community & State	$14.66
Rate for Payer: Wellpoint Medicaid Managed Care	$16.13

PICC TOTAL REPLACEMENT

Facility

$4,221.55

Service Code	HCPCS 36584
Hospital Charge Code	73662005
Hospital Revenue Code	361
Min. Negotiated Rate	$633.23
Max. Negotiated Rate	$633.23
Rate for Payer: Qualcare PPO/HMO/WC	$633.23

PICC TOTAL REPLACEMENT

Facility

$4,221.55

Service Code	HCPCS 36584
Hospital Charge Code	73662005
Hospital Revenue Code	361
Min. Negotiated Rate	$101.74
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	$1,266.46
Rate for Payer: Oxford Commercial	$2,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$633.23
Rate for Payer: UnitedHealthcare Commercial	$3,593.00
Rate for Payer: UnitedHealthcare Community & State	$101.74
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	$111.87

PICC TRAY

Facility

$20.18

Hospital Charge Code	270653944
Hospital Revenue Code	270
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$10.09
Rate for Payer: Aetna Commercial	$7.67
Rate for Payer: Aetna Medicare Advantage	$6.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.15
Rate for Payer: Cigna Commercial	$10.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.05
Rate for Payer: Oxford Commercial	$4.04
Rate for Payer: Qualcare PPO/HMO/WC	$3.03
Rate for Payer: UnitedHealthcare Commercial	$4.04
Rate for Payer: UnitedHealthcare Community & State	$0.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

PICC TRAY

Facility

$20.18

Hospital Charge Code	270653944
Hospital Revenue Code	270
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$3.03
Rate for Payer: Qualcare PPO/HMO/WC	$3.03

PICC TRIPLE LUMEN 5FR

Facility

$3,745.50

Hospital Charge Code	270664039
Hospital Revenue Code	278
Min. Negotiated Rate	$561.83
Max. Negotiated Rate	$906.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$749.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$906.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$824.01
Rate for Payer: Qualcare PPO/HMO/WC	$561.83

PICC TRIPLE LUMEN 5FR

Facility

$3,745.50

Hospital Charge Code	270664039
Hospital Revenue Code	278
Min. Negotiated Rate	$90.27
Max. Negotiated Rate	$1,872.75
Rate for Payer: Aetna Commercial	$1,423.29
Rate for Payer: Aetna Medicare Advantage	$1,123.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$955.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$955.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$749.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$955.10
Rate for Payer: Cigna Commercial	$1,872.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$906.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$824.01
Rate for Payer: Qualcare PPO/HMO/WC	$561.83
Rate for Payer: UnitedHealthcare Community & State	$90.27
Rate for Payer: Wellpoint Medicaid Managed Care	$99.26

PICK UP STAT

Facility

$10.00

Service Code	HCPCS 99199
Hospital Charge Code	39999999
Hospital Revenue Code	999
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

PICK UP STAT

Facility

$10.00

Service Code	HCPCS 99199
Hospital Charge Code	39999999
Hospital Revenue Code	999
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.80
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

PICK VEIN YELLOW 45mmL x9mm

Facility

$575.00

Hospital Charge Code	270644419
Hospital Revenue Code	272
Min. Negotiated Rate	$13.86
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.50
Rate for Payer: Oxford Commercial	$115.00
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Commercial	$115.00
Rate for Payer: UnitedHealthcare Community & State	$13.86
Rate for Payer: Wellpoint Medicaid Managed Care	$15.24

PICK VEIN YELLOW 45mmL x9mm

Facility

$575.00

Hospital Charge Code	270644419
Hospital Revenue Code	272
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$86.25
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

PICK VEIN YELLOW 45mmL x9mm

Facility

$11.50

Hospital Charge Code	272644419
Hospital Revenue Code	270
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$5.75
Rate for Payer: Aetna Commercial	$4.37
Rate for Payer: Aetna Medicare Advantage	$3.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.93
Rate for Payer: Cigna Commercial	$5.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.45
Rate for Payer: Oxford Commercial	$2.30
Rate for Payer: Qualcare PPO/HMO/WC	$1.73
Rate for Payer: UnitedHealthcare Commercial	$2.30
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

PICK VEIN YELLOW 45mmL x9mm

Facility

$11.50

Hospital Charge Code	272644419
Hospital Revenue Code	270
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$1.73
Rate for Payer: Qualcare PPO/HMO/WC	$1.73

PICO 7 NEG PRESS 2 DRESS 15x30

Facility

$1,160.00

Hospital Charge Code	270697769
Hospital Revenue Code	272
Min. Negotiated Rate	$174.00
Max. Negotiated Rate	$174.00
Rate for Payer: Qualcare PPO/HMO/WC	$174.00

PICO 7 NEG PRESS 2 DRESS 15x30

Facility

$1,160.00

Hospital Charge Code	270697769
Hospital Revenue Code	272
Min. Negotiated Rate	$27.96
Max. Negotiated Rate	$580.00
Rate for Payer: Aetna Commercial	$440.80
Rate for Payer: Aetna Medicare Advantage	$348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$295.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$295.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$295.80
Rate for Payer: Cigna Commercial	$580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$348.00
Rate for Payer: Oxford Commercial	$232.00
Rate for Payer: Qualcare PPO/HMO/WC	$174.00
Rate for Payer: UnitedHealthcare Commercial	$232.00
Rate for Payer: UnitedHealthcare Community & State	$27.96
Rate for Payer: Wellpoint Medicaid Managed Care	$30.74

PIERCE SKULL IMPLANT DEVICE

Facility

$13,423.00

Service Code	HCPCS 61210
Hospital Charge Code	1600000593
Hospital Revenue Code	360
Min. Negotiated Rate	$323.49
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$5,100.74
Rate for Payer: Aetna Medicare Advantage	$4,026.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,422.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,422.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,422.86
Rate for Payer: Cigna Commercial	$6,711.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,026.90
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,013.45
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$323.49
Rate for Payer: Wellpoint Medicaid Managed Care	$355.71

PIERCE SKULL IMPLANT DEVICE

Facility

$13,423.00

Service Code	HCPCS 61210
Hospital Charge Code	1600000593
Hospital Revenue Code	360
Min. Negotiated Rate	$2,013.45
Max. Negotiated Rate	$2,013.45
Rate for Payer: Qualcare PPO/HMO/WC	$2,013.45

PIGEON DRO

Facility

$52.00

Service Code	HCPCS 86003
Hospital Charge Code	3035087
Hospital Revenue Code	300
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.84
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.60
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

PIGEON DRO

Facility

$52.00

Service Code	HCPCS 86003
Hospital Charge Code	3035087
Hospital Revenue Code	300
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

Know your out-of-pocket cost for care.

All Charges