Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PL CATH ART 2ND T/B-RT

Facility

$403.00

Service Code	HCPCS 36216RT
Hospital Charge Code	7411091
Hospital Revenue Code	361
Min. Negotiated Rate	$60.45
Max. Negotiated Rate	$60.45
Rate for Payer: Qualcare PPO/HMO/WC	$60.45

PL CATH ART 3RD A/P-BI

Facility

$484.00

Service Code	HCPCS 3624750
Hospital Charge Code	7411111
Hospital Revenue Code	361
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$183.92
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Community & State	$11.66
Rate for Payer: Wellpoint Medicaid Managed Care	$12.83

PL CATH ART 3RD A/P-BI

Facility

$484.00

Service Code	HCPCS 3624750
Hospital Charge Code	7411111
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

PL CATH ART 3RD A/P-LT

Facility

$484.00

Service Code	HCPCS 36247LT
Hospital Charge Code	7411113
Hospital Revenue Code	361
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$183.92
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Community & State	$11.66
Rate for Payer: Wellpoint Medicaid Managed Care	$12.83

PL CATH ART 3RD A/P-LT

Facility

$484.00

Service Code	HCPCS 36247LT
Hospital Charge Code	366836247L
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

PL CATH ART 3RD A/P-LT

Facility

$484.00

Service Code	HCPCS 36247LT
Hospital Charge Code	7411113
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

PL CATH ART 3RD A/P-LT

Facility

$484.00

Service Code	HCPCS 36247LT
Hospital Charge Code	366836247L
Hospital Revenue Code	361
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$183.92
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Community & State	$11.66
Rate for Payer: Wellpoint Medicaid Managed Care	$12.83

PL CATH ART 3RD A/P-RT

Facility

$484.00

Service Code	HCPCS 36247RT
Hospital Charge Code	7411115
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

PL CATH ART 3RD A/P-RT

Facility

$484.00

Service Code	HCPCS 36247RT
Hospital Charge Code	7411115
Hospital Revenue Code	361
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$183.92
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Community & State	$11.66
Rate for Payer: Wellpoint Medicaid Managed Care	$12.83

PL CATH ART 3RD A/P-RT

Facility

$484.00

Service Code	HCPCS 36247RT
Hospital Charge Code	366836247R
Hospital Revenue Code	361
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$183.92
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Community & State	$11.66
Rate for Payer: Wellpoint Medicaid Managed Care	$12.83

PL CATH ART 3RD A/P-RT

Facility

$484.00

Service Code	HCPCS 36247RT
Hospital Charge Code	366836247R
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

PL CATH ART 3RD T/B-BI

Facility

$486.00

Service Code	HCPCS 3621750
Hospital Charge Code	7411093
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

PL CATH ART 3RD T/B-BI

Facility

$486.00

Service Code	HCPCS 3621750
Hospital Charge Code	7411093
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

PL CATH ART 3RD T/B-LT

Facility

$486.00

Service Code	HCPCS 36217LT
Hospital Charge Code	7411095
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

PL CATH ART 3RD T/B-LT

Facility

$486.00

Service Code	HCPCS 36217LT
Hospital Charge Code	7411095
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

PL CATH ART 3RD T/B-RT

Facility

$486.00

Service Code	HCPCS 36217RT
Hospital Charge Code	7411097
Hospital Revenue Code	361
Min. Negotiated Rate	$72.90
Max. Negotiated Rate	$72.90
Rate for Payer: Qualcare PPO/HMO/WC	$72.90

PL CATH ART 3RD T/B-RT

Facility

$486.00

Service Code	HCPCS 36217RT
Hospital Charge Code	7411097
Hospital Revenue Code	361
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$1,626.00
Rate for Payer: Aetna Commercial	$184.68
Rate for Payer: Aetna Medicare Advantage	$145.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.93
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	$123.93
Rate for Payer: Cigna Commercial	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.80
Rate for Payer: Qualcare PPO/HMO/WC	$72.90
Rate for Payer: UnitedHealthcare Community & State	$11.71
Rate for Payer: Wellpoint Medicaid Managed Care	$12.88

PLEDGET 3 X 7 MM SOFT

Facility

$46.60

Hospital Charge Code	270666831
Hospital Revenue Code	278
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.30
Rate for Payer: Aetna Commercial	$17.71
Rate for Payer: Aetna Medicare Advantage	$13.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.88
Rate for Payer: Cigna Commercial	$23.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.99
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

PLEDGET 3 X 7 MM SOFT

Facility

$46.60

Hospital Charge Code	270666831
Hospital Revenue Code	278
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$11.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.99

PLEDGET FELT 1 X 1

Facility

$210.53

Hospital Charge Code	270669534
Hospital Revenue Code	272
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$105.27
Rate for Payer: Aetna Commercial	$80.00
Rate for Payer: Aetna Medicare Advantage	$63.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.69
Rate for Payer: Cigna Commercial	$105.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.16
Rate for Payer: Oxford Commercial	$42.11
Rate for Payer: Qualcare PPO/HMO/WC	$31.58
Rate for Payer: UnitedHealthcare Commercial	$42.11
Rate for Payer: UnitedHealthcare Community & State	$5.07
Rate for Payer: Wellpoint Medicaid Managed Care	$5.58

PLEDGET FELT 1 X 1

Facility

$210.53

Hospital Charge Code	270669534
Hospital Revenue Code	272
Min. Negotiated Rate	$31.58
Max. Negotiated Rate	$31.58
Rate for Payer: Qualcare PPO/HMO/WC	$31.58

PLEDGET FIRM TFE 1/4x1/8

Facility

$14.62

Hospital Charge Code	270671495
Hospital Revenue Code	272
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$2.19
Rate for Payer: Qualcare PPO/HMO/WC	$2.19

PLEDGET FIRM TFE 1/4x1/8

Facility

$14.62

Hospital Charge Code	270671495
Hospital Revenue Code	272
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.31
Rate for Payer: Aetna Commercial	$5.56
Rate for Payer: Aetna Medicare Advantage	$4.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.73
Rate for Payer: Cigna Commercial	$7.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.39
Rate for Payer: Oxford Commercial	$2.92
Rate for Payer: Qualcare PPO/HMO/WC	$2.19
Rate for Payer: UnitedHealthcare Commercial	$2.92
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

PLEDGET PRE PUNCH MM ST

Facility

$17.43

Hospital Charge Code	270661057
Hospital Revenue Code	272
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$8.71
Rate for Payer: Aetna Commercial	$6.62
Rate for Payer: Aetna Medicare Advantage	$5.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.44
Rate for Payer: Cigna Commercial	$8.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.23
Rate for Payer: Oxford Commercial	$3.49
Rate for Payer: Qualcare PPO/HMO/WC	$2.61
Rate for Payer: UnitedHealthcare Commercial	$3.49
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

PLEDGET PRE PUNCH MM ST

Facility

$17.43

Hospital Charge Code	270661057
Hospital Revenue Code	272
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$2.61
Rate for Payer: Qualcare PPO/HMO/WC	$2.61

Know your out-of-pocket cost for care.

All Charges