Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

POLAR CATH 5MMX100MMX120MM

Facility

$778.00

Hospital Charge Code	270638809
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$389.00
Rate for Payer: Aetna Commercial	$295.64
Rate for Payer: Aetna Medicare Advantage	$233.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.39
Rate for Payer: Cigna Commercial	$389.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$233.40
Rate for Payer: Oxford Commercial	$155.60
Rate for Payer: Qualcare PPO/HMO/WC	$116.70
Rate for Payer: UnitedHealthcare Commercial	$155.60
Rate for Payer: UnitedHealthcare Community & State	$18.75
Rate for Payer: Wellpoint Medicaid Managed Care	$20.62

POLAR CATHETER NO2 CARTRIDGE

Facility

$250.00

Hospital Charge Code	2709006112
Hospital Revenue Code	272
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$50.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$50.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

POLAR CATHETER NO2 CARTRIDGE

Facility

$250.00

Hospital Charge Code	2709006112
Hospital Revenue Code	272
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

POLARCATH P54012001

Facility

$3,000.00

Hospital Charge Code	270644108C
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

POLARCATH P54012001

Facility

$3,000.00

Hospital Charge Code	270644107C
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

POLARCATH P54012001

Facility

$3,000.00

Hospital Charge Code	270644107C
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

POLARCATH P54012001

Facility

$3,000.00

Hospital Charge Code	270644108C
Hospital Revenue Code	278
Min. Negotiated Rate	$72.30
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$72.30
Rate for Payer: Wellpoint Medicaid Managed Care	$79.50

POLARCATHPERIPHERAL INFLAM UNI

Facility

$4,750.00

Hospital Charge Code	2709006111
Hospital Revenue Code	272
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$712.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

POLARCATHPERIPHERAL INFLAM UNI

Facility

$4,750.00

Hospital Charge Code	2709006111
Hospital Revenue Code	272
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.00
Rate for Payer: Oxford Commercial	$950.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Commercial	$950.00
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

POLARCATH T3510015001

Facility

$4,232.25

Hospital Charge Code	270644103C
Hospital Revenue Code	278
Min. Negotiated Rate	$634.84
Max. Negotiated Rate	$1,024.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$846.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,024.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$931.10
Rate for Payer: Qualcare PPO/HMO/WC	$634.84

POLARCATH T3510015001

Facility

$4,232.25

Hospital Charge Code	270644103C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$2,116.12
Rate for Payer: Aetna Commercial	$1,608.26
Rate for Payer: Aetna Medicare Advantage	$1,269.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,079.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,079.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$846.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,079.22
Rate for Payer: Cigna Commercial	$2,116.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,024.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$931.10
Rate for Payer: Qualcare PPO/HMO/WC	$634.84
Rate for Payer: UnitedHealthcare Community & State	$102.00
Rate for Payer: Wellpoint Medicaid Managed Care	$112.15

POLAR HEAT/8OZ/GEL

Facility

$28.00

Hospital Charge Code	60634656
Hospital Revenue Code	250
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$4.20
Rate for Payer: Qualcare PPO/HMO/WC	$4.20

POLAR HEAT/8OZ/GEL

Facility

$28.00

Hospital Charge Code	60634656
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$10.64
Rate for Payer: Aetna Medicare Advantage	$8.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.14
Rate for Payer: Cigna Commercial	$14.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Oxford Commercial	$5.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.20
Rate for Payer: UnitedHealthcare Commercial	$5.60
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.74

POLIBAR ACB

Facility

$44.24

Hospital Charge Code	60635825
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$22.12
Rate for Payer: Aetna Commercial	$16.81
Rate for Payer: Aetna Medicare Advantage	$13.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.28
Rate for Payer: Cigna Commercial	$22.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.27
Rate for Payer: Oxford Commercial	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$6.64
Rate for Payer: UnitedHealthcare Commercial	$8.85
Rate for Payer: UnitedHealthcare Community & State	$1.07
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

POLIBAR ACB

Facility

$44.24

Hospital Charge Code	60635825
Hospital Revenue Code	250
Min. Negotiated Rate	$6.64
Max. Negotiated Rate	$6.64
Rate for Payer: Qualcare PPO/HMO/WC	$6.64

POLIBAR PLUS

Facility

$147.04

Hospital Charge Code	60635827
Hospital Revenue Code	250
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$73.52
Rate for Payer: Aetna Commercial	$55.88
Rate for Payer: Aetna Medicare Advantage	$44.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.50
Rate for Payer: Cigna Commercial	$73.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.11
Rate for Payer: Oxford Commercial	$29.41
Rate for Payer: Qualcare PPO/HMO/WC	$22.06
Rate for Payer: UnitedHealthcare Commercial	$29.41
Rate for Payer: UnitedHealthcare Community & State	$3.54
Rate for Payer: Wellpoint Medicaid Managed Care	$3.90

POLIBAR PLUS

Facility

$147.04

Hospital Charge Code	60635827
Hospital Revenue Code	250
Min. Negotiated Rate	$22.06
Max. Negotiated Rate	$22.06
Rate for Payer: Qualcare PPO/HMO/WC	$22.06

POLIBAR PS BARIUM SULFATE 750M

Facility

$103.50

Hospital Charge Code	606390571
Hospital Revenue Code	250
Min. Negotiated Rate	$15.53
Max. Negotiated Rate	$15.53
Rate for Payer: Qualcare PPO/HMO/WC	$15.53

POLIBAR PS BARIUM SULFATE 750M

Facility

$103.50

Hospital Charge Code	606390571
Hospital Revenue Code	250
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$51.75
Rate for Payer: Aetna Commercial	$39.33
Rate for Payer: Aetna Medicare Advantage	$31.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.39
Rate for Payer: Cigna Commercial	$51.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.05
Rate for Payer: Oxford Commercial	$20.70
Rate for Payer: Qualcare PPO/HMO/WC	$15.53
Rate for Payer: UnitedHealthcare Commercial	$20.70
Rate for Payer: UnitedHealthcare Community & State	$2.49
Rate for Payer: Wellpoint Medicaid Managed Care	$2.74

POLIO AB

Facility

$103.25

Service Code	HCPCS 8665891
Hospital Charge Code	3000366A
Hospital Revenue Code	302
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

POLIO AB

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3000366D
Hospital Revenue Code	302
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

POLIO AB

Facility

$103.25

Service Code	HCPCS 8665891
Hospital Charge Code	3000366C
Hospital Revenue Code	302
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.23
Rate for Payer: Aetna Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.33
Rate for Payer: Cigna Commercial	$51.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.49
Rate for Payer: Wellpoint Medicaid Managed Care	$2.74

POLIO AB

Facility

$103.25

Service Code	HCPCS 8665891
Hospital Charge Code	3000366A
Hospital Revenue Code	302
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$39.23
Rate for Payer: Aetna Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.33
Rate for Payer: Cigna Commercial	$51.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$2.49
Rate for Payer: Wellpoint Medicaid Managed Care	$2.74

POLIO AB

Facility

$103.25

Service Code	HCPCS 8665891
Hospital Charge Code	3000366B
Hospital Revenue Code	302
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$15.49
Rate for Payer: Qualcare PPO/HMO/WC	$15.49

POLIO AB

Facility

$103.25

Service Code	HCPCS 86658
Hospital Charge Code	3000366D
Hospital Revenue Code	302
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$124.00
Rate for Payer: Aetna Commercial	$35.44
Rate for Payer: Aetna Medicare Advantage	$42.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.03
Rate for Payer: Cigna Commercial	$51.62
Rate for Payer: Cigna Medicare Advantage	$13.03
Rate for Payer: Clover Medicare Advantage	$12.38
Rate for Payer: EmblemHealth Commercial	$39.09
Rate for Payer: Humana Medicare Advantage	$13.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.49
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$10.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.03
Rate for Payer: Wellcare Medicare Advantage	$13.03
Rate for Payer: Wellpoint Medicaid Managed Care	$2.74

Know your out-of-pocket cost for care.

All Charges