Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

PORT PLUGS SPECTRA SPARE

Facility

$375.00

Hospital Charge Code	270679695
Hospital Revenue Code	272
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

PORT PLUGS SPECTRA SPARE

Facility

$375.00

Hospital Charge Code	270679695
Hospital Revenue Code	272
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$75.00
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

PORT POWER IMPLANTABLE 1708000

Facility

$2,350.00

Service Code	HCPCS C1788
Hospital Charge Code	270637943
Hospital Revenue Code	278
Min. Negotiated Rate	$56.63
Max. Negotiated Rate	$1,175.00
Rate for Payer: Aetna Commercial	$893.00
Rate for Payer: Aetna Medicare Advantage	$705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$599.25
Rate for Payer: Cigna Commercial	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$517.00
Rate for Payer: Qualcare PPO/HMO/WC	$352.50
Rate for Payer: UnitedHealthcare Community & State	$56.63
Rate for Payer: Wellpoint Medicaid Managed Care	$62.27

PORT POWER IMPLANTABLE 1708000

Facility

$2,350.00

Service Code	HCPCS C1788
Hospital Charge Code	270637943
Hospital Revenue Code	278
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$568.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$517.00
Rate for Payer: Qualcare PPO/HMO/WC	$352.50

PORT POWER VUE 1708062

Facility

$3,290.00

Service Code	HCPCS C1751
Hospital Charge Code	270660816S
Hospital Revenue Code	278
Min. Negotiated Rate	$493.50
Max. Negotiated Rate	$796.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$658.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$796.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$723.80
Rate for Payer: Qualcare PPO/HMO/WC	$493.50

PORT POWER VUE 1708062

Facility

$3,290.00

Service Code	HCPCS C1751
Hospital Charge Code	270660816
Hospital Revenue Code	278
Min. Negotiated Rate	$79.29
Max. Negotiated Rate	$1,645.00
Rate for Payer: Aetna Commercial	$1,250.20
Rate for Payer: Aetna Medicare Advantage	$987.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$838.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$838.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$658.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$838.95
Rate for Payer: Cigna Commercial	$1,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$796.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$723.80
Rate for Payer: Qualcare PPO/HMO/WC	$493.50
Rate for Payer: UnitedHealthcare Community & State	$79.29
Rate for Payer: Wellpoint Medicaid Managed Care	$87.19

PORT POWER VUE 1708062

Facility

$3,290.00

Service Code	HCPCS C1751
Hospital Charge Code	270660816
Hospital Revenue Code	278
Min. Negotiated Rate	$493.50
Max. Negotiated Rate	$796.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$658.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$796.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$723.80
Rate for Payer: Qualcare PPO/HMO/WC	$493.50

PORT POWER VUE 1708062

Facility

$3,290.00

Service Code	HCPCS C1751
Hospital Charge Code	270660816S
Hospital Revenue Code	278
Min. Negotiated Rate	$79.29
Max. Negotiated Rate	$1,645.00
Rate for Payer: Aetna Commercial	$1,250.20
Rate for Payer: Aetna Medicare Advantage	$987.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$838.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$838.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$658.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$838.95
Rate for Payer: Cigna Commercial	$1,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$796.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$723.80
Rate for Payer: Qualcare PPO/HMO/WC	$493.50
Rate for Payer: UnitedHealthcare Community & State	$79.29
Rate for Payer: Wellpoint Medicaid Managed Care	$87.19

PORT POWER VUE 1708062

Facility

$2,350.00

Service Code	HCPCS C1751
Hospital Charge Code	270660816N
Hospital Revenue Code	278
Min. Negotiated Rate	$56.63
Max. Negotiated Rate	$1,175.00
Rate for Payer: Aetna Commercial	$893.00
Rate for Payer: Aetna Medicare Advantage	$705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$599.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$599.25
Rate for Payer: Cigna Commercial	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$517.00
Rate for Payer: Qualcare PPO/HMO/WC	$352.50
Rate for Payer: UnitedHealthcare Community & State	$56.63
Rate for Payer: Wellpoint Medicaid Managed Care	$62.27

PORT POWER VUE 1708062

Facility

$2,350.00

Service Code	HCPCS C1751
Hospital Charge Code	270660816N
Hospital Revenue Code	278
Min. Negotiated Rate	$352.50
Max. Negotiated Rate	$568.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$517.00
Rate for Payer: Qualcare PPO/HMO/WC	$352.50

PORT PROTECTOR CUROS LUER LOCK

Facility

$15.22

Hospital Charge Code	270684765
Hospital Revenue Code	272
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$7.61
Rate for Payer: Aetna Commercial	$5.78
Rate for Payer: Aetna Medicare Advantage	$4.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.88
Rate for Payer: Cigna Commercial	$7.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.57
Rate for Payer: Oxford Commercial	$3.04
Rate for Payer: Qualcare PPO/HMO/WC	$2.28
Rate for Payer: UnitedHealthcare Commercial	$3.04
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

PORT PROTECTOR CUROS LUER LOCK

Facility

$15.22

Hospital Charge Code	270684765
Hospital Revenue Code	272
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.28
Rate for Payer: Qualcare PPO/HMO/WC	$2.28

PORT PWR XCELA 8fr 1LUMEN45119

Facility

$3,750.00

Hospital Charge Code	270643866
Hospital Revenue Code	278
Min. Negotiated Rate	$90.38
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$99.38

PORT PWR XCELA 8fr 1LUMEN45119

Facility

$3,750.00

Hospital Charge Code	270643866
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

PORT RENASYS

Facility

$75.00

Hospital Charge Code	270649491
Hospital Revenue Code	272
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

PORT RENASYS

Facility

$75.00

Hospital Charge Code	270649491
Hospital Revenue Code	272
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

PORT RENASYS SOFT STAND ALONE

Facility

$80.73

Hospital Charge Code	270650283
Hospital Revenue Code	272
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$40.37
Rate for Payer: Aetna Commercial	$30.68
Rate for Payer: Aetna Medicare Advantage	$24.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.59
Rate for Payer: Cigna Commercial	$40.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.22
Rate for Payer: Oxford Commercial	$16.15
Rate for Payer: Qualcare PPO/HMO/WC	$12.11
Rate for Payer: UnitedHealthcare Commercial	$16.15
Rate for Payer: UnitedHealthcare Community & State	$1.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.14

PORT RENASYS SOFT STAND ALONE

Facility

$80.73

Hospital Charge Code	270650283
Hospital Revenue Code	272
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$12.11
Rate for Payer: Qualcare PPO/HMO/WC	$12.11

PORT SGL MRI 9.6FR 602680

Facility

$3,440.85

Hospital Charge Code	270611786
Hospital Revenue Code	278
Min. Negotiated Rate	$82.92
Max. Negotiated Rate	$1,720.42
Rate for Payer: Aetna Commercial	$1,307.52
Rate for Payer: Aetna Medicare Advantage	$1,032.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$877.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$877.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$688.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$877.42
Rate for Payer: Cigna Commercial	$1,720.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$832.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$756.99
Rate for Payer: Qualcare PPO/HMO/WC	$516.13
Rate for Payer: UnitedHealthcare Community & State	$82.92
Rate for Payer: Wellpoint Medicaid Managed Care	$91.18

PORT SGL MRI 9.6FR 602680

Facility

$3,440.85

Hospital Charge Code	270611786
Hospital Revenue Code	278
Min. Negotiated Rate	$516.13
Max. Negotiated Rate	$832.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$688.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$832.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$756.99
Rate for Payer: Qualcare PPO/HMO/WC	$516.13

PORT SINGLE PROFUSE CT 8F

Facility

$950.00

Service Code	HCPCS C1788
Hospital Charge Code	270690294
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$229.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$209.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.50

PORT SINGLE PROFUSE CT 8F

Facility

$950.00

Service Code	HCPCS C1788
Hospital Charge Code	270690294
Hospital Revenue Code	278
Min. Negotiated Rate	$22.89
Max. Negotiated Rate	$475.00
Rate for Payer: Aetna Commercial	$361.00
Rate for Payer: Aetna Medicare Advantage	$285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.25
Rate for Payer: Cigna Commercial	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$209.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.50
Rate for Payer: UnitedHealthcare Community & State	$22.89
Rate for Payer: Wellpoint Medicaid Managed Care	$25.18

PORT SINGLE SITE

Facility

$750.00

Hospital Charge Code	270677930
Hospital Revenue Code	272
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

PORT SINGLE SITE

Facility

$750.00

Hospital Charge Code	270677930
Hospital Revenue Code	272
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$150.00
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

PORT SINGLE SITE 8.5

Facility

$750.00

Hospital Charge Code	270664270
Hospital Revenue Code	272
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

Know your out-of-pocket cost for care.

All Charges