Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

POWERPICK 45 DEG 6MM

Facility

$505.00

Service Code	HCPCS C1751
Hospital Charge Code	270681576
Hospital Revenue Code	278
Min. Negotiated Rate	$12.17
Max. Negotiated Rate	$252.50
Rate for Payer: Aetna Commercial	$191.90
Rate for Payer: Aetna Medicare Advantage	$151.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$101.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.78
Rate for Payer: Cigna Commercial	$252.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$111.10
Rate for Payer: Qualcare PPO/HMO/WC	$75.75
Rate for Payer: UnitedHealthcare Community & State	$12.17
Rate for Payer: Wellpoint Medicaid Managed Care	$13.38

POWERPICK 45 DEG SMALL HUB

Facility

$505.00

Hospital Charge Code	270691052
Hospital Revenue Code	272
Min. Negotiated Rate	$12.17
Max. Negotiated Rate	$252.50
Rate for Payer: Aetna Commercial	$191.90
Rate for Payer: Aetna Medicare Advantage	$151.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.78
Rate for Payer: Cigna Commercial	$252.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.50
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.75
Rate for Payer: UnitedHealthcare Commercial	$101.00
Rate for Payer: UnitedHealthcare Community & State	$12.17
Rate for Payer: Wellpoint Medicaid Managed Care	$13.38

POWERPICK 45 DEG SMALL HUB

Facility

$505.00

Hospital Charge Code	270691052
Hospital Revenue Code	272
Min. Negotiated Rate	$75.75
Max. Negotiated Rate	$75.75
Rate for Payer: Qualcare PPO/HMO/WC	$75.75

POWER PORT 6.6FR XCELRA

Facility

$1.25

Service Code	HCPCS C1788
Hospital Charge Code	270639788
Hospital Revenue Code	278
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.28
Rate for Payer: Qualcare PPO/HMO/WC	$0.19

POWER PORT 6.6FR XCELRA

Facility

$1.25

Service Code	HCPCS C1788
Hospital Charge Code	270639788
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.63
Rate for Payer: Aetna Commercial	$0.48
Rate for Payer: Aetna Medicare Advantage	$0.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.32
Rate for Payer: Cigna Commercial	$0.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.28
Rate for Payer: Qualcare PPO/HMO/WC	$0.19
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

POWER PORT 6FR 1706061

Facility

$2,375.00

Service Code	HCPCS C1887
Hospital Charge Code	270639787V
Hospital Revenue Code	278
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$902.50
Rate for Payer: Aetna Medicare Advantage	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.62
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$522.50
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Community & State	$57.24
Rate for Payer: Wellpoint Medicaid Managed Care	$62.94

POWER PORT 6FR 1706061

Facility

$2,375.00

Service Code	HCPCS C1887
Hospital Charge Code	270639787V
Hospital Revenue Code	278
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$574.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$522.50
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

POWER PORT 6FR 1706061

Facility

$2,375.00

Service Code	HCPCS C1887
Hospital Charge Code	270639787
Hospital Revenue Code	278
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$902.50
Rate for Payer: Aetna Medicare Advantage	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.62
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$522.50
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Community & State	$57.24
Rate for Payer: Wellpoint Medicaid Managed Care	$62.94

POWER PORT 6FR 1706061

Facility

$2,375.00

Service Code	HCPCS C1887
Hospital Charge Code	270639787
Hospital Revenue Code	278
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$574.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$522.50
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

POWER PORT 8 FR VUE

Facility

$1,750.00

Service Code	HCPCS C1788
Hospital Charge Code	270654845
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

POWER PORT 8 FR VUE

Facility

$1,895.50

Service Code	HCPCS C1788
Hospital Charge Code	270654845N
Hospital Revenue Code	278
Min. Negotiated Rate	$284.32
Max. Negotiated Rate	$458.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$379.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$458.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$417.01
Rate for Payer: Qualcare PPO/HMO/WC	$284.32

POWER PORT 8 FR VUE

Facility

$1,750.00

Service Code	HCPCS C1788
Hospital Charge Code	270654845S
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

POWER PORT 8 FR VUE

Facility

$1,750.00

Service Code	HCPCS C1788
Hospital Charge Code	270654845
Hospital Revenue Code	278
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

POWER PORT 8 FR VUE

Facility

$1,895.50

Service Code	HCPCS C1788
Hospital Charge Code	270654845N
Hospital Revenue Code	278
Min. Negotiated Rate	$45.68
Max. Negotiated Rate	$947.75
Rate for Payer: Aetna Commercial	$720.29
Rate for Payer: Aetna Medicare Advantage	$568.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$483.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$483.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$379.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$483.35
Rate for Payer: Cigna Commercial	$947.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$458.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$417.01
Rate for Payer: Qualcare PPO/HMO/WC	$284.32
Rate for Payer: UnitedHealthcare Community & State	$45.68
Rate for Payer: Wellpoint Medicaid Managed Care	$50.23

POWER PORT 8 FR VUE

Facility

$1,750.00

Service Code	HCPCS C1788
Hospital Charge Code	270654845S
Hospital Revenue Code	278
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

POWER PORT DUO IMPLANT (BARD

Facility

$3,980.00

Service Code	HCPCS C1788
Hospital Charge Code	270660216
Hospital Revenue Code	278
Min. Negotiated Rate	$597.00
Max. Negotiated Rate	$963.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$796.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$963.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$875.60
Rate for Payer: Qualcare PPO/HMO/WC	$597.00

POWER PORT DUO IMPLANT (BARD

Facility

$3,980.00

Service Code	HCPCS C1788
Hospital Charge Code	270660216
Hospital Revenue Code	278
Min. Negotiated Rate	$95.92
Max. Negotiated Rate	$1,990.00
Rate for Payer: Aetna Commercial	$1,512.40
Rate for Payer: Aetna Medicare Advantage	$1,194.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,014.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,014.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$796.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,014.90
Rate for Payer: Cigna Commercial	$1,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$963.16
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$875.60
Rate for Payer: Qualcare PPO/HMO/WC	$597.00
Rate for Payer: UnitedHealthcare Community & State	$95.92
Rate for Payer: Wellpoint Medicaid Managed Care	$105.47

POWER PORT VUE 6FR 61cm

Facility

$1,550.00

Service Code	HCPCS C1788
Hospital Charge Code	270648423
Hospital Revenue Code	278
Min. Negotiated Rate	$37.35
Max. Negotiated Rate	$775.00
Rate for Payer: Aetna Commercial	$589.00
Rate for Payer: Aetna Medicare Advantage	$465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$395.25
Rate for Payer: Cigna Commercial	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$341.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.50
Rate for Payer: UnitedHealthcare Community & State	$37.35
Rate for Payer: Wellpoint Medicaid Managed Care	$41.08

POWER PORT VUE 6FR 61cm

Facility

$1,550.00

Service Code	HCPCS C1788
Hospital Charge Code	270648423
Hospital Revenue Code	278
Min. Negotiated Rate	$232.50
Max. Negotiated Rate	$375.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$341.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.50

POWERPORT VUE IMPL MRI 8F

Facility

$15,653.00

Service Code	HCPCS C1788
Hospital Charge Code	270698817
Hospital Revenue Code	278
Min. Negotiated Rate	$377.24
Max. Negotiated Rate	$7,826.50
Rate for Payer: Aetna Commercial	$5,948.14
Rate for Payer: Aetna Medicare Advantage	$4,695.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,991.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,991.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,130.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,991.51
Rate for Payer: Cigna Commercial	$7,826.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,788.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,443.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,347.95
Rate for Payer: UnitedHealthcare Community & State	$377.24
Rate for Payer: Wellpoint Medicaid Managed Care	$414.80

POWERPORT VUE IMPL MRI 8F

Facility

$15,653.00

Service Code	HCPCS C1788
Hospital Charge Code	270698817
Hospital Revenue Code	278
Min. Negotiated Rate	$2,347.95
Max. Negotiated Rate	$3,788.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,130.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,788.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,443.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,347.95

POWER PORT VUE MRI 6FR

Facility

$0.01

Hospital Charge Code	270659532
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

POWER PORT VUE MRI 6FR

Facility

$0.01

Hospital Charge Code	270659532
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

POWER PULSE KIT (Y CONNECTOR)

Facility

$170.00

Hospital Charge Code	270645569C
Hospital Revenue Code	272
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$85.00
Rate for Payer: Aetna Commercial	$64.60
Rate for Payer: Aetna Medicare Advantage	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.35
Rate for Payer: Cigna Commercial	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.00
Rate for Payer: Oxford Commercial	$34.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.50
Rate for Payer: UnitedHealthcare Commercial	$34.00
Rate for Payer: UnitedHealthcare Community & State	$4.10
Rate for Payer: Wellpoint Medicaid Managed Care	$4.50

POWER PULSE KIT (Y CONNECTOR)

Facility

$170.00

Hospital Charge Code	270645569C
Hospital Revenue Code	272
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

Know your out-of-pocket cost for care.

All Charges