Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHEATH CARD INTRODC 8F 501-598

Facility

$136.85

Service Code	HCPCS C2629
Hospital Charge Code	270606061
Hospital Revenue Code	272
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$68.42
Rate for Payer: Aetna Commercial	$52.00
Rate for Payer: Aetna Medicare Advantage	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.90
Rate for Payer: Cigna Commercial	$68.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.05
Rate for Payer: Oxford Commercial	$27.37
Rate for Payer: Qualcare PPO/HMO/WC	$20.53
Rate for Payer: UnitedHealthcare Commercial	$27.37
Rate for Payer: UnitedHealthcare Community & State	$3.30
Rate for Payer: Wellpoint Medicaid Managed Care	$3.63

SHEATH CARD INTRODC 8F 501-598

Facility

$136.85

Service Code	HCPCS C2629
Hospital Charge Code	270606061
Hospital Revenue Code	272
Min. Negotiated Rate	$20.53
Max. Negotiated Rate	$20.53
Rate for Payer: Qualcare PPO/HMO/WC	$20.53

SHEATH CATH 16F DRYSEAL FLEX

Facility

$3,020.00

Service Code	HCPCS C1894
Hospital Charge Code	270698776S
Hospital Revenue Code	278
Min. Negotiated Rate	$453.00
Max. Negotiated Rate	$730.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$604.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$730.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$664.40
Rate for Payer: Qualcare PPO/HMO/WC	$453.00

SHEATH CATH 16F DRYSEAL FLEX

Facility

$3,020.00

Service Code	HCPCS C1894
Hospital Charge Code	270698776S
Hospital Revenue Code	278
Min. Negotiated Rate	$72.78
Max. Negotiated Rate	$1,510.00
Rate for Payer: Aetna Commercial	$1,147.60
Rate for Payer: Aetna Medicare Advantage	$906.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$770.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$770.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$604.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$770.10
Rate for Payer: Cigna Commercial	$1,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$730.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$664.40
Rate for Payer: Qualcare PPO/HMO/WC	$453.00
Rate for Payer: UnitedHealthcare Community & State	$72.78
Rate for Payer: Wellpoint Medicaid Managed Care	$80.03

SHEATH CLEAR RENAL

Facility

$180.00

Hospital Charge Code	270650905
Hospital Revenue Code	272
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

SHEATH CLEAR RENAL

Facility

$180.00

Hospital Charge Code	270650905
Hospital Revenue Code	272
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: Aetna Medicare Advantage	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.90
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.00
Rate for Payer: Oxford Commercial	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$36.00
Rate for Payer: UnitedHealthcare Community & State	$4.34
Rate for Payer: Wellpoint Medicaid Managed Care	$4.77

SHEATH CRD BRIT TIP 7F 401790M

Facility

$322.45

Hospital Charge Code	270624400
Hospital Revenue Code	272
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$161.22
Rate for Payer: Aetna Commercial	$122.53
Rate for Payer: Aetna Medicare Advantage	$96.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.22
Rate for Payer: Cigna Commercial	$161.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.73
Rate for Payer: Oxford Commercial	$64.49
Rate for Payer: Qualcare PPO/HMO/WC	$48.37
Rate for Payer: UnitedHealthcare Commercial	$64.49
Rate for Payer: UnitedHealthcare Community & State	$7.77
Rate for Payer: Wellpoint Medicaid Managed Care	$8.54

SHEATH CRD BRIT TIP 7F 401790M

Facility

$322.45

Hospital Charge Code	270624400
Hospital Revenue Code	272
Min. Negotiated Rate	$48.37
Max. Negotiated Rate	$48.37
Rate for Payer: Qualcare PPO/HMO/WC	$48.37

SHEATH CRD BRIT TIP 8F 401823M

Facility

$206.45

Hospital Charge Code	270623511
Hospital Revenue Code	272
Min. Negotiated Rate	$4.98
Max. Negotiated Rate	$103.22
Rate for Payer: Aetna Commercial	$78.45
Rate for Payer: Aetna Medicare Advantage	$61.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.64
Rate for Payer: Cigna Commercial	$103.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.94
Rate for Payer: Oxford Commercial	$41.29
Rate for Payer: Qualcare PPO/HMO/WC	$30.97
Rate for Payer: UnitedHealthcare Commercial	$41.29
Rate for Payer: UnitedHealthcare Community & State	$4.98
Rate for Payer: Wellpoint Medicaid Managed Care	$5.47

SHEATH CRD BRIT TIP 8F 401823M

Facility

$206.45

Hospital Charge Code	270623511
Hospital Revenue Code	272
Min. Negotiated Rate	$30.97
Max. Negotiated Rate	$30.97
Rate for Payer: Qualcare PPO/HMO/WC	$30.97

SHEATH CRD BRIT TIP 8F 401890M

Facility

$323.25

Hospital Charge Code	270624311
Hospital Revenue Code	272
Min. Negotiated Rate	$48.49
Max. Negotiated Rate	$48.49
Rate for Payer: Qualcare PPO/HMO/WC	$48.49

SHEATH CRD BRIT TIP 8F 401890M

Facility

$323.25

Hospital Charge Code	270624311
Hospital Revenue Code	272
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$161.62
Rate for Payer: Aetna Commercial	$122.83
Rate for Payer: Aetna Medicare Advantage	$96.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.43
Rate for Payer: Cigna Commercial	$161.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.97
Rate for Payer: Oxford Commercial	$64.65
Rate for Payer: Qualcare PPO/HMO/WC	$48.49
Rate for Payer: UnitedHealthcare Commercial	$64.65
Rate for Payer: UnitedHealthcare Community & State	$7.79
Rate for Payer: Wellpoint Medicaid Managed Care	$8.57

SHEATH DESILETS-HOFFMAN SET

Facility

$324.45

Service Code	HCPCS C1894
Hospital Charge Code	270659157
Hospital Revenue Code	272
Min. Negotiated Rate	$7.82
Max. Negotiated Rate	$162.22
Rate for Payer: Aetna Commercial	$123.29
Rate for Payer: Aetna Medicare Advantage	$97.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.73
Rate for Payer: Cigna Commercial	$162.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.33
Rate for Payer: Oxford Commercial	$64.89
Rate for Payer: Qualcare PPO/HMO/WC	$48.67
Rate for Payer: UnitedHealthcare Commercial	$64.89
Rate for Payer: UnitedHealthcare Community & State	$7.82
Rate for Payer: Wellpoint Medicaid Managed Care	$8.60

SHEATH DESILETS-HOFFMAN SET

Facility

$324.45

Service Code	HCPCS C1894
Hospital Charge Code	270659157
Hospital Revenue Code	272
Min. Negotiated Rate	$48.67
Max. Negotiated Rate	$48.67
Rate for Payer: Qualcare PPO/HMO/WC	$48.67

SHEATH DRYSEAL 12FR

Facility

$1,250.00

Hospital Charge Code	207645161
Hospital Revenue Code	271
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$250.00
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

SHEATH DRYSEAL 12FR

Facility

$1,250.00

Hospital Charge Code	207645161
Hospital Revenue Code	271
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

SHEATH EDS BIP 4.6 EC714501

Facility

$1,312.85

Hospital Charge Code	270628753
Hospital Revenue Code	272
Min. Negotiated Rate	$31.64
Max. Negotiated Rate	$656.42
Rate for Payer: Aetna Commercial	$498.88
Rate for Payer: Aetna Medicare Advantage	$393.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$334.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$334.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$334.78
Rate for Payer: Cigna Commercial	$656.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.86
Rate for Payer: Oxford Commercial	$262.57
Rate for Payer: Qualcare PPO/HMO/WC	$196.93
Rate for Payer: UnitedHealthcare Commercial	$262.57
Rate for Payer: UnitedHealthcare Community & State	$31.64
Rate for Payer: Wellpoint Medicaid Managed Care	$34.79

SHEATH EDS BIP 4.6 EC714501

Facility

$1,312.85

Hospital Charge Code	270628753
Hospital Revenue Code	272
Min. Negotiated Rate	$196.93
Max. Negotiated Rate	$196.93
Rate for Payer: Qualcare PPO/HMO/WC	$196.93

SHEATH FLEX DRYSEAL 12X4 GORE

Facility

$3,450.00

Service Code	HCPCS C1894
Hospital Charge Code	270687577
Hospital Revenue Code	272
Min. Negotiated Rate	$83.14
Max. Negotiated Rate	$1,725.00
Rate for Payer: Aetna Commercial	$1,311.00
Rate for Payer: Aetna Medicare Advantage	$1,035.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.75
Rate for Payer: Cigna Commercial	$1,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,035.00
Rate for Payer: Oxford Commercial	$690.00
Rate for Payer: Qualcare PPO/HMO/WC	$517.50
Rate for Payer: UnitedHealthcare Commercial	$690.00
Rate for Payer: UnitedHealthcare Community & State	$83.14
Rate for Payer: Wellpoint Medicaid Managed Care	$91.42

SHEATH FLEX DRYSEAL 12X4 GORE

Facility

$3,450.00

Service Code	HCPCS C1894
Hospital Charge Code	270687577
Hospital Revenue Code	272
Min. Negotiated Rate	$517.50
Max. Negotiated Rate	$517.50
Rate for Payer: Qualcare PPO/HMO/WC	$517.50

SHEATH FLEXOR ACCESS 12FR 35cm

Facility

$589.20

Hospital Charge Code	270478885
Hospital Revenue Code	271
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$294.60
Rate for Payer: Aetna Commercial	$223.90
Rate for Payer: Aetna Medicare Advantage	$176.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.25
Rate for Payer: Cigna Commercial	$294.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.76
Rate for Payer: Oxford Commercial	$117.84
Rate for Payer: Qualcare PPO/HMO/WC	$88.38
Rate for Payer: UnitedHealthcare Commercial	$117.84
Rate for Payer: UnitedHealthcare Community & State	$14.20
Rate for Payer: Wellpoint Medicaid Managed Care	$15.61

SHEATH FLEXOR ACCESS 12FR 35cm

Facility

$649.00

Hospital Charge Code	270647885
Hospital Revenue Code	272
Min. Negotiated Rate	$97.35
Max. Negotiated Rate	$97.35
Rate for Payer: Qualcare PPO/HMO/WC	$97.35

SHEATH FLEXOR ACCESS 12FR 35cm

Facility

$649.00

Hospital Charge Code	270647885
Hospital Revenue Code	272
Min. Negotiated Rate	$15.64
Max. Negotiated Rate	$324.50
Rate for Payer: Aetna Commercial	$246.62
Rate for Payer: Aetna Medicare Advantage	$194.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.50
Rate for Payer: Cigna Commercial	$324.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.70
Rate for Payer: Oxford Commercial	$129.80
Rate for Payer: Qualcare PPO/HMO/WC	$97.35
Rate for Payer: UnitedHealthcare Commercial	$129.80
Rate for Payer: UnitedHealthcare Community & State	$15.64
Rate for Payer: Wellpoint Medicaid Managed Care	$17.20

SHEATH FLEXOR ACCESS 12FR 35cm

Facility

$589.20

Hospital Charge Code	270478885
Hospital Revenue Code	271
Min. Negotiated Rate	$88.38
Max. Negotiated Rate	$88.38
Rate for Payer: Qualcare PPO/HMO/WC	$88.38

SHEATH FLEXOR ANSEL GUIDING

Facility

$375.00

Hospital Charge Code	270660259
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

Know your out-of-pocket cost for care.

All Charges