Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHEATH FLEXOR ANSEL GUIDING

Facility

$375.00

Hospital Charge Code	270660259
Hospital Revenue Code	272
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

SHEATH FLEXOR HIGH-FLEX ANSEL

Facility

$450.00

Hospital Charge Code	270662215N
Hospital Revenue Code	272
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.00
Rate for Payer: Oxford Commercial	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$90.00
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

SHEATH FLEXOR HIGH-FLEX ANSEL

Facility

$370.00

Service Code	HCPCS C1894
Hospital Charge Code	270662215
Hospital Revenue Code	272
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$55.50
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

SHEATH FLEXOR HIGH-FLEX ANSEL

Facility

$370.00

Service Code	HCPCS C1894
Hospital Charge Code	270662215
Hospital Revenue Code	272
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$185.00
Rate for Payer: Aetna Commercial	$140.60
Rate for Payer: Aetna Medicare Advantage	$111.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.35
Rate for Payer: Cigna Commercial	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.00
Rate for Payer: Oxford Commercial	$74.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.50
Rate for Payer: UnitedHealthcare Commercial	$74.00
Rate for Payer: UnitedHealthcare Community & State	$8.92
Rate for Payer: Wellpoint Medicaid Managed Care	$9.80

SHEATH FLEXOR HIGH-FLEX ANSEL

Facility

$450.00

Hospital Charge Code	270662215N
Hospital Revenue Code	272
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

SHEATH FLEXOR HIGH-FLEX ANSEL

Facility

$370.00

Hospital Charge Code	270662215S
Hospital Revenue Code	272
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$55.50
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

SHEATH FLEXOR HIGH-FLEX ANSEL

Facility

$370.00

Hospital Charge Code	270662215S
Hospital Revenue Code	272
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$185.00
Rate for Payer: Aetna Commercial	$140.60
Rate for Payer: Aetna Medicare Advantage	$111.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.35
Rate for Payer: Cigna Commercial	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$111.00
Rate for Payer: Oxford Commercial	$74.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.50
Rate for Payer: UnitedHealthcare Commercial	$74.00
Rate for Payer: UnitedHealthcare Community & State	$8.92
Rate for Payer: Wellpoint Medicaid Managed Care	$9.80

SHEATH FOR HDR 3.5x20cm 30-00

Facility

$1.35

Hospital Charge Code	270636674
Hospital Revenue Code	272
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.20

SHEATH FOR HDR 3.5x20cm 30-00

Facility

$1.35

Hospital Charge Code	270636674
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.68
Rate for Payer: Aetna Commercial	$0.51
Rate for Payer: Aetna Medicare Advantage	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.34
Rate for Payer: Cigna Commercial	$0.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.41
Rate for Payer: Oxford Commercial	$0.27
Rate for Payer: Qualcare PPO/HMO/WC	$0.20
Rate for Payer: UnitedHealthcare Commercial	$0.27
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.04

SHEATH FOR H.D.R. 610-010

Facility

$5.00

Hospital Charge Code	270600832
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

SHEATH FOR H.D.R. 610-010

Facility

$5.00

Hospital Charge Code	270600832
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

SHEATH F/VAG SPECULUM ILLUMUN

Facility

$434.05

Hospital Charge Code	270666604
Hospital Revenue Code	270
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$217.03
Rate for Payer: Aetna Commercial	$164.94
Rate for Payer: Aetna Medicare Advantage	$130.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.68
Rate for Payer: Cigna Commercial	$217.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.22
Rate for Payer: Oxford Commercial	$86.81
Rate for Payer: Qualcare PPO/HMO/WC	$65.11
Rate for Payer: UnitedHealthcare Commercial	$86.81
Rate for Payer: UnitedHealthcare Community & State	$10.46
Rate for Payer: Wellpoint Medicaid Managed Care	$11.50

SHEATH F/VAG SPECULUM ILLUMUN

Facility

$434.05

Hospital Charge Code	270666604
Hospital Revenue Code	270
Min. Negotiated Rate	$65.11
Max. Negotiated Rate	$65.11
Rate for Payer: Qualcare PPO/HMO/WC	$65.11

SHEATH GUIDING 7FR 9CM STR.

Facility

$825.00

Hospital Charge Code	270673363
Hospital Revenue Code	272
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$412.50
Rate for Payer: Aetna Commercial	$313.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.50
Rate for Payer: Oxford Commercial	$165.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Commercial	$165.00
Rate for Payer: UnitedHealthcare Community & State	$19.88
Rate for Payer: Wellpoint Medicaid Managed Care	$21.86

SHEATH GUIDING 7FR 9CM STR.

Facility

$825.00

Hospital Charge Code	270673363
Hospital Revenue Code	272
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$123.75
Rate for Payer: Qualcare PPO/HMO/WC	$123.75

SHEATH GUIDING CHARIOT 6F 45CM

Facility

$425.00

Hospital Charge Code	270675696
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

SHEATH GUIDING CHARIOT 6F 45CM

Facility

$425.00

Hospital Charge Code	270675696
Hospital Revenue Code	278
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

SHEATH GUIDING CHARIOT 7F 45CM

Facility

$425.00

Hospital Charge Code	270675428
Hospital Revenue Code	278
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$10.24
Rate for Payer: Wellpoint Medicaid Managed Care	$11.26

SHEATH GUIDING CHARIOT 7F 45CM

Facility

$425.00

Hospital Charge Code	270675428
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$93.50
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

SHEATH GUIDING CHARIOT 7F 65CM

Facility

$450.00

Hospital Charge Code	270675429
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

SHEATH GUIDING CHARIOT 7F 65CM

Facility

$450.00

Hospital Charge Code	270675429
Hospital Revenue Code	278
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$10.85
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

SHEATH GUIDING CHARIOT 7F 90CM

Facility

$475.00

Hospital Charge Code	270675430
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

SHEATH GUIDING CHARIOT 7F 90CM

Facility

$475.00

Hospital Charge Code	270675430
Hospital Revenue Code	278
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

SHEATH GUIDING PINNACLE 7FR

Facility

$550.00

Service Code	HCPCS C1894
Hospital Charge Code	270676233N
Hospital Revenue Code	278
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$13.26
Rate for Payer: Wellpoint Medicaid Managed Care	$14.57

SHEATH GUIDING PINNACLE 7FR

Facility

$637.50

Service Code	HCPCS C1894
Hospital Charge Code	270676233
Hospital Revenue Code	278
Min. Negotiated Rate	$95.62
Max. Negotiated Rate	$154.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$140.25
Rate for Payer: Qualcare PPO/HMO/WC	$95.62

Know your out-of-pocket cost for care.

All Charges