Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHEATH PINNACLE 11FR 10cm .035

Facility

$51.73

Service Code	HCPCS C1894
Hospital Charge Code	270627343
Hospital Revenue Code	278
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$12.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.38
Rate for Payer: Qualcare PPO/HMO/WC	$7.76

SHEATH PINNACLE 11FR 10cm .035

Facility

$51.73

Service Code	HCPCS C1894
Hospital Charge Code	270627343
Hospital Revenue Code	278
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$25.86
Rate for Payer: Aetna Commercial	$19.66
Rate for Payer: Aetna Medicare Advantage	$15.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.19
Rate for Payer: Cigna Commercial	$25.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$11.38
Rate for Payer: Qualcare PPO/HMO/WC	$7.76
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.37

SHEATH PINNACLE 4F 10cm 15-720

Facility

$88.15

Hospital Charge Code	270630132
Hospital Revenue Code	278
Min. Negotiated Rate	$13.22
Max. Negotiated Rate	$21.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.39
Rate for Payer: Qualcare PPO/HMO/WC	$13.22

SHEATH PINNACLE 4F 10cm 15-720

Facility

$88.15

Hospital Charge Code	270630132
Hospital Revenue Code	278
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$44.08
Rate for Payer: Aetna Commercial	$33.50
Rate for Payer: Aetna Medicare Advantage	$26.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.48
Rate for Payer: Cigna Commercial	$44.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.39
Rate for Payer: Qualcare PPO/HMO/WC	$13.22
Rate for Payer: UnitedHealthcare Community & State	$2.12
Rate for Payer: Wellpoint Medicaid Managed Care	$2.34

SHEATH PINNACLE 4FR 2.5cm

Facility

$700.00

Hospital Charge Code	270705455
Hospital Revenue Code	279
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$210.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Commercial	$140.00
Rate for Payer: UnitedHealthcare Community & State	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$18.55

SHEATH PINNACLE 4FR 2.5cm

Facility

$700.00

Hospital Charge Code	270705455
Hospital Revenue Code	279
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

SHEATH PINNACLE 5 FR

Facility

$522.50

Service Code	HCPCS C1894
Hospital Charge Code	270664722
Hospital Revenue Code	278
Min. Negotiated Rate	$12.59
Max. Negotiated Rate	$261.25
Rate for Payer: Aetna Commercial	$198.55
Rate for Payer: Aetna Medicare Advantage	$156.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.24
Rate for Payer: Cigna Commercial	$261.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$78.38
Rate for Payer: UnitedHealthcare Community & State	$12.59
Rate for Payer: Wellpoint Medicaid Managed Care	$13.85

SHEATH PINNACLE 5 FR

Facility

$522.50

Service Code	HCPCS C1894
Hospital Charge Code	270664722
Hospital Revenue Code	278
Min. Negotiated Rate	$78.38
Max. Negotiated Rate	$126.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$126.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$78.38

SHEATH PINNACLE 5FR 10CM .035

Facility

$700.00

Hospital Charge Code	270689904
Hospital Revenue Code	272
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$210.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Commercial	$140.00
Rate for Payer: UnitedHealthcare Community & State	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$18.55

SHEATH PINNACLE 5FR 10CM .035

Facility

$700.00

Hospital Charge Code	270689904
Hospital Revenue Code	272
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

SHEATH PINNACLE 5FR 25cm 15730

Facility

$164.35

Hospital Charge Code	270628362
Hospital Revenue Code	278
Min. Negotiated Rate	$24.65
Max. Negotiated Rate	$39.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$36.16
Rate for Payer: Qualcare PPO/HMO/WC	$24.65

SHEATH PINNACLE 5FR 25cm 15730

Facility

$164.35

Hospital Charge Code	270628362
Hospital Revenue Code	278
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$82.17
Rate for Payer: Aetna Commercial	$62.45
Rate for Payer: Aetna Medicare Advantage	$49.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.91
Rate for Payer: Cigna Commercial	$82.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$36.16
Rate for Payer: Qualcare PPO/HMO/WC	$24.65
Rate for Payer: UnitedHealthcare Community & State	$3.96
Rate for Payer: Wellpoint Medicaid Managed Care	$4.36

SHEATH PINNACLE 6FR 10CM .035

Facility

$700.00

Hospital Charge Code	270689905
Hospital Revenue Code	272
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

SHEATH PINNACLE 6FR 10CM .035

Facility

$700.00

Hospital Charge Code	270689905
Hospital Revenue Code	272
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$210.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Commercial	$140.00
Rate for Payer: UnitedHealthcare Community & State	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$18.55

SHEATH PINNACLE 6FR 10CM .038

Facility

$650.00

Service Code	HCPCS C1893
Hospital Charge Code	270642942
Hospital Revenue Code	278
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Community & State	$15.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.23

SHEATH PINNACLE 6FR 10CM .038

Facility

$650.00

Service Code	HCPCS C1893
Hospital Charge Code	270642942
Hospital Revenue Code	278
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

SHEATH PINNACLE 6FR 25CM

Facility

$1,525.00

Service Code	HCPCS C1894
Hospital Charge Code	270643051
Hospital Revenue Code	278
Min. Negotiated Rate	$228.75
Max. Negotiated Rate	$369.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$335.50
Rate for Payer: Qualcare PPO/HMO/WC	$228.75

SHEATH PINNACLE 6FR 25CM

Facility

$1,525.00

Service Code	HCPCS C1894
Hospital Charge Code	270643051
Hospital Revenue Code	278
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$762.50
Rate for Payer: Aetna Commercial	$579.50
Rate for Payer: Aetna Medicare Advantage	$457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$388.88
Rate for Payer: Cigna Commercial	$762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$335.50
Rate for Payer: Qualcare PPO/HMO/WC	$228.75
Rate for Payer: UnitedHealthcare Community & State	$36.75
Rate for Payer: Wellpoint Medicaid Managed Care	$40.41

SHEATH PINNACLE 6FR 45cm

Facility

$650.00

Hospital Charge Code	270642214
Hospital Revenue Code	279
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Commercial	$130.00
Rate for Payer: UnitedHealthcare Community & State	$15.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.23

SHEATH PINNACLE 6FR 45cm

Facility

$650.00

Hospital Charge Code	270642214
Hospital Revenue Code	279
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

SHEATH PINNACLE 6FR 45cm RSR01

Facility

$543.25

Hospital Charge Code	270672214C
Hospital Revenue Code	278
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$271.62
Rate for Payer: Aetna Commercial	$206.44
Rate for Payer: Aetna Medicare Advantage	$162.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.53
Rate for Payer: Cigna Commercial	$271.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$119.52
Rate for Payer: Qualcare PPO/HMO/WC	$81.49
Rate for Payer: UnitedHealthcare Community & State	$13.09
Rate for Payer: Wellpoint Medicaid Managed Care	$14.40

SHEATH PINNACLE 6FR 45cm RSR01

Facility

$543.25

Hospital Charge Code	270672214C
Hospital Revenue Code	278
Min. Negotiated Rate	$81.49
Max. Negotiated Rate	$131.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$119.52
Rate for Payer: Qualcare PPO/HMO/WC	$81.49

SHEATH PINNACLE 6FR 45cm RXR01

Facility

$155.00

Service Code	HCPCS C1887
Hospital Charge Code	270642214C
Hospital Revenue Code	278
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$77.50
Rate for Payer: Aetna Commercial	$58.90
Rate for Payer: Aetna Medicare Advantage	$46.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.52
Rate for Payer: Cigna Commercial	$77.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.25
Rate for Payer: UnitedHealthcare Community & State	$3.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.11

SHEATH PINNACLE 6FR 45cm RXR01

Facility

$155.00

Service Code	HCPCS C1887
Hospital Charge Code	270642214C
Hospital Revenue Code	278
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$37.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$34.10
Rate for Payer: Qualcare PPO/HMO/WC	$23.25

SHEATH PINNACLE 6FR 65CM RSP01

Facility

$580.00

Service Code	HCPCS C1887
Hospital Charge Code	270642215C
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$140.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.60
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

Know your out-of-pocket cost for care.

All Charges