Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHEATH PINNACLE 6FR 65CM RSP01

Facility

$580.00

Service Code	HCPCS C1887
Hospital Charge Code	270642215C
Hospital Revenue Code	278
Min. Negotiated Rate	$13.98
Max. Negotiated Rate	$290.00
Rate for Payer: Aetna Commercial	$220.40
Rate for Payer: Aetna Medicare Advantage	$174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.90
Rate for Payer: Cigna Commercial	$290.00
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
Rate for Payer: UnitedHealthcare Community & State	$13.98
Rate for Payer: Wellpoint Medicaid Managed Care	$15.37

SHEATH PINNACLE 6FR 65CM RSP01

Facility

$585.65

Service Code	HCPCS C1887
Hospital Charge Code	270642215N
Hospital Revenue Code	278
Min. Negotiated Rate	$87.85
Max. Negotiated Rate	$141.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$128.84
Rate for Payer: Qualcare PPO/HMO/WC	$87.85

SHEATH PINNACLE 6FR 65CM RSP01

Facility

$585.65

Service Code	HCPCS C1887
Hospital Charge Code	270642215N
Hospital Revenue Code	278
Min. Negotiated Rate	$14.11
Max. Negotiated Rate	$292.82
Rate for Payer: Aetna Commercial	$222.55
Rate for Payer: Aetna Medicare Advantage	$175.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.34
Rate for Payer: Cigna Commercial	$292.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$128.84
Rate for Payer: Qualcare PPO/HMO/WC	$87.85
Rate for Payer: UnitedHealthcare Community & State	$14.11
Rate for Payer: Wellpoint Medicaid Managed Care	$15.52

SHEATH PINNACLE 7FR

Facility

$48.76

Service Code	HCPCS C1894
Hospital Charge Code	270653587
Hospital Revenue Code	278
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$24.38
Rate for Payer: Aetna Commercial	$18.53
Rate for Payer: Aetna Medicare Advantage	$14.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.43
Rate for Payer: Cigna Commercial	$24.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10.73
Rate for Payer: Qualcare PPO/HMO/WC	$7.31
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.29

SHEATH PINNACLE 7FR

Facility

$48.76

Service Code	HCPCS C1894
Hospital Charge Code	270653587
Hospital Revenue Code	278
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$11.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10.73
Rate for Payer: Qualcare PPO/HMO/WC	$7.31

SHEATH PINNACLE 7FR 45CM

Facility

$427.50

Service Code	HCPCS C1894
Hospital Charge Code	270652537
Hospital Revenue Code	278
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$213.75
Rate for Payer: Aetna Commercial	$162.45
Rate for Payer: Aetna Medicare Advantage	$128.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.01
Rate for Payer: Cigna Commercial	$213.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$94.05
Rate for Payer: Qualcare PPO/HMO/WC	$64.12
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: Wellpoint Medicaid Managed Care	$11.33

SHEATH PINNACLE 7FR 45CM

Facility

$427.50

Service Code	HCPCS C1894
Hospital Charge Code	270652537
Hospital Revenue Code	278
Min. Negotiated Rate	$64.12
Max. Negotiated Rate	$103.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$94.05
Rate for Payer: Qualcare PPO/HMO/WC	$64.12

SHEATH PINNACLE 8FR 10CM .035

Facility

$700.00

Hospital Charge Code	270705456
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 8FR 10CM .035

Facility

$700.00

Hospital Charge Code	270705456
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 9x10x035 15715

Facility

$927.60

Hospital Charge Code	270625050
Hospital Revenue Code	278
Min. Negotiated Rate	$139.14
Max. Negotiated Rate	$224.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$139.14

SHEATH PINNACLE 9x10x035 15715

Facility

$927.60

Hospital Charge Code	270625050
Hospital Revenue Code	278
Min. Negotiated Rate	$22.36
Max. Negotiated Rate	$463.80
Rate for Payer: Aetna Commercial	$352.49
Rate for Payer: Aetna Medicare Advantage	$278.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$236.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$236.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$236.54
Rate for Payer: Cigna Commercial	$463.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$204.07
Rate for Payer: Qualcare PPO/HMO/WC	$139.14
Rate for Payer: UnitedHealthcare Community & State	$22.36
Rate for Payer: Wellpoint Medicaid Managed Care	$24.58

SHEATH PINNACLE II INTROD 8FX6

Facility

$29.70

Hospital Charge Code	270658246
Hospital Revenue Code	278
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$7.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$4.46

SHEATH PINNACLE II INTROD 8FX6

Facility

$29.70

Hospital Charge Code	270658246
Hospital Revenue Code	278
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$14.85
Rate for Payer: Aetna Commercial	$11.29
Rate for Payer: Aetna Medicare Advantage	$8.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.57
Rate for Payer: Cigna Commercial	$14.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$6.53
Rate for Payer: Qualcare PPO/HMO/WC	$4.46
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

SHEATH PINNACLE INTRODUCER R/O

Facility

$172.68

Hospital Charge Code	270655407
Hospital Revenue Code	270
Min. Negotiated Rate	$25.90
Max. Negotiated Rate	$25.90
Rate for Payer: Qualcare PPO/HMO/WC	$25.90

SHEATH PINNACLE INTRODUCER R/O

Facility

$172.68

Hospital Charge Code	270655407
Hospital Revenue Code	270
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$86.34
Rate for Payer: Aetna Commercial	$65.62
Rate for Payer: Aetna Medicare Advantage	$51.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.03
Rate for Payer: Cigna Commercial	$86.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.80
Rate for Payer: Oxford Commercial	$34.54
Rate for Payer: Qualcare PPO/HMO/WC	$25.90
Rate for Payer: UnitedHealthcare Commercial	$34.54
Rate for Payer: UnitedHealthcare Community & State	$4.16
Rate for Payer: Wellpoint Medicaid Managed Care	$4.58

SHEATH PINNACLE R/O 5FR X 6

Facility

$170.00

Hospital Charge Code	270666809
Hospital Revenue Code	270
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

SHEATH PINNACLE R/O 5FR X 6

Facility

$170.00

Hospital Charge Code	270666809
Hospital Revenue Code	270
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

SHEATH PINNACLE R/O HI/FLO

Facility

$173.25

Hospital Charge Code	270670033
Hospital Revenue Code	278
Min. Negotiated Rate	$25.99
Max. Negotiated Rate	$41.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.12
Rate for Payer: Qualcare PPO/HMO/WC	$25.99

SHEATH PINNACLE R/O HI/FLO

Facility

$173.25

Hospital Charge Code	270670033
Hospital Revenue Code	278
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$86.62
Rate for Payer: Aetna Commercial	$65.83
Rate for Payer: Aetna Medicare Advantage	$51.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.18
Rate for Payer: Cigna Commercial	$86.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.93
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.12
Rate for Payer: Qualcare PPO/HMO/WC	$25.99
Rate for Payer: UnitedHealthcare Community & State	$4.18
Rate for Payer: Wellpoint Medicaid Managed Care	$4.59

SHEATH PINNACLE R/O II 5FR X10

Facility

$150.00

Hospital Charge Code	270666810
Hospital Revenue Code	270
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

SHEATH PINNACLE R/O II 5FR X10

Facility

$150.00

Hospital Charge Code	270666810
Hospital Revenue Code	270
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$3.62
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

SHEATH PINNACLE R/O II 5FRX10

Facility

$159.50

Hospital Charge Code	2709003946
Hospital Revenue Code	272
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$79.75
Rate for Payer: Aetna Commercial	$60.61
Rate for Payer: Aetna Medicare Advantage	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.67
Rate for Payer: Cigna Commercial	$79.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.85
Rate for Payer: Oxford Commercial	$31.90
Rate for Payer: Qualcare PPO/HMO/WC	$23.93
Rate for Payer: UnitedHealthcare Commercial	$31.90
Rate for Payer: UnitedHealthcare Community & State	$3.84
Rate for Payer: Wellpoint Medicaid Managed Care	$4.23

SHEATH PINNACLE R/O II 5FRX10

Facility

$159.50

Hospital Charge Code	2709003946
Hospital Revenue Code	272
Min. Negotiated Rate	$23.93
Max. Negotiated Rate	$23.93
Rate for Payer: Qualcare PPO/HMO/WC	$23.93

SHEATH PINNACLE R/O II 5FRX6

Facility

$148.50

Hospital Charge Code	2709003939
Hospital Revenue Code	272
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$74.25
Rate for Payer: Aetna Commercial	$56.43
Rate for Payer: Aetna Medicare Advantage	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.87
Rate for Payer: Cigna Commercial	$74.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.55
Rate for Payer: Oxford Commercial	$29.70
Rate for Payer: Qualcare PPO/HMO/WC	$22.27
Rate for Payer: UnitedHealthcare Commercial	$29.70
Rate for Payer: UnitedHealthcare Community & State	$3.58
Rate for Payer: Wellpoint Medicaid Managed Care	$3.94

SHEATH PINNACLE R/O II 5FRX6

Facility

$148.50

Hospital Charge Code	2709003939
Hospital Revenue Code	272
Min. Negotiated Rate	$22.27
Max. Negotiated Rate	$22.27
Rate for Payer: Qualcare PPO/HMO/WC	$22.27

Know your out-of-pocket cost for care.

All Charges