Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHEATH PINNACLE R/O II 6FRX10

Facility

$159.50

Hospital Charge Code	2709003947
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 6FRX10

Facility

$159.50

Hospital Charge Code	2709003947
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 6FRX25

Facility

$195.55

Hospital Charge Code	2709003952
Hospital Revenue Code	272
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$97.78
Rate for Payer: Aetna Commercial	$74.31
Rate for Payer: Aetna Medicare Advantage	$58.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.87
Rate for Payer: Cigna Commercial	$97.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.66
Rate for Payer: Oxford Commercial	$39.11
Rate for Payer: Qualcare PPO/HMO/WC	$29.33
Rate for Payer: UnitedHealthcare Commercial	$39.11
Rate for Payer: UnitedHealthcare Community & State	$4.71
Rate for Payer: Wellpoint Medicaid Managed Care	$5.18

SHEATH PINNACLE R/O II 6FRX25

Facility

$195.55

Hospital Charge Code	2709003952
Hospital Revenue Code	272
Min. Negotiated Rate	$29.33
Max. Negotiated Rate	$29.33
Rate for Payer: Qualcare PPO/HMO/WC	$29.33

SHEATH PINNACLE R/O II 6FRX6

Facility

$148.50

Hospital Charge Code	2709003941
Hospital Revenue Code	272
Min. Negotiated Rate	$22.27
Max. Negotiated Rate	$22.27
Rate for Payer: Qualcare PPO/HMO/WC	$22.27

SHEATH PINNACLE R/O II 6FRX6

Facility

$148.50

Hospital Charge Code	2709003941
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 7FRX6

Facility

$148.50

Hospital Charge Code	2709003942
Hospital Revenue Code	272
Min. Negotiated Rate	$22.27
Max. Negotiated Rate	$22.27
Rate for Payer: Qualcare PPO/HMO/WC	$22.27

SHEATH PINNACLE R/O II 7FRX6

Facility

$148.50

Hospital Charge Code	2709003942
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 8FRX10

Facility

$159.50

Hospital Charge Code	2709003948
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 8FRX10

Facility

$159.50

Hospital Charge Code	2709003948
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 8FRX6

Facility

$148.50

Hospital Charge Code	2709003943
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 8FRX6

Facility

$148.50

Hospital Charge Code	2709003943
Hospital Revenue Code	272
Min. Negotiated Rate	$22.27
Max. Negotiated Rate	$22.27
Rate for Payer: Qualcare PPO/HMO/WC	$22.27

SHEATH PINNACLE R/O II 9FRX10

Facility

$159.50

Hospital Charge Code	2709003949
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 9FRX10

Facility

$159.50

Hospital Charge Code	2709003949
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 9FRX6

Facility

$148.50

Hospital Charge Code	2709003944
Hospital Revenue Code	272
Min. Negotiated Rate	$22.27
Max. Negotiated Rate	$22.27
Rate for Payer: Qualcare PPO/HMO/WC	$22.27

SHEATH PINNACLE R/O II 9FRX6

Facility

$148.50

Hospital Charge Code	2709003944
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 INTRO

Facility

$121.50

Service Code	HCPCS C1894
Hospital Charge Code	270653781
Hospital Revenue Code	278
Min. Negotiated Rate	$18.23
Max. Negotiated Rate	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$26.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.23

SHEATH PINNACLE R/O II INTRO

Facility

$121.50

Service Code	HCPCS C1894
Hospital Charge Code	270653781
Hospital Revenue Code	278
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$60.75
Rate for Payer: Aetna Commercial	$46.17
Rate for Payer: Aetna Medicare Advantage	$36.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.98
Rate for Payer: Cigna Commercial	$60.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$26.73
Rate for Payer: Qualcare PPO/HMO/WC	$18.23
Rate for Payer: UnitedHealthcare Community & State	$2.93
Rate for Payer: Wellpoint Medicaid Managed Care	$3.22

SHEATH PINNACLE R/O II INTRO 5

Facility

$86.55

Hospital Charge Code	270666811
Hospital Revenue Code	270
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$43.27
Rate for Payer: Aetna Commercial	$32.89
Rate for Payer: Aetna Medicare Advantage	$25.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.07
Rate for Payer: Cigna Commercial	$43.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.96
Rate for Payer: Oxford Commercial	$17.31
Rate for Payer: Qualcare PPO/HMO/WC	$12.98
Rate for Payer: UnitedHealthcare Commercial	$17.31
Rate for Payer: UnitedHealthcare Community & State	$2.09
Rate for Payer: Wellpoint Medicaid Managed Care	$2.29

SHEATH PINNACLE R/O II INTRO 5

Facility

$86.55

Hospital Charge Code	270666811
Hospital Revenue Code	270
Min. Negotiated Rate	$12.98
Max. Negotiated Rate	$12.98
Rate for Payer: Qualcare PPO/HMO/WC	$12.98

SHEATH PINNACLE R/O II INTROD

Facility

$166.00

Hospital Charge Code	270653921S
Hospital Revenue Code	271
Min. Negotiated Rate	$24.90
Max. Negotiated Rate	$24.90
Rate for Payer: Qualcare PPO/HMO/WC	$24.90

SHEATH PINNACLE R/O II INTROD

Facility

$1,150.00

Hospital Charge Code	270653921N
Hospital Revenue Code	271
Min. Negotiated Rate	$27.71
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$437.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$345.00
Rate for Payer: Oxford Commercial	$230.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Commercial	$230.00
Rate for Payer: UnitedHealthcare Community & State	$27.71
Rate for Payer: Wellpoint Medicaid Managed Care	$30.48

SHEATH PINNACLE R/O II INTROD

Facility

$166.00

Hospital Charge Code	270653921S
Hospital Revenue Code	271
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$83.00
Rate for Payer: Aetna Commercial	$63.08
Rate for Payer: Aetna Medicare Advantage	$49.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.33
Rate for Payer: Cigna Commercial	$83.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.80
Rate for Payer: Oxford Commercial	$33.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.90
Rate for Payer: UnitedHealthcare Commercial	$33.20
Rate for Payer: UnitedHealthcare Community & State	$4.00
Rate for Payer: Wellpoint Medicaid Managed Care	$4.40

SHEATH PINNACLE R/O II INTROD

Facility

$1,150.00

Hospital Charge Code	270653921N
Hospital Revenue Code	271
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

SHEATH PINNACLE R/O II INTROD

Facility

$166.00

Hospital Charge Code	270653921
Hospital Revenue Code	271
Min. Negotiated Rate	$24.90
Max. Negotiated Rate	$24.90
Rate for Payer: Qualcare PPO/HMO/WC	$24.90

Know your out-of-pocket cost for care.

All Charges