Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHEATH RAIN RADIAL 6FR

Facility

$1,600.00

Hospital Charge Code	270699122
Hospital Revenue Code	279
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$240.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.00

SHEATH RIST RADIAL 079 95CM

Facility

$6,500.00

Service Code	HCPCS C1894
Hospital Charge Code	270696066S
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

SHEATH RIST RADIAL 079 95CM

Facility

$6,500.00

Service Code	HCPCS C1894
Hospital Charge Code	270696066S
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

SHEATH SAFE 11FR 13CM

Facility

$250.00

Hospital Charge Code	270677290
Hospital Revenue Code	272
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.00
Rate for Payer: Oxford Commercial	$50.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$50.00
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

SHEATH SAFE 11FR 13CM

Facility

$250.00

Hospital Charge Code	270677290
Hospital Revenue Code	272
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

SHEATH SET URETERAL ACCESS NAV

Facility

$876.39

Service Code	HCPCS C1884
Hospital Charge Code	270684749
Hospital Revenue Code	278
Min. Negotiated Rate	$21.12
Max. Negotiated Rate	$438.19
Rate for Payer: Aetna Commercial	$333.03
Rate for Payer: Aetna Medicare Advantage	$262.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.48
Rate for Payer: Cigna Commercial	$438.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$192.81
Rate for Payer: Qualcare PPO/HMO/WC	$131.46
Rate for Payer: UnitedHealthcare Community & State	$21.12
Rate for Payer: Wellpoint Medicaid Managed Care	$23.22

SHEATH SET URETERAL ACCESS NAV

Facility

$876.39

Service Code	HCPCS C1884
Hospital Charge Code	270684749
Hospital Revenue Code	278
Min. Negotiated Rate	$131.46
Max. Negotiated Rate	$212.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.09
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$192.81
Rate for Payer: Qualcare PPO/HMO/WC	$131.46

SHEATHS INTRODUCER 6FR

Facility

$51.73

Service Code	HCPCS C1894
Hospital Charge Code	270660565
Hospital Revenue Code	272
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) PPO	$13.19
Rate for Payer: Cigna Commercial	$25.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.52
Rate for Payer: Oxford Commercial	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.76
Rate for Payer: UnitedHealthcare Commercial	$10.35
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.37

SHEATHS INTRODUCER 6FR

Facility

$51.73

Service Code	HCPCS C1894
Hospital Charge Code	270660565
Hospital Revenue Code	272
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$7.76
Rate for Payer: Qualcare PPO/HMO/WC	$7.76

SHEATH SLENDER 6FR W 21G NEEDL

Facility

$240.00

Service Code	HCPCS C1894
Hospital Charge Code	270675360N
Hospital Revenue Code	278
Min. Negotiated Rate	$5.78
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Community & State	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

SHEATH SLENDER 6FR W 21G NEEDL

Facility

$240.00

Service Code	HCPCS C1894
Hospital Charge Code	270675360N
Hospital Revenue Code	278
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$58.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

SHEATH SLENDER 6FR W 21G NEEDL

Facility

$302.50

Service Code	HCPCS C1894
Hospital Charge Code	270675360
Hospital Revenue Code	278
Min. Negotiated Rate	$45.38
Max. Negotiated Rate	$73.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$45.38

SHEATH SLENDER 6FR W 21G NEEDL

Facility

$302.50

Service Code	HCPCS C1894
Hospital Charge Code	270675360
Hospital Revenue Code	278
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$151.25
Rate for Payer: Aetna Commercial	$114.95
Rate for Payer: Aetna Medicare Advantage	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.14
Rate for Payer: Cigna Commercial	$151.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$66.55
Rate for Payer: Qualcare PPO/HMO/WC	$45.38
Rate for Payer: UnitedHealthcare Community & State	$7.29
Rate for Payer: Wellpoint Medicaid Managed Care	$8.02

SHEATH STABILIZATION DEVICE

Facility

$1,895.00

Hospital Charge Code	2709003701
Hospital Revenue Code	272
Min. Negotiated Rate	$45.67
Max. Negotiated Rate	$947.50
Rate for Payer: Aetna Commercial	$720.10
Rate for Payer: Aetna Medicare Advantage	$568.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$483.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$483.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$483.23
Rate for Payer: Cigna Commercial	$947.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.50
Rate for Payer: Oxford Commercial	$379.00
Rate for Payer: Qualcare PPO/HMO/WC	$284.25
Rate for Payer: UnitedHealthcare Commercial	$379.00
Rate for Payer: UnitedHealthcare Community & State	$45.67
Rate for Payer: Wellpoint Medicaid Managed Care	$50.22

SHEATH STABILIZATION DEVICE

Facility

$89.50

Hospital Charge Code	270637975S
Hospital Revenue Code	271
Min. Negotiated Rate	$13.43
Max. Negotiated Rate	$13.43
Rate for Payer: Qualcare PPO/HMO/WC	$13.43

SHEATH STABILIZATION DEVICE

Facility

$89.50

Hospital Charge Code	270637975S
Hospital Revenue Code	271
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$44.75
Rate for Payer: Aetna Commercial	$34.01
Rate for Payer: Aetna Medicare Advantage	$26.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.82
Rate for Payer: Cigna Commercial	$44.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.85
Rate for Payer: Oxford Commercial	$17.90
Rate for Payer: Qualcare PPO/HMO/WC	$13.43
Rate for Payer: UnitedHealthcare Commercial	$17.90
Rate for Payer: UnitedHealthcare Community & State	$2.16
Rate for Payer: Wellpoint Medicaid Managed Care	$2.37

SHEATH STABILIZATION DEVICE

Facility

$89.50

Hospital Charge Code	270637975N
Hospital Revenue Code	271
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$44.75
Rate for Payer: Aetna Commercial	$34.01
Rate for Payer: Aetna Medicare Advantage	$26.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.82
Rate for Payer: Cigna Commercial	$44.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.85
Rate for Payer: Oxford Commercial	$17.90
Rate for Payer: Qualcare PPO/HMO/WC	$13.43
Rate for Payer: UnitedHealthcare Commercial	$17.90
Rate for Payer: UnitedHealthcare Community & State	$2.16
Rate for Payer: Wellpoint Medicaid Managed Care	$2.37

SHEATH STABILIZATION DEVICE

Facility

$89.50

Hospital Charge Code	270637975
Hospital Revenue Code	271
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$44.75
Rate for Payer: Aetna Commercial	$34.01
Rate for Payer: Aetna Medicare Advantage	$26.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.82
Rate for Payer: Cigna Commercial	$44.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.85
Rate for Payer: Oxford Commercial	$17.90
Rate for Payer: Qualcare PPO/HMO/WC	$13.43
Rate for Payer: UnitedHealthcare Commercial	$17.90
Rate for Payer: UnitedHealthcare Community & State	$2.16
Rate for Payer: Wellpoint Medicaid Managed Care	$2.37

SHEATH STABILIZATION DEVICE

Facility

$89.50

Hospital Charge Code	270637975
Hospital Revenue Code	271
Min. Negotiated Rate	$13.43
Max. Negotiated Rate	$13.43
Rate for Payer: Qualcare PPO/HMO/WC	$13.43

SHEATH STABILIZATION DEVICE

Facility

$1,895.00

Hospital Charge Code	2709003701
Hospital Revenue Code	272
Min. Negotiated Rate	$284.25
Max. Negotiated Rate	$284.25
Rate for Payer: Qualcare PPO/HMO/WC	$284.25

SHEATH STABILIZATION DEVICE

Facility

$89.50

Hospital Charge Code	270637975N
Hospital Revenue Code	271
Min. Negotiated Rate	$13.43
Max. Negotiated Rate	$13.43
Rate for Payer: Qualcare PPO/HMO/WC	$13.43

SHEATH STAPLER 45

Facility

$100.00

Hospital Charge Code	270666137
Hospital Revenue Code	272
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

SHEATH STAPLER 45

Facility

$100.00

Hospital Charge Code	270666137
Hospital Revenue Code	272
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.00
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$20.00
Rate for Payer: UnitedHealthcare Community & State	$2.41
Rate for Payer: Wellpoint Medicaid Managed Care	$2.65

SHEATH SUPER 12FR

Facility

$51.73

Hospital Charge Code	270660036
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 SUPER 12FR

Facility

$51.73

Hospital Charge Code	270660036
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

Know your out-of-pocket cost for care.

All Charges