Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHEATH SUPER 5FR 11cm .035

Facility

$48.76

Service Code	HCPCS C1894
Hospital Charge Code	270623265
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 SUPER 5FR 11cm .035

Facility

$48.76

Service Code	HCPCS C1894
Hospital Charge Code	270623265
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 SUPER PINNACLE 12FR

Facility

$51.73

Hospital Charge Code	270660039
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 SUPER PINNACLE 12FR

Facility

$51.73

Hospital Charge Code	270660039
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 W/O GW 10FR 25CM

Facility

$113.85

Hospital Charge Code	270677316
Hospital Revenue Code	272
Min. Negotiated Rate	$17.08
Max. Negotiated Rate	$17.08
Rate for Payer: Qualcare PPO/HMO/WC	$17.08

SHEATH SUPER W/O GW 10FR 25CM

Facility

$113.85

Hospital Charge Code	270677316O
Hospital Revenue Code	272
Min. Negotiated Rate	$17.08
Max. Negotiated Rate	$17.08
Rate for Payer: Qualcare PPO/HMO/WC	$17.08

SHEATH SUPER W/O GW 10FR 25CM

Facility

$113.85

Hospital Charge Code	270677316O
Hospital Revenue Code	272
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$56.92
Rate for Payer: Aetna Commercial	$43.26
Rate for Payer: Aetna Medicare Advantage	$34.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.03
Rate for Payer: Cigna Commercial	$56.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.16
Rate for Payer: Oxford Commercial	$22.77
Rate for Payer: Qualcare PPO/HMO/WC	$17.08
Rate for Payer: UnitedHealthcare Commercial	$22.77
Rate for Payer: UnitedHealthcare Community & State	$2.74
Rate for Payer: Wellpoint Medicaid Managed Care	$3.02

SHEATH SUPER W/O GW 10FR 25CM

Facility

$113.85

Hospital Charge Code	270677316
Hospital Revenue Code	272
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$56.92
Rate for Payer: Aetna Commercial	$43.26
Rate for Payer: Aetna Medicare Advantage	$34.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.03
Rate for Payer: Cigna Commercial	$56.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.16
Rate for Payer: Oxford Commercial	$22.77
Rate for Payer: Qualcare PPO/HMO/WC	$17.08
Rate for Payer: UnitedHealthcare Commercial	$22.77
Rate for Payer: UnitedHealthcare Community & State	$2.74
Rate for Payer: Wellpoint Medicaid Managed Care	$3.02

SHEATH SUPER W/O GW 4FR 11cm

Facility

$48.76

Service Code	HCPCS C1894
Hospital Charge Code	270637756
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 SUPER W/O GW 4FR 11cm

Facility

$48.76

Service Code	HCPCS C1894
Hospital Charge Code	270637756
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 SUPER W/O GW 5FR 11cm

Facility

$48.76

Service Code	HCPCS C1894
Hospital Charge Code	270626580
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 SUPER W/O GW 5FR 11cm

Facility

$48.76

Service Code	HCPCS C1894
Hospital Charge Code	270626580
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 SUPER W/O GW 5FR 11CM

Facility

$50.00

Hospital Charge Code	270626580C
Hospital Revenue Code	272
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

SHEATH SUPER W/O GW 5FR 11CM

Facility

$50.00

Hospital Charge Code	270626580C
Hospital Revenue Code	272
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.00
Rate for Payer: Oxford Commercial	$10.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$10.00
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

SHEATH SUPER W/O GW 5FR 25cm

Facility

$174.71

Hospital Charge Code	270637586
Hospital Revenue Code	278
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$87.36
Rate for Payer: Aetna Commercial	$66.39
Rate for Payer: Aetna Medicare Advantage	$52.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.55
Rate for Payer: Cigna Commercial	$87.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.44
Rate for Payer: Qualcare PPO/HMO/WC	$26.21
Rate for Payer: UnitedHealthcare Community & State	$4.21
Rate for Payer: Wellpoint Medicaid Managed Care	$4.63

SHEATH SUPER W/O GW 5FR 25cm

Facility

$174.71

Hospital Charge Code	270637586
Hospital Revenue Code	278
Min. Negotiated Rate	$26.21
Max. Negotiated Rate	$42.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.44
Rate for Payer: Qualcare PPO/HMO/WC	$26.21

SHEATH SUPER W/O GW 5FR 25CM

Facility

$184.06

Hospital Charge Code	270637586C
Hospital Revenue Code	272
Min. Negotiated Rate	$27.61
Max. Negotiated Rate	$27.61
Rate for Payer: Qualcare PPO/HMO/WC	$27.61

SHEATH SUPER W/O GW 5FR 25CM

Facility

$184.06

Hospital Charge Code	270637586C
Hospital Revenue Code	272
Min. Negotiated Rate	$4.44
Max. Negotiated Rate	$92.03
Rate for Payer: Aetna Commercial	$69.94
Rate for Payer: Aetna Medicare Advantage	$55.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.94
Rate for Payer: Cigna Commercial	$92.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.22
Rate for Payer: Oxford Commercial	$36.81
Rate for Payer: Qualcare PPO/HMO/WC	$27.61
Rate for Payer: UnitedHealthcare Commercial	$36.81
Rate for Payer: UnitedHealthcare Community & State	$4.44
Rate for Payer: Wellpoint Medicaid Managed Care	$4.88

SHEATH SUPER W/O GW 6FR 11cm

Facility

$48.76

Service Code	HCPCS C1894
Hospital Charge Code	270638086
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 SUPER W/O GW 6FR 11cm

Facility

$48.76

Service Code	HCPCS C1894
Hospital Charge Code	270638086
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 SUPER W/O GW 6FR 25cm

Facility

$174.71

Service Code	HCPCS C1894
Hospital Charge Code	270637678
Hospital Revenue Code	278
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$87.36
Rate for Payer: Aetna Commercial	$66.39
Rate for Payer: Aetna Medicare Advantage	$52.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.55
Rate for Payer: Cigna Commercial	$87.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.44
Rate for Payer: Qualcare PPO/HMO/WC	$26.21
Rate for Payer: UnitedHealthcare Community & State	$4.21
Rate for Payer: Wellpoint Medicaid Managed Care	$4.63

SHEATH SUPER W/O GW 6FR 25cm

Facility

$1,840.50

Hospital Charge Code	270637678C
Hospital Revenue Code	272
Min. Negotiated Rate	$44.36
Max. Negotiated Rate	$920.25
Rate for Payer: Aetna Commercial	$699.39
Rate for Payer: Aetna Medicare Advantage	$552.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$469.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$469.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$469.33
Rate for Payer: Cigna Commercial	$920.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$552.15
Rate for Payer: Oxford Commercial	$368.10
Rate for Payer: Qualcare PPO/HMO/WC	$276.07
Rate for Payer: UnitedHealthcare Commercial	$368.10
Rate for Payer: UnitedHealthcare Community & State	$44.36
Rate for Payer: Wellpoint Medicaid Managed Care	$48.77

SHEATH SUPER W/O GW 6FR 25cm

Facility

$174.71

Service Code	HCPCS C1894
Hospital Charge Code	270637678
Hospital Revenue Code	278
Min. Negotiated Rate	$26.21
Max. Negotiated Rate	$42.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.28
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$38.44
Rate for Payer: Qualcare PPO/HMO/WC	$26.21

SHEATH SUPER W/O GW 6FR 25cm

Facility

$1,840.50

Hospital Charge Code	270637678C
Hospital Revenue Code	272
Min. Negotiated Rate	$276.07
Max. Negotiated Rate	$276.07
Rate for Payer: Qualcare PPO/HMO/WC	$276.07

SHEATH SUPER W/O GW 7FR 11cm

Facility

$51.73

Service Code	HCPCS C1894
Hospital Charge Code	270641355
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

Know your out-of-pocket cost for care.

All Charges