Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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	$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 W/O GW 7FR 11cm

Facility

$57.25

Service Code	HCPCS C1894
Hospital Charge Code	270624071
Hospital Revenue Code	278
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$28.62
Rate for Payer: Aetna Commercial	$21.75
Rate for Payer: Aetna Medicare Advantage	$17.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.60
Rate for Payer: Cigna Commercial	$28.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$8.59
Rate for Payer: UnitedHealthcare Community & State	$1.38
Rate for Payer: Wellpoint Medicaid Managed Care	$1.52

SHEATH SUPER W/O GW 7FR 11cm

Facility

$57.25

Service Code	HCPCS C1894
Hospital Charge Code	270624071
Hospital Revenue Code	278
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$13.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.60
Rate for Payer: Qualcare PPO/HMO/WC	$8.59

SHEATH SUPER W/O GW 7FR 25cm

Facility

$125.00

Service Code	HCPCS C1894
Hospital Charge Code	270625247
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$27.50
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

SHEATH SUPER W/O GW 7FR 25cm

Facility

$125.00

Service Code	HCPCS C1894
Hospital Charge Code	270625247
Hospital Revenue Code	278
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$27.50
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.31

SHEATH SUPER W/O GW 7FR 25CM

Facility

$180.27

Hospital Charge Code	270625247C
Hospital Revenue Code	272
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$27.04
Rate for Payer: Qualcare PPO/HMO/WC	$27.04

SHEATH SUPER W/O GW 7FR 25CM

Facility

$180.27

Hospital Charge Code	270625247C
Hospital Revenue Code	272
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$90.14
Rate for Payer: Aetna Commercial	$68.50
Rate for Payer: Aetna Medicare Advantage	$54.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.97
Rate for Payer: Cigna Commercial	$90.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.08
Rate for Payer: Oxford Commercial	$36.05
Rate for Payer: Qualcare PPO/HMO/WC	$27.04
Rate for Payer: UnitedHealthcare Commercial	$36.05
Rate for Payer: UnitedHealthcare Community & State	$4.34
Rate for Payer: Wellpoint Medicaid Managed Care	$4.78

SHEATH SUPER WO GW 8F 11 1596B

Facility

$139.50

Hospital Charge Code	270637587C
Hospital Revenue Code	272
Min. Negotiated Rate	$20.93
Max. Negotiated Rate	$20.93
Rate for Payer: Qualcare PPO/HMO/WC	$20.93

SHEATH SUPER WO GW 8F 11 1596B

Facility

$139.50

Hospital Charge Code	270637587C
Hospital Revenue Code	272
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$69.75
Rate for Payer: Aetna Commercial	$53.01
Rate for Payer: Aetna Medicare Advantage	$41.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.57
Rate for Payer: Cigna Commercial	$69.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.85
Rate for Payer: Oxford Commercial	$27.90
Rate for Payer: Qualcare PPO/HMO/WC	$20.93
Rate for Payer: UnitedHealthcare Commercial	$27.90
Rate for Payer: UnitedHealthcare Community & State	$3.36
Rate for Payer: Wellpoint Medicaid Managed Care	$3.70

SHEATH SUPER W/O GW 8FR 11cm

Facility

$51.73

Hospital Charge Code	270623288
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 8FR 11cm

Facility

$51.73

Hospital Charge Code	270623288
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 W/O GW 8FR 11cm

Facility

$137.88

Service Code	HCPCS C1894
Hospital Charge Code	270637587
Hospital Revenue Code	278
Min. Negotiated Rate	$20.68
Max. Negotiated Rate	$33.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.33
Rate for Payer: Qualcare PPO/HMO/WC	$20.68

SHEATH SUPER W/O GW 8FR 11cm

Facility

$137.88

Service Code	HCPCS C1894
Hospital Charge Code	270637587
Hospital Revenue Code	278
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$68.94
Rate for Payer: Aetna Commercial	$52.39
Rate for Payer: Aetna Medicare Advantage	$41.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.16
Rate for Payer: Cigna Commercial	$68.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$30.33
Rate for Payer: Qualcare PPO/HMO/WC	$20.68
Rate for Payer: UnitedHealthcare Community & State	$3.32
Rate for Payer: Wellpoint Medicaid Managed Care	$3.65

SHEATH SUPER W/O GW 8FR 25cm

Facility

$174.71

Service Code	HCPCS C1894
Hospital Charge Code	270631406
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 8FR 25cm

Facility

$174.71

Service Code	HCPCS C1894
Hospital Charge Code	270631406
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 9FR 11cm

Facility

$51.73

Service Code	HCPCS C1894
Hospital Charge Code	270637679N
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 W/O GW 9FR 11cm

Facility

$51.73

Service Code	HCPCS C1894
Hospital Charge Code	270637679
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 W/O GW 9FR 11cm

Facility

$51.73

Service Code	HCPCS C1894
Hospital Charge Code	270637679
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 9FR 11cm

Facility

$51.73

Service Code	HCPCS C1894
Hospital Charge Code	270637679N
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 9FR 11CM

Facility

$48.76

Hospital Charge Code	270637679C
Hospital Revenue Code	272
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$7.31
Rate for Payer: Qualcare PPO/HMO/WC	$7.31

SHEATH SUPER W/O GW 9FR 11CM

Facility

$48.76

Hospital Charge Code	270637679C
Hospital Revenue Code	272
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) PPO	$12.43
Rate for Payer: Cigna Commercial	$24.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.63
Rate for Payer: Oxford Commercial	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$7.31
Rate for Payer: UnitedHealthcare Commercial	$9.75
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.29

SHEATH SUPER W/O GW 9FR 25cm

Facility

$113.85

Service Code	HCPCS C1894
Hospital Charge Code	270626413
Hospital Revenue Code	278
Min. Negotiated Rate	$17.08
Max. Negotiated Rate	$27.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$17.08

SHEATH SUPER W/O GW 9FR 25cm

Facility

$113.85

Service Code	HCPCS C1894
Hospital Charge Code	270626413
Hospital Revenue Code	278
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) NJ Health	$22.77
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	$27.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$17.08
Rate for Payer: UnitedHealthcare Community & State	$2.74
Rate for Payer: Wellpoint Medicaid Managed Care	$3.02

SHEATH TIBIAL 30MM INTRAFIX

Facility

$1,475.00

Hospital Charge Code	270636750
Hospital Revenue Code	272
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$442.50
Rate for Payer: Oxford Commercial	$295.00
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Commercial	$295.00
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$39.09

SHEATH TIBIAL 30MM INTRAFIX

Facility

$1,475.00

Hospital Charge Code	270636750
Hospital Revenue Code	272
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$221.25
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

Know your out-of-pocket cost for care.

All Charges