Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SHEATH ULTRA 7FR 13 cm

Facility

$263.25

Service Code	HCPCS C1894
Hospital Charge Code	270664019
Hospital Revenue Code	278
Min. Negotiated Rate	$39.49
Max. Negotiated Rate	$63.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$57.91
Rate for Payer: Qualcare PPO/HMO/WC	$39.49

SHEATH ULTRA 7FR 13 cm

Facility

$263.25

Service Code	HCPCS C1894
Hospital Charge Code	270664019
Hospital Revenue Code	278
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$131.62
Rate for Payer: Aetna Commercial	$100.03
Rate for Payer: Aetna Medicare Advantage	$78.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.13
Rate for Payer: Cigna Commercial	$131.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$57.91
Rate for Payer: Qualcare PPO/HMO/WC	$39.49
Rate for Payer: UnitedHealthcare Community & State	$6.34
Rate for Payer: Wellpoint Medicaid Managed Care	$6.98

SHEATH URETERAL ACCESS 12FR 28

Facility

$247.50

Hospital Charge Code	270639249
Hospital Revenue Code	272
Min. Negotiated Rate	$37.12
Max. Negotiated Rate	$37.12
Rate for Payer: Qualcare PPO/HMO/WC	$37.12

SHEATH URETERAL ACCESS 12FR 28

Facility

$247.50

Hospital Charge Code	270639249
Hospital Revenue Code	272
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$123.75
Rate for Payer: Aetna Commercial	$94.05
Rate for Payer: Aetna Medicare Advantage	$74.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.11
Rate for Payer: Cigna Commercial	$123.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.25
Rate for Payer: Oxford Commercial	$49.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.12
Rate for Payer: UnitedHealthcare Commercial	$49.50
Rate for Payer: UnitedHealthcare Community & State	$5.96
Rate for Payer: Wellpoint Medicaid Managed Care	$6.56

SHEATH URETERAL ACCESS 12FRx20

Facility

$463.50

Hospital Charge Code	270625501
Hospital Revenue Code	272
Min. Negotiated Rate	$11.17
Max. Negotiated Rate	$231.75
Rate for Payer: Aetna Commercial	$176.13
Rate for Payer: Aetna Medicare Advantage	$139.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.19
Rate for Payer: Cigna Commercial	$231.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.05
Rate for Payer: Oxford Commercial	$92.70
Rate for Payer: Qualcare PPO/HMO/WC	$69.53
Rate for Payer: UnitedHealthcare Commercial	$92.70
Rate for Payer: UnitedHealthcare Community & State	$11.17
Rate for Payer: Wellpoint Medicaid Managed Care	$12.28

SHEATH URETERAL ACCESS 12FRx20

Facility

$463.50

Hospital Charge Code	270625501
Hospital Revenue Code	272
Min. Negotiated Rate	$69.53
Max. Negotiated Rate	$69.53
Rate for Payer: Qualcare PPO/HMO/WC	$69.53

SHEATH URETERAL ACCESS 12FRx35

Facility

$247.50

Hospital Charge Code	270639289
Hospital Revenue Code	272
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$123.75
Rate for Payer: Aetna Commercial	$94.05
Rate for Payer: Aetna Medicare Advantage	$74.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.11
Rate for Payer: Cigna Commercial	$123.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.25
Rate for Payer: Oxford Commercial	$49.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.12
Rate for Payer: UnitedHealthcare Commercial	$49.50
Rate for Payer: UnitedHealthcare Community & State	$5.96
Rate for Payer: Wellpoint Medicaid Managed Care	$6.56

SHEATH URETERAL ACCESS 12FRx35

Facility

$247.50

Hospital Charge Code	270639289
Hospital Revenue Code	272
Min. Negotiated Rate	$37.12
Max. Negotiated Rate	$37.12
Rate for Payer: Qualcare PPO/HMO/WC	$37.12

SHEATH W/HYDROPHILIC COAT 12FR

Facility

$1,300.00

Hospital Charge Code	270663540
Hospital Revenue Code	278
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$314.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$286.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00

SHEATH W/HYDROPHILIC COAT 12FR

Facility

$1,300.00

Hospital Charge Code	270663540
Hospital Revenue Code	278
Min. Negotiated Rate	$31.33
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Commercial	$494.00
Rate for Payer: Aetna Medicare Advantage	$390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.50
Rate for Payer: Cigna Commercial	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$286.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00
Rate for Payer: UnitedHealthcare Community & State	$31.33
Rate for Payer: Wellpoint Medicaid Managed Care	$34.45

SHEET ANGIOGRAPHIC FEMORAL

Facility

$32.75

Hospital Charge Code	270649504S
Hospital Revenue Code	272
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$16.38
Rate for Payer: Aetna Commercial	$12.45
Rate for Payer: Aetna Medicare Advantage	$9.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.35
Rate for Payer: Cigna Commercial	$16.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.82
Rate for Payer: Oxford Commercial	$6.55
Rate for Payer: Qualcare PPO/HMO/WC	$4.91
Rate for Payer: UnitedHealthcare Commercial	$6.55
Rate for Payer: UnitedHealthcare Community & State	$0.79
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

SHEET ANGIOGRAPHIC FEMORAL

Facility

$35.08

Hospital Charge Code	270649504N
Hospital Revenue Code	272
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$17.54
Rate for Payer: Aetna Commercial	$13.33
Rate for Payer: Aetna Medicare Advantage	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.95
Rate for Payer: Cigna Commercial	$17.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.52
Rate for Payer: Oxford Commercial	$7.02
Rate for Payer: Qualcare PPO/HMO/WC	$5.26
Rate for Payer: UnitedHealthcare Commercial	$7.02
Rate for Payer: UnitedHealthcare Community & State	$0.85
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

SHEET ANGIOGRAPHIC FEMORAL

Facility

$32.75

Hospital Charge Code	270649504S
Hospital Revenue Code	272
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$4.91
Rate for Payer: Qualcare PPO/HMO/WC	$4.91

SHEET ANGIOGRAPHIC FEMORAL

Facility

$32.75

Hospital Charge Code	270649504
Hospital Revenue Code	272
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$16.38
Rate for Payer: Aetna Commercial	$12.45
Rate for Payer: Aetna Medicare Advantage	$9.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.35
Rate for Payer: Cigna Commercial	$16.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.82
Rate for Payer: Oxford Commercial	$6.55
Rate for Payer: Qualcare PPO/HMO/WC	$4.91
Rate for Payer: UnitedHealthcare Commercial	$6.55
Rate for Payer: UnitedHealthcare Community & State	$0.79
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

SHEET ANGIOGRAPHIC FEMORAL

Facility

$35.08

Hospital Charge Code	270649504N
Hospital Revenue Code	272
Min. Negotiated Rate	$5.26
Max. Negotiated Rate	$5.26
Rate for Payer: Qualcare PPO/HMO/WC	$5.26

SHEET ANGIOGRAPHIC FEMORAL

Facility

$32.75

Hospital Charge Code	270649504
Hospital Revenue Code	272
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$4.91
Rate for Payer: Qualcare PPO/HMO/WC	$4.91

SHEET BILATERAL LIMB ********

Facility

$45.00

Hospital Charge Code	1608421
Hospital Revenue Code	272
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

SHEET BILATERAL LIMB ********

Facility

$45.00

Hospital Charge Code	1608421
Hospital Revenue Code	272
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$17.10
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.50
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$9.00
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

SHEET BIL LIMB 89291

Facility

$46.45

Hospital Charge Code	270608981
Hospital Revenue Code	272
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

SHEET BIL LIMB 89291

Facility

$46.45

Hospital Charge Code	270608981
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$23.23
Rate for Payer: Aetna Commercial	$17.65
Rate for Payer: Aetna Medicare Advantage	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.84
Rate for Payer: Cigna Commercial	$23.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.94
Rate for Payer: Oxford Commercial	$9.29
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$9.29
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

SHEET CONFORM QPACK 45x20x7mm

Facility

$11,550.00

Hospital Charge Code	270665698
Hospital Revenue Code	272
Min. Negotiated Rate	$278.36
Max. Negotiated Rate	$5,775.00
Rate for Payer: Aetna Commercial	$4,389.00
Rate for Payer: Aetna Medicare Advantage	$3,465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,945.25
Rate for Payer: Cigna Commercial	$5,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,465.00
Rate for Payer: Oxford Commercial	$2,310.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50
Rate for Payer: UnitedHealthcare Commercial	$2,310.00
Rate for Payer: UnitedHealthcare Community & State	$278.36
Rate for Payer: Wellpoint Medicaid Managed Care	$306.07

SHEET CONFORM QPACK 45x20x7mm

Facility

$11,550.00

Hospital Charge Code	270665698
Hospital Revenue Code	272
Min. Negotiated Rate	$1,732.50
Max. Negotiated Rate	$1,732.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50

SHEET CRANIAL/INCISE ********

Facility

$27.00

Hospital Charge Code	1608033
Hospital Revenue Code	251
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.10
Rate for Payer: Oxford Commercial	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$5.40
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

SHEET CRANIAL/INCISE ********

Facility

$27.00

Hospital Charge Code	1608033
Hospital Revenue Code	251
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

SHEET C/S 3M *******

Facility

$282.00

Hospital Charge Code	1800101
Hospital Revenue Code	279
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$141.00
Rate for Payer: Aetna Commercial	$107.16
Rate for Payer: Aetna Medicare Advantage	$84.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.91
Rate for Payer: Cigna Commercial	$141.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.60
Rate for Payer: Oxford Commercial	$56.40
Rate for Payer: Qualcare PPO/HMO/WC	$42.30
Rate for Payer: UnitedHealthcare Commercial	$56.40
Rate for Payer: UnitedHealthcare Community & State	$6.80
Rate for Payer: Wellpoint Medicaid Managed Care	$7.47

Know your out-of-pocket cost for care.

All Charges