Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH 6F LCB

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270639849
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

CATH 6F LCB

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270639849
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

CATH 6 F MPA 1

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270636331
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

CATH 6 F MPA 1

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270636331S
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

CATH 6 F MPA 1

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270636331S
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

CATH 6 F MPA 1

Facility

$54.95

Service Code	HCPCS C1887
Hospital Charge Code	270636331N
Hospital Revenue Code	278
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$27.48
Rate for Payer: Aetna Commercial	$20.88
Rate for Payer: Aetna Medicare Advantage	$16.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.01
Rate for Payer: Cigna Commercial	$27.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.09
Rate for Payer: Qualcare PPO/HMO/WC	$8.24
Rate for Payer: UnitedHealthcare Community & State	$1.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

CATH 6 F MPA 1

Facility

$54.95

Service Code	HCPCS C1887
Hospital Charge Code	270636331N
Hospital Revenue Code	278
Min. Negotiated Rate	$8.24
Max. Negotiated Rate	$13.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.09
Rate for Payer: Qualcare PPO/HMO/WC	$8.24

CATH 6 F MPA 1

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270636331
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

CATH 6F MPA2 533642

Facility

$42.25

Hospital Charge Code	270604410
Hospital Revenue Code	272
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$6.34
Rate for Payer: Qualcare PPO/HMO/WC	$6.34

CATH 6F MPA2 533642

Facility

$42.25

Hospital Charge Code	270604410
Hospital Revenue Code	272
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$21.12
Rate for Payer: Aetna Commercial	$16.05
Rate for Payer: Aetna Medicare Advantage	$12.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.77
Rate for Payer: Cigna Commercial	$21.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.68
Rate for Payer: Oxford Commercial	$8.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.34
Rate for Payer: UnitedHealthcare Commercial	$8.45
Rate for Payer: UnitedHealthcare Community & State	$1.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

CATH 6FR 100CML LEFT 7501-21

Facility

$475.00

Hospital Charge Code	270647848C
Hospital Revenue Code	272
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$71.25
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

CATH 6FR 100CML LEFT 7501-21

Facility

$475.00

Hospital Charge Code	270647848C
Hospital Revenue Code	272
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.50
Rate for Payer: Oxford Commercial	$95.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Commercial	$95.00
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

CATH 6FR 90CM THROMBECTOMY

Facility

$7,950.00

Service Code	HCPCS C1757
Hospital Charge Code	270648157N
Hospital Revenue Code	278
Min. Negotiated Rate	$191.59
Max. Negotiated Rate	$3,975.00
Rate for Payer: Aetna Commercial	$3,021.00
Rate for Payer: Aetna Medicare Advantage	$2,385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,027.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,027.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,027.25
Rate for Payer: Cigna Commercial	$3,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,923.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,749.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,192.50
Rate for Payer: UnitedHealthcare Community & State	$191.59
Rate for Payer: Wellpoint Medicaid Managed Care	$210.68

CATH 6FR 90CM THROMBECTOMY

Facility

$7,950.00

Service Code	HCPCS C1757
Hospital Charge Code	270648157N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,192.50
Max. Negotiated Rate	$1,923.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,923.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,749.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,192.50

CATH 6FR 90CM THROMBECTOMY

Facility

$7,950.00

Service Code	HCPCS C1757
Hospital Charge Code	270648157
Hospital Revenue Code	278
Min. Negotiated Rate	$191.59
Max. Negotiated Rate	$3,975.00
Rate for Payer: Aetna Commercial	$3,021.00
Rate for Payer: Aetna Medicare Advantage	$2,385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,027.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,027.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,027.25
Rate for Payer: Cigna Commercial	$3,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,923.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,749.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,192.50
Rate for Payer: UnitedHealthcare Community & State	$191.59
Rate for Payer: Wellpoint Medicaid Managed Care	$210.68

CATH 6FR 90CM THROMBECTOMY

Facility

$7,950.00

Service Code	HCPCS C1757
Hospital Charge Code	270648157
Hospital Revenue Code	278
Min. Negotiated Rate	$1,192.50
Max. Negotiated Rate	$1,923.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,923.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,749.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,192.50

CATH 6FR 90CM THROMBECTOMY

Facility

$7,950.00

Service Code	HCPCS C1757
Hospital Charge Code	270648157C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,192.50
Max. Negotiated Rate	$1,923.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,923.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,749.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,192.50

CATH 6FR 90CM THROMBECTOMY

Facility

$7,950.00

Service Code	HCPCS C1757
Hospital Charge Code	270648157C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.59
Max. Negotiated Rate	$3,975.00
Rate for Payer: Aetna Commercial	$3,021.00
Rate for Payer: Aetna Medicare Advantage	$2,385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,027.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,027.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,027.25
Rate for Payer: Cigna Commercial	$3,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,923.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,749.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,192.50
Rate for Payer: UnitedHealthcare Community & State	$191.59
Rate for Payer: Wellpoint Medicaid Managed Care	$210.68

CATH 6FR AL 2.0 SH

Facility

$230.00

Hospital Charge Code	270644740
Hospital Revenue Code	272
Min. Negotiated Rate	$34.50
Max. Negotiated Rate	$34.50
Rate for Payer: Qualcare PPO/HMO/WC	$34.50

CATH 6FR AL 2.0 SH

Facility

$230.00

Hospital Charge Code	270644740
Hospital Revenue Code	272
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$115.00
Rate for Payer: Aetna Commercial	$87.40
Rate for Payer: Aetna Medicare Advantage	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.65
Rate for Payer: Cigna Commercial	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.00
Rate for Payer: Oxford Commercial	$46.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.50
Rate for Payer: UnitedHealthcare Commercial	$46.00
Rate for Payer: UnitedHealthcare Community & State	$5.54
Rate for Payer: Wellpoint Medicaid Managed Care	$6.09

CATH 6FR AL2 SH

Facility

$255.00

Hospital Charge Code	270640091
Hospital Revenue Code	272
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$127.50
Rate for Payer: Aetna Commercial	$96.90
Rate for Payer: Aetna Medicare Advantage	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.03
Rate for Payer: Cigna Commercial	$127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.50
Rate for Payer: Oxford Commercial	$51.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.25
Rate for Payer: UnitedHealthcare Commercial	$51.00
Rate for Payer: UnitedHealthcare Community & State	$6.15
Rate for Payer: Wellpoint Medicaid Managed Care	$6.76

CATH 6FR AL2 SH

Facility

$255.00

Hospital Charge Code	270640091
Hospital Revenue Code	272
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$38.25
Rate for Payer: Qualcare PPO/HMO/WC	$38.25

CATH 6FR DRC 3 .07

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270636344S
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

CATH 6FR DRC 3 .07

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270636344
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

CATH 6FR DRC 3 .07

Facility

$240.00

Service Code	HCPCS C1887
Hospital Charge Code	270636344
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

Know your out-of-pocket cost for care.

All Charges