Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH 9F LUMEN DUAL 008273-902

Facility

$925.00

Service Code	HCPCS C1887
Hospital Charge Code	270658556
Hospital Revenue Code	278
Min. Negotiated Rate	$138.75
Max. Negotiated Rate	$223.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$203.50
Rate for Payer: Qualcare PPO/HMO/WC	$138.75

CATH ACCESS ********

Facility

$98.00

Hospital Charge Code	8001422
Hospital Revenue Code	279
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

CATH ACCESS ********

Facility

$98.00

Hospital Charge Code	8001422
Hospital Revenue Code	279
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.40
Rate for Payer: Oxford Commercial	$19.60
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Commercial	$19.60
Rate for Payer: UnitedHealthcare Community & State	$2.36
Rate for Payer: Wellpoint Medicaid Managed Care	$2.60

CATH ACCU-FLO PERITONEAL

Facility

$1,445.00

Hospital Charge Code	270654009
Hospital Revenue Code	272
Min. Negotiated Rate	$34.82
Max. Negotiated Rate	$722.50
Rate for Payer: Aetna Commercial	$549.10
Rate for Payer: Aetna Medicare Advantage	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$368.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$368.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$368.48
Rate for Payer: Cigna Commercial	$722.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$433.50
Rate for Payer: Oxford Commercial	$289.00
Rate for Payer: Qualcare PPO/HMO/WC	$216.75
Rate for Payer: UnitedHealthcare Commercial	$289.00
Rate for Payer: UnitedHealthcare Community & State	$34.82
Rate for Payer: Wellpoint Medicaid Managed Care	$38.29

CATH ACCU-FLO PERITONEAL

Facility

$1,445.00

Hospital Charge Code	270654009
Hospital Revenue Code	272
Min. Negotiated Rate	$216.75
Max. Negotiated Rate	$216.75
Rate for Payer: Qualcare PPO/HMO/WC	$216.75

CATH ACCU KIT INTERM 18GX2.25

Facility

$580.00

Service Code	HCPCS C1751
Hospital Charge Code	270699051
Hospital Revenue Code	278
Min. Negotiated Rate	$13.98
Max. Negotiated Rate	$290.00
Rate for Payer: Aetna Commercial	$220.40
Rate for Payer: Aetna Medicare Advantage	$174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.90
Rate for Payer: Cigna Commercial	$290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.60
Rate for Payer: Qualcare PPO/HMO/WC	$87.00
Rate for Payer: UnitedHealthcare Community & State	$13.98
Rate for Payer: Wellpoint Medicaid Managed Care	$15.37

CATH ACCU KIT INTERM 18GX2.25

Facility

$580.00

Service Code	HCPCS C1751
Hospital Charge Code	270699051
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$140.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.60
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

CATH ACCU KIT INTERM 18GX2.25

Facility

$580.00

Service Code	HCPCS C1751
Hospital Charge Code	270699051C
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$140.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.60
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

CATH ACCU KIT INTERM 18GX2.25

Facility

$580.00

Service Code	HCPCS C1751
Hospital Charge Code	270699051C
Hospital Revenue Code	278
Min. Negotiated Rate	$13.98
Max. Negotiated Rate	$290.00
Rate for Payer: Aetna Commercial	$220.40
Rate for Payer: Aetna Medicare Advantage	$174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.90
Rate for Payer: Cigna Commercial	$290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.60
Rate for Payer: Qualcare PPO/HMO/WC	$87.00
Rate for Payer: UnitedHealthcare Community & State	$13.98
Rate for Payer: Wellpoint Medicaid Managed Care	$15.37

CATH ACCU KIT INTERM 20GX2.25

Facility

$580.00

Service Code	HCPCS C1751
Hospital Charge Code	270699196C
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$140.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.60
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

CATH ACCU KIT INTERM 20GX2.25

Facility

$580.00

Service Code	HCPCS C1751
Hospital Charge Code	270699196C
Hospital Revenue Code	278
Min. Negotiated Rate	$13.98
Max. Negotiated Rate	$290.00
Rate for Payer: Aetna Commercial	$220.40
Rate for Payer: Aetna Medicare Advantage	$174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.90
Rate for Payer: Cigna Commercial	$290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.60
Rate for Payer: Qualcare PPO/HMO/WC	$87.00
Rate for Payer: UnitedHealthcare Community & State	$13.98
Rate for Payer: Wellpoint Medicaid Managed Care	$15.37

CATH ACCU KIT INTERM 20GX2.25

Facility

$580.00

Service Code	HCPCS C1751
Hospital Charge Code	270699196
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$140.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.60
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

CATH ACCU KIT INTERM 20GX2.25

Facility

$580.00

Service Code	HCPCS C1751
Hospital Charge Code	270699196
Hospital Revenue Code	278
Min. Negotiated Rate	$13.98
Max. Negotiated Rate	$290.00
Rate for Payer: Aetna Commercial	$220.40
Rate for Payer: Aetna Medicare Advantage	$174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.90
Rate for Payer: Cigna Commercial	$290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.60
Rate for Payer: Qualcare PPO/HMO/WC	$87.00
Rate for Payer: UnitedHealthcare Community & State	$13.98
Rate for Payer: Wellpoint Medicaid Managed Care	$15.37

CATH ACUTHERM DECOM 7210442

Facility

$8,975.00

Hospital Charge Code	270640709
Hospital Revenue Code	272
Min. Negotiated Rate	$216.30
Max. Negotiated Rate	$4,487.50
Rate for Payer: Aetna Commercial	$3,410.50
Rate for Payer: Aetna Medicare Advantage	$2,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.62
Rate for Payer: Cigna Commercial	$4,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,692.50
Rate for Payer: Oxford Commercial	$1,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25
Rate for Payer: UnitedHealthcare Commercial	$1,795.00
Rate for Payer: UnitedHealthcare Community & State	$216.30
Rate for Payer: Wellpoint Medicaid Managed Care	$237.84

CATH ACUTHERM DECOM 7210442

Facility

$8,975.00

Hospital Charge Code	270640709
Hospital Revenue Code	272
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$1,346.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

CATH AD BEREN 5F .038 10722105

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270623924
Hospital Revenue Code	278
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

CATH AD BEREN 5F .038 10722105

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270623924
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$21.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CATH AD CARD 5F .035 10732201

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270623313
Hospital Revenue Code	278
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

CATH AD CARD 5F .035 10732201

Facility

$147.00

Hospital Charge Code	270623313V
Hospital Revenue Code	278
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$35.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$32.34
Rate for Payer: Qualcare PPO/HMO/WC	$22.05

CATH AD CARD 5F .035 10732201

Facility

$147.00

Hospital Charge Code	270623313V
Hospital Revenue Code	278
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$73.50
Rate for Payer: Aetna Commercial	$55.86
Rate for Payer: Aetna Medicare Advantage	$44.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.48
Rate for Payer: Cigna Commercial	$73.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$32.34
Rate for Payer: Qualcare PPO/HMO/WC	$22.05
Rate for Payer: UnitedHealthcare Community & State	$3.54
Rate for Payer: Wellpoint Medicaid Managed Care	$3.90

CATH AD CARD 5F .035 10732201

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270623313
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$21.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CATH AD CARD 5F .035 50722822

Facility

$89.65

Hospital Charge Code	270623312
Hospital Revenue Code	278
Min. Negotiated Rate	$13.45
Max. Negotiated Rate	$21.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.72
Rate for Payer: Qualcare PPO/HMO/WC	$13.45

CATH AD CARD 5F .035 50722822

Facility

$89.65

Hospital Charge Code	270623312
Hospital Revenue Code	278
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$44.83
Rate for Payer: Aetna Commercial	$34.07
Rate for Payer: Aetna Medicare Advantage	$26.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.86
Rate for Payer: Cigna Commercial	$44.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.72
Rate for Payer: Qualcare PPO/HMO/WC	$13.45
Rate for Payer: UnitedHealthcare Community & State	$2.16
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

CATH AD CARD 5F .038 10732203

Facility

$94.45

Hospital Charge Code	270623923
Hospital Revenue Code	272
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$47.23
Rate for Payer: Aetna Commercial	$35.89
Rate for Payer: Aetna Medicare Advantage	$28.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.08
Rate for Payer: Cigna Commercial	$47.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.34
Rate for Payer: Oxford Commercial	$18.89
Rate for Payer: Qualcare PPO/HMO/WC	$14.17
Rate for Payer: UnitedHealthcare Commercial	$18.89
Rate for Payer: UnitedHealthcare Community & State	$2.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.50

CATH AD CARD 5F .038 10732203

Facility

$94.45

Hospital Charge Code	270623923
Hospital Revenue Code	272
Min. Negotiated Rate	$14.17
Max. Negotiated Rate	$14.17
Rate for Payer: Qualcare PPO/HMO/WC	$14.17

Know your out-of-pocket cost for care.

All Charges