Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH ANGIO 5fx90x038 10709110

Facility

$99.25

Service Code	HCPCS C1887
Hospital Charge Code	270626621
Hospital Revenue Code	278
Min. Negotiated Rate	$14.89
Max. Negotiated Rate	$24.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$21.84
Rate for Payer: Qualcare PPO/HMO/WC	$14.89

CATH ANGIO BALLOON SV/5.0

Facility

$1,493.50

Hospital Charge Code	270655403
Hospital Revenue Code	278
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$361.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$298.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$328.57
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

CATH ANGIO BALLOON SV/5.0

Facility

$1,493.50

Hospital Charge Code	270655403
Hospital Revenue Code	278
Min. Negotiated Rate	$35.99
Max. Negotiated Rate	$746.75
Rate for Payer: Aetna Commercial	$567.53
Rate for Payer: Aetna Medicare Advantage	$448.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$298.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$380.84
Rate for Payer: Cigna Commercial	$746.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$328.57
Rate for Payer: Qualcare PPO/HMO/WC	$224.03
Rate for Payer: UnitedHealthcare Community & State	$35.99
Rate for Payer: Wellpoint Medicaid Managed Care	$39.58

CATH ANGIO DXT 6F 100CM UL40

Facility

$1,125.00

Service Code	HCPCS C1887
Hospital Charge Code	270695283S
Hospital Revenue Code	272
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$168.75
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

CATH ANGIO DXT 6F 100CM UL40

Facility

$1,125.00

Service Code	HCPCS C1887
Hospital Charge Code	270695283S
Hospital Revenue Code	272
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.50
Rate for Payer: Oxford Commercial	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Commercial	$225.00
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

CATH ANGIOGR 6F POSTR 0864151

Facility

$45.00

Service Code	HCPCS C1887
Hospital Charge Code	270633183
Hospital Revenue Code	278
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$10.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

CATH ANGIOGR 6F POSTR 0864151

Facility

$45.00

Service Code	HCPCS C1887
Hospital Charge Code	270633183
Hospital Revenue Code	278
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) NJ Health	$9.00
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	$10.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

CATH ANGIOGR WRC 6FR 0864150

Facility

$45.00

Service Code	HCPCS C1887
Hospital Charge Code	270633182
Hospital Revenue Code	278
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) NJ Health	$9.00
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	$10.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

CATH ANGIOGR WRC 6FR 0864150

Facility

$45.00

Service Code	HCPCS C1887
Hospital Charge Code	270633182
Hospital Revenue Code	278
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$10.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.89
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

CATH ANGIOPL LUT 6X300MMX100CM

Facility

$13,750.00

Service Code	HCPCS C2623
Hospital Charge Code	270695613
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

CATH ANGIOPL LUT 6X300MMX100CM

Facility

$13,750.00

Service Code	HCPCS C2623
Hospital Charge Code	270695613
Hospital Revenue Code	278
Min. Negotiated Rate	$331.38
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$5,225.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50
Rate for Payer: UnitedHealthcare Community & State	$331.38
Rate for Payer: Wellpoint Medicaid Managed Care	$364.38

CATH ANGIOPL LUT 6X300MMX100CM

Facility

$13,750.00

Service Code	HCPCS C2623
Hospital Charge Code	270695613C
Hospital Revenue Code	278
Min. Negotiated Rate	$331.38
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$5,225.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50
Rate for Payer: UnitedHealthcare Community & State	$331.38
Rate for Payer: Wellpoint Medicaid Managed Care	$364.38

CATH ANGIOPL LUT 6X300MMX100CM

Facility

$13,750.00

Service Code	HCPCS C2623
Hospital Charge Code	270695613C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

CATH ANGIOPL LUT 6X300MMX100CM

Facility

$13,750.00

Service Code	HCPCS C2623
Hospital Charge Code	270695613S
Hospital Revenue Code	278
Min. Negotiated Rate	$331.38
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$5,225.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50
Rate for Payer: UnitedHealthcare Community & State	$331.38
Rate for Payer: Wellpoint Medicaid Managed Care	$364.38

CATH ANGIOPL LUT 6X300MMX100CM

Facility

$13,750.00

Service Code	HCPCS C2623
Hospital Charge Code	270695613S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

CATH APEX MONORAIL15MMX1.5MM

Facility

$245.00

Hospital Charge Code	270659098
Hospital Revenue Code	272
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$122.50
Rate for Payer: Aetna Commercial	$93.10
Rate for Payer: Aetna Medicare Advantage	$73.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.48
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.50
Rate for Payer: Oxford Commercial	$49.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$49.00
Rate for Payer: UnitedHealthcare Community & State	$5.90
Rate for Payer: Wellpoint Medicaid Managed Care	$6.49

CATH APEX MONORAIL15MMX1.5MM

Facility

$245.00

Hospital Charge Code	270659098
Hospital Revenue Code	272
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

CATH APEX MONORAIL 15mmx2.50mm

Facility

$1,225.00

Hospital Charge Code	2709007374
Hospital Revenue Code	272
Min. Negotiated Rate	$183.75
Max. Negotiated Rate	$183.75
Rate for Payer: Qualcare PPO/HMO/WC	$183.75

CATH APEX MONORAIL 15mmx2.50mm

Facility

$1,225.00

Hospital Charge Code	2709007374
Hospital Revenue Code	272
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$612.50
Rate for Payer: Aetna Commercial	$465.50
Rate for Payer: Aetna Medicare Advantage	$367.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.38
Rate for Payer: Cigna Commercial	$612.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.50
Rate for Payer: Oxford Commercial	$245.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.75
Rate for Payer: UnitedHealthcare Commercial	$245.00
Rate for Payer: UnitedHealthcare Community & State	$29.52
Rate for Payer: Wellpoint Medicaid Managed Care	$32.46

CATH APEX MONORAIL15MMX2MM

Facility

$245.00

Hospital Charge Code	270659100
Hospital Revenue Code	272
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

CATH APEX MONORAIL15MMX2MM

Facility

$245.00

Hospital Charge Code	270659100
Hospital Revenue Code	272
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$122.50
Rate for Payer: Aetna Commercial	$93.10
Rate for Payer: Aetna Medicare Advantage	$73.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.48
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.50
Rate for Payer: Oxford Commercial	$49.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$49.00
Rate for Payer: UnitedHealthcare Community & State	$5.90
Rate for Payer: Wellpoint Medicaid Managed Care	$6.49

CATH APEX MONORAIL 15mmx3.00mm

Facility

$1,225.00

Hospital Charge Code	2709007376
Hospital Revenue Code	272
Min. Negotiated Rate	$183.75
Max. Negotiated Rate	$183.75
Rate for Payer: Qualcare PPO/HMO/WC	$183.75

CATH APEX MONORAIL 15mmx3.00mm

Facility

$1,225.00

Hospital Charge Code	2709007376
Hospital Revenue Code	272
Min. Negotiated Rate	$29.52
Max. Negotiated Rate	$612.50
Rate for Payer: Aetna Commercial	$465.50
Rate for Payer: Aetna Medicare Advantage	$367.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$312.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$312.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$312.38
Rate for Payer: Cigna Commercial	$612.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.50
Rate for Payer: Oxford Commercial	$245.00
Rate for Payer: Qualcare PPO/HMO/WC	$183.75
Rate for Payer: UnitedHealthcare Commercial	$245.00
Rate for Payer: UnitedHealthcare Community & State	$29.52
Rate for Payer: Wellpoint Medicaid Managed Care	$32.46

CATH APEX MONORAIL 15X2 5

Facility

$245.00

Hospital Charge Code	270653670
Hospital Revenue Code	278
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$122.50
Rate for Payer: Aetna Commercial	$93.10
Rate for Payer: Aetna Medicare Advantage	$73.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.48
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$53.90
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Community & State	$5.90
Rate for Payer: Wellpoint Medicaid Managed Care	$6.49

CATH APEX MONORAIL 15X2 5

Facility

$245.00

Hospital Charge Code	270653670
Hospital Revenue Code	278
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$59.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.29
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$53.90
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

Know your out-of-pocket cost for care.

All Charges