Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH DUAL LUMEN URETERAL 10F .

Facility

$602.70

Service Code	HCPCS C1758
Hospital Charge Code	270601073
Hospital Revenue Code	278
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$301.35
Rate for Payer: Aetna Commercial	$229.03
Rate for Payer: Aetna Medicare Advantage	$180.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.69
Rate for Payer: Cigna Commercial	$301.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$132.59
Rate for Payer: Qualcare PPO/HMO/WC	$90.41
Rate for Payer: UnitedHealthcare Community & State	$14.53
Rate for Payer: Wellpoint Medicaid Managed Care	$15.97

CATH DUAL LUMEN URETERAL 10F .

Facility

$602.70

Service Code	HCPCS C1758
Hospital Charge Code	270601073
Hospital Revenue Code	278
Min. Negotiated Rate	$90.41
Max. Negotiated Rate	$145.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$132.59
Rate for Payer: Qualcare PPO/HMO/WC	$90.41

CATH DUPEN EPIDURAL

Facility

$2,860.85

Hospital Charge Code	270600872
Hospital Revenue Code	278
Min. Negotiated Rate	$429.13
Max. Negotiated Rate	$692.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$572.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$692.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$629.39
Rate for Payer: Qualcare PPO/HMO/WC	$429.13

CATH DUPEN EPIDURAL

Facility

$2,860.85

Hospital Charge Code	270600872
Hospital Revenue Code	278
Min. Negotiated Rate	$68.95
Max. Negotiated Rate	$1,430.42
Rate for Payer: Aetna Commercial	$1,087.12
Rate for Payer: Aetna Medicare Advantage	$858.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$729.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$729.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$572.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$729.52
Rate for Payer: Cigna Commercial	$1,430.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$692.33
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$629.39
Rate for Payer: Qualcare PPO/HMO/WC	$429.13
Rate for Payer: UnitedHealthcare Community & State	$68.95
Rate for Payer: Wellpoint Medicaid Managed Care	$75.81

CATH DX AXS CATALYST 5/132CM

Facility

$10,119.30

Service Code	HCPCS C1887
Hospital Charge Code	270694250S
Hospital Revenue Code	278
Min. Negotiated Rate	$243.88
Max. Negotiated Rate	$5,059.65
Rate for Payer: Aetna Commercial	$3,845.33
Rate for Payer: Aetna Medicare Advantage	$3,035.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,580.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,580.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,023.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,580.42
Rate for Payer: Cigna Commercial	$5,059.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,448.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,226.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,517.89
Rate for Payer: UnitedHealthcare Community & State	$243.88
Rate for Payer: Wellpoint Medicaid Managed Care	$268.16

CATH DX AXS CATALYST 5/132CM

Facility

$10,119.30

Service Code	HCPCS C1887
Hospital Charge Code	270694250S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,517.89
Max. Negotiated Rate	$2,448.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,023.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,448.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,226.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,517.89

CATH DXT 5F JL35 100 CM

Facility

$41.25

Hospital Charge Code	270683017
Hospital Revenue Code	272
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$6.19
Rate for Payer: Qualcare PPO/HMO/WC	$6.19

CATH DXT 5F JL35 100 CM

Facility

$41.25

Hospital Charge Code	270683017
Hospital Revenue Code	272
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$20.62
Rate for Payer: Aetna Commercial	$15.68
Rate for Payer: Aetna Medicare Advantage	$12.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.52
Rate for Payer: Cigna Commercial	$20.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.38
Rate for Payer: Oxford Commercial	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.19
Rate for Payer: UnitedHealthcare Commercial	$8.25
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

CATH DXT 5F JL35 100 CM

Facility

$41.25

Hospital Charge Code	270683017N
Hospital Revenue Code	272
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$6.19
Rate for Payer: Qualcare PPO/HMO/WC	$6.19

CATH DXT 5F JL35 100 CM

Facility

$41.25

Hospital Charge Code	270683017N
Hospital Revenue Code	272
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$20.62
Rate for Payer: Aetna Commercial	$15.68
Rate for Payer: Aetna Medicare Advantage	$12.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.52
Rate for Payer: Cigna Commercial	$20.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.38
Rate for Payer: Oxford Commercial	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.19
Rate for Payer: UnitedHealthcare Commercial	$8.25
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

CATH DXT 5F JL40 100CM

Facility

$41.25

Hospital Charge Code	270683022
Hospital Revenue Code	272
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$20.62
Rate for Payer: Aetna Commercial	$15.68
Rate for Payer: Aetna Medicare Advantage	$12.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.52
Rate for Payer: Cigna Commercial	$20.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.38
Rate for Payer: Oxford Commercial	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.19
Rate for Payer: UnitedHealthcare Commercial	$8.25
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

CATH DXT 5F JL40 100CM

Facility

$41.25

Hospital Charge Code	270683022N
Hospital Revenue Code	272
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$20.62
Rate for Payer: Aetna Commercial	$15.68
Rate for Payer: Aetna Medicare Advantage	$12.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.52
Rate for Payer: Cigna Commercial	$20.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.38
Rate for Payer: Oxford Commercial	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.19
Rate for Payer: UnitedHealthcare Commercial	$8.25
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

CATH DXT 5F JL40 100CM

Facility

$41.25

Hospital Charge Code	270683022
Hospital Revenue Code	272
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$6.19
Rate for Payer: Qualcare PPO/HMO/WC	$6.19

CATH DXT 5F JL40 100CM

Facility

$41.25

Hospital Charge Code	270683022N
Hospital Revenue Code	272
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$6.19
Rate for Payer: Qualcare PPO/HMO/WC	$6.19

CATH DXT 5 F JR35 100CM

Facility

$41.25

Hospital Charge Code	270683018
Hospital Revenue Code	272
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$20.62
Rate for Payer: Aetna Commercial	$15.68
Rate for Payer: Aetna Medicare Advantage	$12.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.52
Rate for Payer: Cigna Commercial	$20.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.38
Rate for Payer: Oxford Commercial	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.19
Rate for Payer: UnitedHealthcare Commercial	$8.25
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

CATH DXT 5 F JR35 100CM

Facility

$41.25

Hospital Charge Code	270683018N
Hospital Revenue Code	278
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$20.62
Rate for Payer: Aetna Commercial	$15.68
Rate for Payer: Aetna Medicare Advantage	$12.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.52
Rate for Payer: Cigna Commercial	$20.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9.07
Rate for Payer: Qualcare PPO/HMO/WC	$6.19
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

CATH DXT 5 F JR35 100CM

Facility

$41.25

Hospital Charge Code	270683018
Hospital Revenue Code	272
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$6.19
Rate for Payer: Qualcare PPO/HMO/WC	$6.19

CATH DXT 5 F JR35 100CM

Facility

$41.25

Hospital Charge Code	270683018N
Hospital Revenue Code	278
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$9.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.98
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9.07
Rate for Payer: Qualcare PPO/HMO/WC	$6.19

CATH DXT 5F JR40 100CM

Facility

$41.25

Hospital Charge Code	270683021
Hospital Revenue Code	272
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$6.19
Rate for Payer: Qualcare PPO/HMO/WC	$6.19

CATH DXT 5F JR40 100CM

Facility

$41.25

Hospital Charge Code	270683021
Hospital Revenue Code	272
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$20.62
Rate for Payer: Aetna Commercial	$15.68
Rate for Payer: Aetna Medicare Advantage	$12.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.52
Rate for Payer: Cigna Commercial	$20.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.38
Rate for Payer: Oxford Commercial	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.19
Rate for Payer: UnitedHealthcare Commercial	$8.25
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

CATH DXT 5F JR40 100CM

Facility

$41.25

Hospital Charge Code	270683021N
Hospital Revenue Code	272
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$6.19
Rate for Payer: Qualcare PPO/HMO/WC	$6.19

CATH DXT 5F JR40 100CM

Facility

$41.25

Hospital Charge Code	270683021N
Hospital Revenue Code	272
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$20.62
Rate for Payer: Aetna Commercial	$15.68
Rate for Payer: Aetna Medicare Advantage	$12.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.52
Rate for Payer: Cigna Commercial	$20.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.38
Rate for Payer: Oxford Commercial	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.19
Rate for Payer: UnitedHealthcare Commercial	$8.25
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

CATH DXT 5F PG145 110CM

Facility

$41.25

Hospital Charge Code	270683023
Hospital Revenue Code	272
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$6.19
Rate for Payer: Qualcare PPO/HMO/WC	$6.19

CATH DXT 5F PG145 110CM

Facility

$41.25

Hospital Charge Code	270683023
Hospital Revenue Code	272
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$20.62
Rate for Payer: Aetna Commercial	$15.68
Rate for Payer: Aetna Medicare Advantage	$12.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.52
Rate for Payer: Cigna Commercial	$20.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.38
Rate for Payer: Oxford Commercial	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.19
Rate for Payer: UnitedHealthcare Commercial	$8.25
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

CATH DXT 5F PG145 110CM

Facility

$41.25

Hospital Charge Code	270683023N
Hospital Revenue Code	272
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$20.62
Rate for Payer: Aetna Commercial	$15.68
Rate for Payer: Aetna Medicare Advantage	$12.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.52
Rate for Payer: Cigna Commercial	$20.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.38
Rate for Payer: Oxford Commercial	$8.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.19
Rate for Payer: UnitedHealthcare Commercial	$8.25
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

Know your out-of-pocket cost for care.

All Charges