Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH EKOSONIC MACH 4 50x135CM

Facility

$14,225.00

Service Code	HCPCS C1751
Hospital Charge Code	270649756
Hospital Revenue Code	278
Min. Negotiated Rate	$2,133.75
Max. Negotiated Rate	$3,442.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,845.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,442.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,129.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,133.75

CATH EKOSONIC MACH 4 50x135CM

Facility

$13,475.00

Service Code	HCPCS C1751
Hospital Charge Code	270649756N
Hospital Revenue Code	278
Min. Negotiated Rate	$324.75
Max. Negotiated Rate	$6,737.50
Rate for Payer: Aetna Commercial	$5,120.50
Rate for Payer: Aetna Medicare Advantage	$4,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,436.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,436.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,436.12
Rate for Payer: Cigna Commercial	$6,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,260.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,021.25
Rate for Payer: UnitedHealthcare Community & State	$324.75
Rate for Payer: Wellpoint Medicaid Managed Care	$357.09

CATH EKOSONIC MACH 4 50x135CM

Facility

$13,475.00

Service Code	HCPCS C1751
Hospital Charge Code	270649756N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,021.25
Max. Negotiated Rate	$3,260.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,260.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,021.25

CATH EKOSONIC MACH 4 50x135CM

Facility

$14,225.00

Service Code	HCPCS C1751
Hospital Charge Code	270649756
Hospital Revenue Code	278
Min. Negotiated Rate	$342.82
Max. Negotiated Rate	$7,112.50
Rate for Payer: Aetna Commercial	$5,405.50
Rate for Payer: Aetna Medicare Advantage	$4,267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,627.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,627.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,627.38
Rate for Payer: Cigna Commercial	$7,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,442.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,129.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,133.75
Rate for Payer: UnitedHealthcare Community & State	$342.82
Rate for Payer: Wellpoint Medicaid Managed Care	$376.96

CATH EKOSONIC MACH 4 6x106cm

Facility

$14,225.00

Service Code	HCPCS C1751
Hospital Charge Code	270642114
Hospital Revenue Code	278
Min. Negotiated Rate	$342.82
Max. Negotiated Rate	$7,112.50
Rate for Payer: Aetna Commercial	$5,405.50
Rate for Payer: Aetna Medicare Advantage	$4,267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,627.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,627.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,627.38
Rate for Payer: Cigna Commercial	$7,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,442.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,129.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,133.75
Rate for Payer: UnitedHealthcare Community & State	$342.82
Rate for Payer: Wellpoint Medicaid Managed Care	$376.96

CATH EKOSONIC MACH 4 6x106cm

Facility

$14,225.00

Service Code	HCPCS C1887
Hospital Charge Code	270642114C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,133.75
Max. Negotiated Rate	$3,442.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,845.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,442.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,129.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,133.75

CATH EKOSONIC MACH 4 6x106cm

Facility

$14,225.00

Service Code	HCPCS C1751
Hospital Charge Code	270642114
Hospital Revenue Code	278
Min. Negotiated Rate	$2,133.75
Max. Negotiated Rate	$3,442.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,845.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,442.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,129.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,133.75

CATH EKOSONIC MACH 4 6x106cm

Facility

$14,225.00

Service Code	HCPCS C1887
Hospital Charge Code	270642114C
Hospital Revenue Code	278
Min. Negotiated Rate	$342.82
Max. Negotiated Rate	$7,112.50
Rate for Payer: Aetna Commercial	$5,405.50
Rate for Payer: Aetna Medicare Advantage	$4,267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,627.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,627.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,627.38
Rate for Payer: Cigna Commercial	$7,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,442.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,129.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,133.75
Rate for Payer: UnitedHealthcare Community & State	$342.82
Rate for Payer: Wellpoint Medicaid Managed Care	$376.96

CATH EKOSONIC MACH 500-55124

Facility

$14,225.00

Service Code	HCPCS C1887
Hospital Charge Code	270639437C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,133.75
Max. Negotiated Rate	$3,442.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,845.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,442.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,129.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,133.75

CATH EKOSONIC MACH 500-55124

Facility

$14,225.00

Service Code	HCPCS C1887
Hospital Charge Code	270639437C
Hospital Revenue Code	278
Min. Negotiated Rate	$342.82
Max. Negotiated Rate	$7,112.50
Rate for Payer: Aetna Commercial	$5,405.50
Rate for Payer: Aetna Medicare Advantage	$4,267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,627.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,627.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,627.38
Rate for Payer: Cigna Commercial	$7,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,442.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,129.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,133.75
Rate for Payer: UnitedHealthcare Community & State	$342.82
Rate for Payer: Wellpoint Medicaid Managed Care	$376.96

CATHELER BALLOON HIGH PRESSURE

Facility

$975.00

Hospital Charge Code	270CH0010
Hospital Revenue Code	272
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$146.25
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

CATHELER BALLOON HIGH PRESSURE

Facility

$975.00

Hospital Charge Code	270CH0010
Hospital Revenue Code	272
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$370.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Commercial	$195.00
Rate for Payer: UnitedHealthcare Community & State	$23.50
Rate for Payer: Wellpoint Medicaid Managed Care	$25.84

CATH EMBOLECT 2FR 120602F

Facility

$440.00

Service Code	HCPCS C1757
Hospital Charge Code	270600382
Hospital Revenue Code	278
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$96.80
Rate for Payer: Qualcare PPO/HMO/WC	$66.00

CATH EMBOLECT 2FR 120602F

Facility

$440.00

Service Code	HCPCS C1757
Hospital Charge Code	270600382
Hospital Revenue Code	278
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$220.00
Rate for Payer: Aetna Commercial	$167.20
Rate for Payer: Aetna Medicare Advantage	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.20
Rate for Payer: Cigna Commercial	$220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$96.80
Rate for Payer: Qualcare PPO/HMO/WC	$66.00
Rate for Payer: UnitedHealthcare Community & State	$10.60
Rate for Payer: Wellpoint Medicaid Managed Care	$11.66

CATH EMBOLECT 3FR 120803F

Facility

$250.00

Service Code	HCPCS C1757
Hospital Charge Code	270600372
Hospital Revenue Code	278
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

CATH EMBOLECT 3FR 120803F

Facility

$463.25

Service Code	HCPCS C1757
Hospital Charge Code	270600372N
Hospital Revenue Code	278
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$231.62
Rate for Payer: Aetna Commercial	$176.03
Rate for Payer: Aetna Medicare Advantage	$138.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.13
Rate for Payer: Cigna Commercial	$231.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$101.92
Rate for Payer: Qualcare PPO/HMO/WC	$69.49
Rate for Payer: UnitedHealthcare Community & State	$11.16
Rate for Payer: Wellpoint Medicaid Managed Care	$12.28

CATH EMBOLECT 3FR 120803F

Facility

$463.25

Service Code	HCPCS C1757
Hospital Charge Code	270600372N
Hospital Revenue Code	278
Min. Negotiated Rate	$69.49
Max. Negotiated Rate	$112.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$101.92
Rate for Payer: Qualcare PPO/HMO/WC	$69.49

CATH EMBOLECT 3FR 120803F

Facility

$250.00

Service Code	HCPCS C1757
Hospital Charge Code	270600372S
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CATH EMBOLECT 3FR 120803F

Facility

$250.00

Service Code	HCPCS C1757
Hospital Charge Code	270600372S
Hospital Revenue Code	278
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

CATH EMBOLECT 3FR 120803F

Facility

$250.00

Service Code	HCPCS C1757
Hospital Charge Code	270600372
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CATH EMBOLECT 4FR 120804F

Facility

$313.50

Service Code	HCPCS C1757
Hospital Charge Code	270600371
Hospital Revenue Code	278
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$156.75
Rate for Payer: Aetna Commercial	$119.13
Rate for Payer: Aetna Medicare Advantage	$94.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.94
Rate for Payer: Cigna Commercial	$156.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.97
Rate for Payer: Qualcare PPO/HMO/WC	$47.02
Rate for Payer: UnitedHealthcare Community & State	$7.56
Rate for Payer: Wellpoint Medicaid Managed Care	$8.31

CATH EMBOLECT 4FR 120804F

Facility

$313.50

Service Code	HCPCS C1757
Hospital Charge Code	270600371
Hospital Revenue Code	278
Min. Negotiated Rate	$47.02
Max. Negotiated Rate	$75.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.97
Rate for Payer: Qualcare PPO/HMO/WC	$47.02

CATH EMBOLECT 5FR 120805F

Facility

$343.85

Service Code	HCPCS C1757
Hospital Charge Code	270600383
Hospital Revenue Code	278
Min. Negotiated Rate	$8.29
Max. Negotiated Rate	$171.93
Rate for Payer: Aetna Commercial	$130.66
Rate for Payer: Aetna Medicare Advantage	$103.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$68.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.68
Rate for Payer: Cigna Commercial	$171.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$75.65
Rate for Payer: Qualcare PPO/HMO/WC	$51.58
Rate for Payer: UnitedHealthcare Community & State	$8.29
Rate for Payer: Wellpoint Medicaid Managed Care	$9.11

CATH EMBOLECT 5FR 120805F

Facility

$343.85

Service Code	HCPCS C1757
Hospital Charge Code	270600383
Hospital Revenue Code	278
Min. Negotiated Rate	$51.58
Max. Negotiated Rate	$83.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$68.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.21
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$75.65
Rate for Payer: Qualcare PPO/HMO/WC	$51.58

CATH EMBOLECT 5FR 50CM 160245F

Facility

$2,493.65

Hospital Charge Code	270601079
Hospital Revenue Code	278
Min. Negotiated Rate	$374.05
Max. Negotiated Rate	$603.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$498.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$603.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$548.60
Rate for Payer: Qualcare PPO/HMO/WC	$374.05

Know your out-of-pocket cost for care.

All Charges