Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH EMBOLECT 5FR 50CM 160245F

Facility

$2,493.65

Hospital Charge Code	270601079
Hospital Revenue Code	278
Min. Negotiated Rate	$60.10
Max. Negotiated Rate	$1,246.83
Rate for Payer: Aetna Commercial	$947.59
Rate for Payer: Aetna Medicare Advantage	$748.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$635.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$635.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$498.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$635.88
Rate for Payer: Cigna Commercial	$1,246.83
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
Rate for Payer: UnitedHealthcare Community & State	$60.10
Rate for Payer: Wellpoint Medicaid Managed Care	$66.08

CATH EMBOLECT 6FR 120806F

Facility

$313.50

Service Code	HCPCS C1757
Hospital Charge Code	270600384
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 6FR 120806F

Facility

$313.50

Service Code	HCPCS C1757
Hospital Charge Code	270600384
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 7FR *********

Facility

$204.00

Hospital Charge Code	1600733
Hospital Revenue Code	272
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$30.60
Rate for Payer: Qualcare PPO/HMO/WC	$30.60

CATH EMBOLECT 7FR *********

Facility

$204.00

Hospital Charge Code	1600733
Hospital Revenue Code	272
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Commercial	$77.52
Rate for Payer: Aetna Medicare Advantage	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.02
Rate for Payer: Cigna Commercial	$102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.20
Rate for Payer: Oxford Commercial	$40.80
Rate for Payer: Qualcare PPO/HMO/WC	$30.60
Rate for Payer: UnitedHealthcare Commercial	$40.80
Rate for Payer: UnitedHealthcare Community & State	$4.92
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

CATH EMBOLECT 7FR 120807F

Facility

$263.17

Hospital Charge Code	270600370
Hospital Revenue Code	278
Min. Negotiated Rate	$6.34
Max. Negotiated Rate	$131.59
Rate for Payer: Aetna Commercial	$100.00
Rate for Payer: Aetna Medicare Advantage	$78.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.11
Rate for Payer: Cigna Commercial	$131.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$57.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.48
Rate for Payer: UnitedHealthcare Community & State	$6.34
Rate for Payer: Wellpoint Medicaid Managed Care	$6.97

CATH EMBOLECT 7FR 120807F

Facility

$263.17

Hospital Charge Code	270600370
Hospital Revenue Code	278
Min. Negotiated Rate	$39.48
Max. Negotiated Rate	$63.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$57.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.48

CATH EMBOLECT D6 4FR 140806

Facility

$2,395.25

Hospital Charge Code	270601075
Hospital Revenue Code	278
Min. Negotiated Rate	$57.73
Max. Negotiated Rate	$1,197.62
Rate for Payer: Aetna Commercial	$910.20
Rate for Payer: Aetna Medicare Advantage	$718.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$610.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$610.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$479.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$610.79
Rate for Payer: Cigna Commercial	$1,197.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$579.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$526.96
Rate for Payer: Qualcare PPO/HMO/WC	$359.29
Rate for Payer: UnitedHealthcare Community & State	$57.73
Rate for Payer: Wellpoint Medicaid Managed Care	$63.47

CATH EMBOLECT D6 4FR 140806

Facility

$2,395.25

Hospital Charge Code	270601075
Hospital Revenue Code	278
Min. Negotiated Rate	$359.29
Max. Negotiated Rate	$579.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$479.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$579.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$526.96
Rate for Payer: Qualcare PPO/HMO/WC	$359.29

CATH EMBOLECT D6 50CM 160246F

Facility

$2,493.65

Service Code	HCPCS C1757
Hospital Charge Code	270601078
Hospital Revenue Code	278
Min. Negotiated Rate	$60.10
Max. Negotiated Rate	$1,246.83
Rate for Payer: Aetna Commercial	$947.59
Rate for Payer: Aetna Medicare Advantage	$748.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$635.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$635.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$498.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$635.88
Rate for Payer: Cigna Commercial	$1,246.83
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
Rate for Payer: UnitedHealthcare Community & State	$60.10
Rate for Payer: Wellpoint Medicaid Managed Care	$66.08

CATH EMBOLECT D6 50CM 160246F

Facility

$2,493.65

Service Code	HCPCS C1757
Hospital Charge Code	270601078
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

CATH EMBOLECT D8 5FR 140808

Facility

$2,395.25

Hospital Charge Code	270601074
Hospital Revenue Code	272
Min. Negotiated Rate	$57.73
Max. Negotiated Rate	$1,197.62
Rate for Payer: Aetna Commercial	$910.20
Rate for Payer: Aetna Medicare Advantage	$718.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$610.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$610.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$610.79
Rate for Payer: Cigna Commercial	$1,197.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$718.58
Rate for Payer: Oxford Commercial	$479.05
Rate for Payer: Qualcare PPO/HMO/WC	$359.29
Rate for Payer: UnitedHealthcare Commercial	$479.05
Rate for Payer: UnitedHealthcare Community & State	$57.73
Rate for Payer: Wellpoint Medicaid Managed Care	$63.47

CATH EMBOLECT D8 5FR 140808

Facility

$2,395.25

Hospital Charge Code	270601074
Hospital Revenue Code	272
Min. Negotiated Rate	$359.29
Max. Negotiated Rate	$359.29
Rate for Payer: Qualcare PPO/HMO/WC	$359.29

CATH EMBOLECT FOGARTY 4FR 40cm

Facility

$272.90

Hospital Charge Code	270651780
Hospital Revenue Code	272
Min. Negotiated Rate	$40.94
Max. Negotiated Rate	$40.94
Rate for Payer: Qualcare PPO/HMO/WC	$40.94

CATH EMBOLECT FOGARTY 4FR 40cm

Facility

$272.90

Hospital Charge Code	270651780
Hospital Revenue Code	272
Min. Negotiated Rate	$6.58
Max. Negotiated Rate	$136.45
Rate for Payer: Aetna Commercial	$103.70
Rate for Payer: Aetna Medicare Advantage	$81.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.59
Rate for Payer: Cigna Commercial	$136.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.87
Rate for Payer: Oxford Commercial	$54.58
Rate for Payer: Qualcare PPO/HMO/WC	$40.94
Rate for Payer: UnitedHealthcare Commercial	$54.58
Rate for Payer: UnitedHealthcare Community & State	$6.58
Rate for Payer: Wellpoint Medicaid Managed Care	$7.23

CATH EMBOLECTMY 3F 6x80 165138

Facility

$386.95

Service Code	HCPCS C1757
Hospital Charge Code	270631115
Hospital Revenue Code	278
Min. Negotiated Rate	$58.04
Max. Negotiated Rate	$93.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$85.13
Rate for Payer: Qualcare PPO/HMO/WC	$58.04

CATH EMBOLECTMY 3F 6x80 165138

Facility

$386.95

Service Code	HCPCS C1757
Hospital Charge Code	270631115
Hospital Revenue Code	278
Min. Negotiated Rate	$9.33
Max. Negotiated Rate	$193.47
Rate for Payer: Aetna Commercial	$147.04
Rate for Payer: Aetna Medicare Advantage	$116.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.67
Rate for Payer: Cigna Commercial	$193.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$85.13
Rate for Payer: Qualcare PPO/HMO/WC	$58.04
Rate for Payer: UnitedHealthcare Community & State	$9.33
Rate for Payer: Wellpoint Medicaid Managed Care	$10.25

CATH EMBOLECTOMY 4FR.10MMx40cm

Facility

$360.00

Hospital Charge Code	270631116
Hospital Revenue Code	278
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$136.80
Rate for Payer: Aetna Medicare Advantage	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.80
Rate for Payer: Cigna Commercial	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$79.20
Rate for Payer: Qualcare PPO/HMO/WC	$54.00
Rate for Payer: UnitedHealthcare Community & State	$8.68
Rate for Payer: Wellpoint Medicaid Managed Care	$9.54

CATH EMBOLECTOMY 4FR.10MMx40cm

Facility

$360.00

Hospital Charge Code	270631116
Hospital Revenue Code	278
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$87.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$79.20
Rate for Payer: Qualcare PPO/HMO/WC	$54.00

CATH EMBOLECTOMY 5FR 1651-58

Facility

$386.95

Hospital Charge Code	270631119
Hospital Revenue Code	278
Min. Negotiated Rate	$9.33
Max. Negotiated Rate	$193.47
Rate for Payer: Aetna Commercial	$147.04
Rate for Payer: Aetna Medicare Advantage	$116.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.67
Rate for Payer: Cigna Commercial	$193.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$85.13
Rate for Payer: Qualcare PPO/HMO/WC	$58.04
Rate for Payer: UnitedHealthcare Community & State	$9.33
Rate for Payer: Wellpoint Medicaid Managed Care	$10.25

CATH EMBOLECTOMY 5FR 1651-58

Facility

$386.95

Hospital Charge Code	270631119
Hospital Revenue Code	278
Min. Negotiated Rate	$58.04
Max. Negotiated Rate	$93.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$85.13
Rate for Payer: Qualcare PPO/HMO/WC	$58.04

CATH EMBOLECTOMY 7FR

Facility

$225.00

Hospital Charge Code	270654345
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.50
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

CATH EMBOLECTOMY 7FR

Facility

$225.00

Hospital Charge Code	270654345
Hospital Revenue Code	278
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$49.50
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Community & State	$5.42
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

CATH EMBOLECT PYTH 4F 5MMX40CM

Facility

$995.00

Service Code	HCPCS C1757
Hospital Charge Code	270698568
Hospital Revenue Code	278
Min. Negotiated Rate	$23.98
Max. Negotiated Rate	$497.50
Rate for Payer: Aetna Commercial	$378.10
Rate for Payer: Aetna Medicare Advantage	$298.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.72
Rate for Payer: Cigna Commercial	$497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$218.90
Rate for Payer: Qualcare PPO/HMO/WC	$149.25
Rate for Payer: UnitedHealthcare Community & State	$23.98
Rate for Payer: Wellpoint Medicaid Managed Care	$26.37

CATH EMBOLECT PYTH 4F 5MMX40CM

Facility

$995.00

Service Code	HCPCS C1757
Hospital Charge Code	270698568
Hospital Revenue Code	278
Min. Negotiated Rate	$149.25
Max. Negotiated Rate	$240.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$218.90
Rate for Payer: Qualcare PPO/HMO/WC	$149.25

Know your out-of-pocket cost for care.

All Charges