Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH EMBOLECT PYTH 5F11MMX40CM

Facility

$995.00

Service Code	HCPCS C1757
Hospital Charge Code	270698570
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 5F11MMX40CM

Facility

$995.00

Service Code	HCPCS C1757
Hospital Charge Code	270698570
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

CATH EMBOLECT PYTH 5F 9MMX40CM

Facility

$995.00

Service Code	HCPCS C1757
Hospital Charge Code	270698569
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 5F 9MMX40CM

Facility

$995.00

Service Code	HCPCS C1757
Hospital Charge Code	270698569
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

CATH EMBOLETOMY 3F 6x40 165134

Facility

$386.95

Hospital Charge Code	270631114
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 EMBOLETOMY 3F 6x40 165134

Facility

$386.95

Hospital Charge Code	270631114
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 EMBOLTOMY 4F 10x80 165148

Facility

$386.95

Service Code	HCPCS C1757
Hospital Charge Code	270631117
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 EMBOLTOMY 4F 10x80 165148

Facility

$386.95

Service Code	HCPCS C1757
Hospital Charge Code	270631117
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 EMBOLTOMY 5F 12x40 165154

Facility

$386.95

Hospital Charge Code	270631118
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 EMBOLTOMY 5F 12x40 165154

Facility

$386.95

Hospital Charge Code	270631118
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 ENDOBRONC 5FR 089-076

Facility

$72.85

Hospital Charge Code	270600830
Hospital Revenue Code	272
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$36.42
Rate for Payer: Aetna Commercial	$27.68
Rate for Payer: Aetna Medicare Advantage	$21.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.58
Rate for Payer: Cigna Commercial	$36.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.86
Rate for Payer: Oxford Commercial	$14.57
Rate for Payer: Qualcare PPO/HMO/WC	$10.93
Rate for Payer: UnitedHealthcare Commercial	$14.57
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

CATH ENDOBRONC 5FR 089-076

Facility

$72.85

Hospital Charge Code	270600830
Hospital Revenue Code	272
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$10.93
Rate for Payer: Qualcare PPO/HMO/WC	$10.93

CATH ENDOBRONC 6FR 089-075

Facility

$412.85

Hospital Charge Code	270603086
Hospital Revenue Code	272
Min. Negotiated Rate	$9.95
Max. Negotiated Rate	$206.43
Rate for Payer: Aetna Commercial	$156.88
Rate for Payer: Aetna Medicare Advantage	$123.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.28
Rate for Payer: Cigna Commercial	$206.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.86
Rate for Payer: Oxford Commercial	$82.57
Rate for Payer: Qualcare PPO/HMO/WC	$61.93
Rate for Payer: UnitedHealthcare Commercial	$82.57
Rate for Payer: UnitedHealthcare Community & State	$9.95
Rate for Payer: Wellpoint Medicaid Managed Care	$10.94

CATH ENDOBRONC 6FR 089-075

Facility

$412.85

Hospital Charge Code	270603086
Hospital Revenue Code	272
Min. Negotiated Rate	$61.93
Max. Negotiated Rate	$61.93
Rate for Payer: Qualcare PPO/HMO/WC	$61.93

CATH EPIDURAL 19G CLOSED TIP

Facility

$1,322.00

Hospital Charge Code	270676362
Hospital Revenue Code	272
Min. Negotiated Rate	$31.86
Max. Negotiated Rate	$661.00
Rate for Payer: Aetna Commercial	$502.36
Rate for Payer: Aetna Medicare Advantage	$396.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.11
Rate for Payer: Cigna Commercial	$661.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$396.60
Rate for Payer: Oxford Commercial	$264.40
Rate for Payer: Qualcare PPO/HMO/WC	$198.30
Rate for Payer: UnitedHealthcare Commercial	$264.40
Rate for Payer: UnitedHealthcare Community & State	$31.86
Rate for Payer: Wellpoint Medicaid Managed Care	$35.03

CATH EPIDURAL 19G CLOSED TIP

Facility

$1,322.00

Hospital Charge Code	270676362
Hospital Revenue Code	272
Min. Negotiated Rate	$198.30
Max. Negotiated Rate	$198.30
Rate for Payer: Qualcare PPO/HMO/WC	$198.30

CATHEPSIN D,BREAST TUMOR

Facility

$390.00

Service Code	HCPCS 88360
Hospital Charge Code	3007244
Hospital Revenue Code	310
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CATHEPSIN D,BREAST TUMOR

Facility

$390.00

Service Code	HCPCS 88360
Hospital Charge Code	3007244
Hospital Revenue Code	310
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$730.60
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$730.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$730.60
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$97.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

CATH EQUISTREAM XK 16FR 36CM

Facility

$1,825.00

Service Code	HCPCS C1750
Hospital Charge Code	270653414N
Hospital Revenue Code	278
Min. Negotiated Rate	$43.98
Max. Negotiated Rate	$912.50
Rate for Payer: Aetna Commercial	$693.50
Rate for Payer: Aetna Medicare Advantage	$547.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$365.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.38
Rate for Payer: Cigna Commercial	$912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$401.50
Rate for Payer: Qualcare PPO/HMO/WC	$273.75
Rate for Payer: UnitedHealthcare Community & State	$43.98
Rate for Payer: Wellpoint Medicaid Managed Care	$48.36

CATH EQUISTREAM XK 16FR 36CM

Facility

$1,755.00

Service Code	HCPCS C1750
Hospital Charge Code	270653414S
Hospital Revenue Code	278
Min. Negotiated Rate	$263.25
Max. Negotiated Rate	$424.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$351.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$386.10
Rate for Payer: Qualcare PPO/HMO/WC	$263.25

CATH EQUISTREAM XK 16FR 36CM

Facility

$1,755.00

Service Code	HCPCS C1750
Hospital Charge Code	270653414S
Hospital Revenue Code	278
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$877.50
Rate for Payer: Aetna Commercial	$666.90
Rate for Payer: Aetna Medicare Advantage	$526.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$351.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$447.52
Rate for Payer: Cigna Commercial	$877.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$386.10
Rate for Payer: Qualcare PPO/HMO/WC	$263.25
Rate for Payer: UnitedHealthcare Community & State	$42.30
Rate for Payer: Wellpoint Medicaid Managed Care	$46.51

CATH EQUISTREAM XK 16FR 36CM

Facility

$1,825.00

Service Code	HCPCS C1750
Hospital Charge Code	270653414N
Hospital Revenue Code	278
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$441.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$401.50
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

CATH EQUISTREAM XK 16FR 36CM

Facility

$1,755.00

Service Code	HCPCS C1750
Hospital Charge Code	270653414
Hospital Revenue Code	278
Min. Negotiated Rate	$263.25
Max. Negotiated Rate	$424.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$351.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$386.10
Rate for Payer: Qualcare PPO/HMO/WC	$263.25

CATH EQUISTREAM XK 16FR 36CM

Facility

$1,755.00

Service Code	HCPCS C1750
Hospital Charge Code	270653414
Hospital Revenue Code	278
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$877.50
Rate for Payer: Aetna Commercial	$666.90
Rate for Payer: Aetna Medicare Advantage	$526.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$351.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$447.52
Rate for Payer: Cigna Commercial	$877.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.71
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$386.10
Rate for Payer: Qualcare PPO/HMO/WC	$263.25
Rate for Payer: UnitedHealthcare Community & State	$42.30
Rate for Payer: Wellpoint Medicaid Managed Care	$46.51

CATHER BALLON ADM. 60.40.130

Facility

$900.00

Hospital Charge Code	2709003822
Hospital Revenue Code	272
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$135.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

Know your out-of-pocket cost for care.

All Charges