Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATHETER ASH SPLIT 14F X 40CM

Facility

$1,750.00

Service Code	HCPCS C1750
Hospital Charge Code	270661307S
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

CATHETER ASH SPLIT 14F X 40CM

Facility

$1,800.00

Service Code	HCPCS C1750
Hospital Charge Code	270661307N
Hospital Revenue Code	278
Min. Negotiated Rate	$43.38
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$684.00
Rate for Payer: Aetna Medicare Advantage	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.00
Rate for Payer: Cigna Commercial	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$396.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00
Rate for Payer: UnitedHealthcare Community & State	$43.38
Rate for Payer: Wellpoint Medicaid Managed Care	$47.70

CATHETER ASH SPLIT 32FR

Facility

$1,750.00

Service Code	HCPCS C1750
Hospital Charge Code	270650776
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

CATHETER ASH SPLIT 32FR

Facility

$1,750.00

Service Code	HCPCS C1750
Hospital Charge Code	270650776
Hospital Revenue Code	278
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

CATHETER ASPIRA PERITON15.5FR

Facility

$2,500.00

Hospital Charge Code	270679381
Hospital Revenue Code	272
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

CATHETER ASPIRA PERITON15.5FR

Facility

$2,500.00

Hospital Charge Code	270679381
Hospital Revenue Code	272
Min. Negotiated Rate	$60.25
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.00
Rate for Payer: Oxford Commercial	$500.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Commercial	$500.00
Rate for Payer: UnitedHealthcare Community & State	$60.25
Rate for Payer: Wellpoint Medicaid Managed Care	$66.25

CATHETER ASPIRA PLEURL 4992506

Facility

$2,537.50

Service Code	HCPCS C1729
Hospital Charge Code	270649128
Hospital Revenue Code	278
Min. Negotiated Rate	$380.62
Max. Negotiated Rate	$614.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$507.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$614.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$558.25
Rate for Payer: Qualcare PPO/HMO/WC	$380.62

CATHETER ASPIRA PLEURL 4992506

Facility

$2,537.50

Service Code	HCPCS C1729
Hospital Charge Code	270649128
Hospital Revenue Code	278
Min. Negotiated Rate	$61.15
Max. Negotiated Rate	$1,268.75
Rate for Payer: Aetna Commercial	$964.25
Rate for Payer: Aetna Medicare Advantage	$761.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$647.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$647.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$507.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$647.06
Rate for Payer: Cigna Commercial	$1,268.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$614.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$558.25
Rate for Payer: Qualcare PPO/HMO/WC	$380.62
Rate for Payer: UnitedHealthcare Community & State	$61.15
Rate for Payer: Wellpoint Medicaid Managed Care	$67.24

CATHETER ASPIRATION SEPARATOR7

Facility

$8,400.00

Service Code	HCPCS C1757
Hospital Charge Code	270693838S
Hospital Revenue Code	278
Min. Negotiated Rate	$202.44
Max. Negotiated Rate	$4,200.00
Rate for Payer: Aetna Commercial	$3,192.00
Rate for Payer: Aetna Medicare Advantage	$2,520.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,142.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,142.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,142.00
Rate for Payer: Cigna Commercial	$4,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,032.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,848.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,260.00
Rate for Payer: UnitedHealthcare Community & State	$202.44
Rate for Payer: Wellpoint Medicaid Managed Care	$222.60

CATHETER ASPIRATION SEPARATOR7

Facility

$8,400.00

Service Code	HCPCS C1757
Hospital Charge Code	270693838S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,260.00
Max. Negotiated Rate	$2,032.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,032.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,848.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,260.00

CATHETER ASPIRATION ZOOM 45M

Facility

$12,425.00

Service Code	HCPCS C1757
Hospital Charge Code	270694802S
Hospital Revenue Code	278
Min. Negotiated Rate	$299.44
Max. Negotiated Rate	$6,212.50
Rate for Payer: Aetna Commercial	$4,721.50
Rate for Payer: Aetna Medicare Advantage	$3,727.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,168.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,168.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,168.38
Rate for Payer: Cigna Commercial	$6,212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,006.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,733.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,863.75
Rate for Payer: UnitedHealthcare Community & State	$299.44
Rate for Payer: Wellpoint Medicaid Managed Care	$329.26

CATHETER ASPIRATION ZOOM 45M

Facility

$12,425.00

Service Code	HCPCS C1757
Hospital Charge Code	270694802S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,863.75
Max. Negotiated Rate	$3,006.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,485.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,006.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,733.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,863.75

CATHETER ASP LIGHTNING BOLT

Facility

$40,100.00

Service Code	HCPCS C1887
Hospital Charge Code	270700572S
Hospital Revenue Code	278
Min. Negotiated Rate	$6,015.00
Max. Negotiated Rate	$9,704.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,020.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,704.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,822.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,015.00

CATHETER ASP LIGHTNING BOLT

Facility

$40,100.00

Service Code	HCPCS C1887
Hospital Charge Code	270700572S
Hospital Revenue Code	278
Min. Negotiated Rate	$966.41
Max. Negotiated Rate	$20,050.00
Rate for Payer: Aetna Commercial	$15,238.00
Rate for Payer: Aetna Medicare Advantage	$12,030.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,225.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,225.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,225.50
Rate for Payer: Cigna Commercial	$20,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,704.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,822.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,015.00
Rate for Payer: UnitedHealthcare Community & State	$966.41
Rate for Payer: Wellpoint Medicaid Managed Care	$1,062.65

CATHETER AVIATOR PTA 6X30MM

Facility

$1,710.00

Service Code	HCPCS C1725
Hospital Charge Code	270688838S
Hospital Revenue Code	278
Min. Negotiated Rate	$256.50
Max. Negotiated Rate	$413.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$342.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$413.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$376.20
Rate for Payer: Qualcare PPO/HMO/WC	$256.50

CATHETER AVIATOR PTA 6X30MM

Facility

$1,710.00

Service Code	HCPCS C1725
Hospital Charge Code	270688838S
Hospital Revenue Code	278
Min. Negotiated Rate	$41.21
Max. Negotiated Rate	$855.00
Rate for Payer: Aetna Commercial	$649.80
Rate for Payer: Aetna Medicare Advantage	$513.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$436.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$436.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$436.05
Rate for Payer: Cigna Commercial	$855.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$413.82
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$376.20
Rate for Payer: Qualcare PPO/HMO/WC	$256.50
Rate for Payer: UnitedHealthcare Community & State	$41.21
Rate for Payer: Wellpoint Medicaid Managed Care	$45.31

CATHETER AXS CAT 5

Facility

$10,901.25

Service Code	HCPCS C1887
Hospital Charge Code	270690864
Hospital Revenue Code	278
Min. Negotiated Rate	$262.72
Max. Negotiated Rate	$5,450.62
Rate for Payer: Aetna Commercial	$4,142.48
Rate for Payer: Aetna Medicare Advantage	$3,270.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,779.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,779.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,180.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,779.82
Rate for Payer: Cigna Commercial	$5,450.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,638.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,398.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,635.19
Rate for Payer: UnitedHealthcare Community & State	$262.72
Rate for Payer: Wellpoint Medicaid Managed Care	$288.88

CATHETER AXS CAT 5

Facility

$10,901.25

Service Code	HCPCS C1887
Hospital Charge Code	270690864
Hospital Revenue Code	278
Min. Negotiated Rate	$1,635.19
Max. Negotiated Rate	$2,638.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,180.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,638.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,398.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,635.19

CATHETER AXS CATALST 6

Facility

$11,475.00

Hospital Charge Code	270685067
Hospital Revenue Code	272
Min. Negotiated Rate	$1,721.25
Max. Negotiated Rate	$1,721.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25

CATHETER AXS CATALST 6

Facility

$11,475.00

Hospital Charge Code	270685067
Hospital Revenue Code	272
Min. Negotiated Rate	$276.55
Max. Negotiated Rate	$5,737.50
Rate for Payer: Aetna Commercial	$4,360.50
Rate for Payer: Aetna Medicare Advantage	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,926.12
Rate for Payer: Cigna Commercial	$5,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,442.50
Rate for Payer: Oxford Commercial	$2,295.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25
Rate for Payer: UnitedHealthcare Commercial	$2,295.00
Rate for Payer: UnitedHealthcare Community & State	$276.55
Rate for Payer: Wellpoint Medicaid Managed Care	$304.09

CATHETER BAL ECLIPSE 2L 6X12MM

Facility

$9,250.00

Service Code	HCPCS C2628
Hospital Charge Code	270698131S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

CATHETER BAL ECLIPSE 2L 6X12MM

Facility

$9,250.00

Service Code	HCPCS C2628
Hospital Charge Code	270698131S
Hospital Revenue Code	278
Min. Negotiated Rate	$222.93
Max. Negotiated Rate	$4,625.00
Rate for Payer: Aetna Commercial	$3,515.00
Rate for Payer: Aetna Medicare Advantage	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.75
Rate for Payer: Cigna Commercial	$4,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50
Rate for Payer: UnitedHealthcare Community & State	$222.93
Rate for Payer: Wellpoint Medicaid Managed Care	$245.12

CATHETER BAL ECLIPSE 2L 6X9

Facility

$9,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270697721S
Hospital Revenue Code	278
Min. Negotiated Rate	$222.93
Max. Negotiated Rate	$4,625.00
Rate for Payer: Aetna Commercial	$3,515.00
Rate for Payer: Aetna Medicare Advantage	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.75
Rate for Payer: Cigna Commercial	$4,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50
Rate for Payer: UnitedHealthcare Community & State	$222.93
Rate for Payer: Wellpoint Medicaid Managed Care	$245.12

CATHETER BAL ECLIPSE 2L 6X9

Facility

$9,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270697721S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

CATHETER BALLON UDT/4-4/5/75

Facility

$1,058.40

Hospital Charge Code	2703100588
Hospital Revenue Code	272
Min. Negotiated Rate	$158.76
Max. Negotiated Rate	$158.76
Rate for Payer: Qualcare PPO/HMO/WC	$158.76

Know your out-of-pocket cost for care.

All Charges