Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATHETER JETSTREAM G3 SF 1.6

Facility

$16,500.00

Hospital Charge Code	270CH0005
Hospital Revenue Code	272
Min. Negotiated Rate	$397.65
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,950.00
Rate for Payer: Oxford Commercial	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Commercial	$3,300.00
Rate for Payer: UnitedHealthcare Community & State	$397.65
Rate for Payer: Wellpoint Medicaid Managed Care	$437.25

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,500.00

Hospital Charge Code	270CH0006
Hospital Revenue Code	272
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270661977S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270661977
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,500.00

Hospital Charge Code	2709007406
Hospital Revenue Code	272
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270661977
Hospital Revenue Code	278
Min. Negotiated Rate	$388.61
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$388.61
Rate for Payer: Wellpoint Medicaid Managed Care	$427.31

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270661977N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270661977S
Hospital Revenue Code	278
Min. Negotiated Rate	$388.61
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$388.61
Rate for Payer: Wellpoint Medicaid Managed Care	$427.31

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,500.00

Hospital Charge Code	270CH0006
Hospital Revenue Code	272
Min. Negotiated Rate	$397.65
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,950.00
Rate for Payer: Oxford Commercial	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Commercial	$3,300.00
Rate for Payer: UnitedHealthcare Community & State	$397.65
Rate for Payer: Wellpoint Medicaid Managed Care	$437.25

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,500.00

Hospital Charge Code	2709007406
Hospital Revenue Code	272
Min. Negotiated Rate	$397.65
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,950.00
Rate for Payer: Oxford Commercial	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Commercial	$3,300.00
Rate for Payer: UnitedHealthcare Community & State	$397.65
Rate for Payer: Wellpoint Medicaid Managed Care	$437.25

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270661977N
Hospital Revenue Code	278
Min. Negotiated Rate	$388.61
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$388.61
Rate for Payer: Wellpoint Medicaid Managed Care	$427.31

CATHETER JETSTREAM NAVITUS

Facility

$16,500.00

Hospital Charge Code	270CH0004
Hospital Revenue Code	272
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

CATHETER JETSTREAM NAVITUS

Facility

$16,500.00

Hospital Charge Code	270CH0004
Hospital Revenue Code	272
Min. Negotiated Rate	$397.65
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,950.00
Rate for Payer: Oxford Commercial	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Commercial	$3,300.00
Rate for Payer: UnitedHealthcare Community & State	$397.65
Rate for Payer: Wellpoint Medicaid Managed Care	$437.25

CATHETER JETSTREAM NAVITUS

Facility

$16,500.00

Hospital Charge Code	2709007404
Hospital Revenue Code	272
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

CATHETER JETSTREAM NAVITUS

Facility

$16,500.00

Hospital Charge Code	2709007404
Hospital Revenue Code	272
Min. Negotiated Rate	$397.65
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,950.00
Rate for Payer: Oxford Commercial	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Commercial	$3,300.00
Rate for Payer: UnitedHealthcare Community & State	$397.65
Rate for Payer: Wellpoint Medicaid Managed Care	$437.25

CATHETER JETSTREAM NAVITUS-L

Facility

$16,500.00

Hospital Charge Code	270CH0003
Hospital Revenue Code	272
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

CATHETER JETSTREAM NAVITUS-L

Facility

$16,500.00

Hospital Charge Code	270CH0003
Hospital Revenue Code	272
Min. Negotiated Rate	$397.65
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,950.00
Rate for Payer: Oxford Commercial	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Commercial	$3,300.00
Rate for Payer: UnitedHealthcare Community & State	$397.65
Rate for Payer: Wellpoint Medicaid Managed Care	$437.25

CATHETER JETSTREAM NAVITUS-L

Facility

$16,500.00

Hospital Charge Code	2709007403
Hospital Revenue Code	272
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$2,475.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

CATHETER JETSTREAM NAVITUS-L

Facility

$16,500.00

Hospital Charge Code	2709007403
Hospital Revenue Code	272
Min. Negotiated Rate	$397.65
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,950.00
Rate for Payer: Oxford Commercial	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Commercial	$3,300.00
Rate for Payer: UnitedHealthcare Community & State	$397.65
Rate for Payer: Wellpoint Medicaid Managed Care	$437.25

CATHETER JETSTREAM XC 2.1/3MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270643857S
Hospital Revenue Code	278
Min. Negotiated Rate	$388.61
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$388.61
Rate for Payer: Wellpoint Medicaid Managed Care	$427.31

CATHETER JETSTREAM XC 2.1/3MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270643857
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM XC 2.1/3MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270643857
Hospital Revenue Code	278
Min. Negotiated Rate	$388.61
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$388.61
Rate for Payer: Wellpoint Medicaid Managed Care	$427.31

CATHETER JETSTREAM XC 2.1/3MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270643857S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM XC 2.1/3MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270643857N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM XC 2.1/3MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270643857N
Hospital Revenue Code	278
Min. Negotiated Rate	$388.61
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,547.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$388.61
Rate for Payer: Wellpoint Medicaid Managed Care	$427.31

Know your out-of-pocket cost for care.

All Charges