Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATHETER JETSTREAM XC, 2.4MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270647519S
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, 2.4MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270647519S
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, 2.4MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270647519N
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, 2.4MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270647519N
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 JL6.0/100CM/.035

Facility

$40.00

Hospital Charge Code	2709000392
Hospital Revenue Code	272
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

CATHETER JL6.0/100CM/.035

Facility

$40.00

Hospital Charge Code	2709000392
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

CATHETER JL6.0 6FR/100CM/.035

Facility

$37.35

Service Code	HCPCS C1887
Hospital Charge Code	270658052
Hospital Revenue Code	278
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$18.68
Rate for Payer: Aetna Commercial	$14.19
Rate for Payer: Aetna Medicare Advantage	$11.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.52
Rate for Payer: Cigna Commercial	$18.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.22
Rate for Payer: Qualcare PPO/HMO/WC	$5.60
Rate for Payer: UnitedHealthcare Community & State	$0.90
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

CATHETER JL6.0 6FR/100CM/.035

Facility

$37.35

Service Code	HCPCS C1887
Hospital Charge Code	270658022
Hospital Revenue Code	278
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$18.68
Rate for Payer: Aetna Commercial	$14.19
Rate for Payer: Aetna Medicare Advantage	$11.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.52
Rate for Payer: Cigna Commercial	$18.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.22
Rate for Payer: Qualcare PPO/HMO/WC	$5.60
Rate for Payer: UnitedHealthcare Community & State	$0.90
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

CATHETER JL6.0 6FR/100CM/.035

Facility

$37.35

Service Code	HCPCS C1887
Hospital Charge Code	270658052
Hospital Revenue Code	278
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$9.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.22
Rate for Payer: Qualcare PPO/HMO/WC	$5.60

CATHETER JL6.0 6FR/100CM/.035

Facility

$37.35

Service Code	HCPCS C1887
Hospital Charge Code	270658022
Hospital Revenue Code	278
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$9.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.04
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.22
Rate for Payer: Qualcare PPO/HMO/WC	$5.60

CATHETER JR6.06FR/100CM/.038

Facility

$40.00

Hospital Charge Code	2709000393
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

CATHETER JR6.06FR/100CM/.038

Facility

$40.00

Hospital Charge Code	2709000393
Hospital Revenue Code	272
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna Commercial	$15.20
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.20
Rate for Payer: Cigna Commercial	$20.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.00
Rate for Payer: Oxford Commercial	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

CATHETER JR6.0FR.100CM/.038

Facility

$47.25

Service Code	HCPCS C1887
Hospital Charge Code	270658031
Hospital Revenue Code	278
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$11.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10.39
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

CATHETER JR6.0FR.100CM/.038

Facility

$47.25

Service Code	HCPCS C1887
Hospital Charge Code	270658031
Hospital Revenue Code	278
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$23.62
Rate for Payer: Aetna Commercial	$17.95
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.05
Rate for Payer: Cigna Commercial	$23.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$10.39
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

CATHETER JR6.0FR.100CM/.038

Facility

$8.00

Service Code	HCPCS C1887
Hospital Charge Code	270658031N
Hospital Revenue Code	278
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1.76
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

CATHETER JR6.0FR.100CM/.038

Facility

$45.25

Service Code	HCPCS C1887
Hospital Charge Code	270658031S
Hospital Revenue Code	278
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$10.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9.96
Rate for Payer: Qualcare PPO/HMO/WC	$6.79

CATHETER JR6.0FR.100CM/.038

Facility

$8.00

Service Code	HCPCS C1887
Hospital Charge Code	270658031N
Hospital Revenue Code	278
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1.76
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

CATHETER JR6.0FR.100CM/.038

Facility

$45.25

Service Code	HCPCS C1887
Hospital Charge Code	270658031S
Hospital Revenue Code	278
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$22.62
Rate for Payer: Aetna Commercial	$17.20
Rate for Payer: Aetna Medicare Advantage	$13.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.54
Rate for Payer: Cigna Commercial	$22.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9.96
Rate for Payer: Qualcare PPO/HMO/WC	$6.79
Rate for Payer: UnitedHealthcare Community & State	$1.09
Rate for Payer: Wellpoint Medicaid Managed Care	$1.20

CATHETER JUDKINS RIGH T6FR .07

Facility

$90.00

Hospital Charge Code	270667182
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CATHETER JUDKINS RIGH T6FR .07

Facility

$90.00

Hospital Charge Code	270667182
Hospital Revenue Code	272
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.00
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

CATHETER KIT INFANT 5FR

Facility

$8.67

Service Code	HCPCS A4338
Hospital Charge Code	270650094
Hospital Revenue Code	272
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$1.30

CATHETER KIT INFANT 5FR

Facility

$8.67

Service Code	HCPCS A4338
Hospital Charge Code	270650094
Hospital Revenue Code	272
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.33
Rate for Payer: Aetna Commercial	$3.29
Rate for Payer: Aetna Medicare Advantage	$2.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.21
Rate for Payer: Cigna Commercial	$4.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.60
Rate for Payer: Oxford Commercial	$1.73
Rate for Payer: Qualcare PPO/HMO/WC	$1.30
Rate for Payer: UnitedHealthcare Commercial	$1.73
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

CATHETER KIT TENCKHOFF 42CM

Facility

$438.95

Hospital Charge Code	270660019
Hospital Revenue Code	272
Min. Negotiated Rate	$10.58
Max. Negotiated Rate	$219.47
Rate for Payer: Aetna Commercial	$166.80
Rate for Payer: Aetna Medicare Advantage	$131.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.93
Rate for Payer: Cigna Commercial	$219.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.69
Rate for Payer: Oxford Commercial	$87.79
Rate for Payer: Qualcare PPO/HMO/WC	$65.84
Rate for Payer: UnitedHealthcare Commercial	$87.79
Rate for Payer: UnitedHealthcare Community & State	$10.58
Rate for Payer: Wellpoint Medicaid Managed Care	$11.63

CATHETER KIT TENCKHOFF 42CM

Facility

$438.95

Hospital Charge Code	270660019
Hospital Revenue Code	272
Min. Negotiated Rate	$65.84
Max. Negotiated Rate	$65.84
Rate for Payer: Qualcare PPO/HMO/WC	$65.84

CATHETER KIT UROFORCE 4MMx6CM

Facility

$813.40

Hospital Charge Code	270682632
Hospital Revenue Code	272
Min. Negotiated Rate	$122.01
Max. Negotiated Rate	$122.01
Rate for Payer: Qualcare PPO/HMO/WC	$122.01

Know your out-of-pocket cost for care.

All Charges