Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATHETER OLIVE TIP 3FR. WOVEN

Facility

$797.00

Hospital Charge Code	270332029
Hospital Revenue Code	278
Min. Negotiated Rate	$119.55
Max. Negotiated Rate	$192.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$175.34
Rate for Payer: Qualcare PPO/HMO/WC	$119.55

CATHETER OLIVE TIP 3FR. WOVEN

Facility

$797.00

Hospital Charge Code	270332029
Hospital Revenue Code	278
Min. Negotiated Rate	$19.21
Max. Negotiated Rate	$398.50
Rate for Payer: Aetna Commercial	$302.86
Rate for Payer: Aetna Medicare Advantage	$239.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$203.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$203.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$203.24
Rate for Payer: Cigna Commercial	$398.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.87
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$175.34
Rate for Payer: Qualcare PPO/HMO/WC	$119.55
Rate for Payer: UnitedHealthcare Community & State	$19.21
Rate for Payer: Wellpoint Medicaid Managed Care	$21.12

CATHETER OLIVE TIP URETERAL4FR

Facility

$44.58

Hospital Charge Code	270663719
Hospital Revenue Code	278
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$22.29
Rate for Payer: Aetna Commercial	$16.94
Rate for Payer: Aetna Medicare Advantage	$13.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.37
Rate for Payer: Cigna Commercial	$22.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$6.69
Rate for Payer: UnitedHealthcare Community & State	$1.07
Rate for Payer: Wellpoint Medicaid Managed Care	$1.18

CATHETER OLIVE TIP URETERAL4FR

Facility

$44.58

Hospital Charge Code	270663719
Hospital Revenue Code	278
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$10.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$6.69

CATHETER OLIVE TIP URETERAL5FR

Facility

$44.58

Hospital Charge Code	270663720
Hospital Revenue Code	278
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$10.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$6.69

CATHETER OLIVE TIP URETERAL5FR

Facility

$44.58

Hospital Charge Code	270663720
Hospital Revenue Code	278
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$22.29
Rate for Payer: Aetna Commercial	$16.94
Rate for Payer: Aetna Medicare Advantage	$13.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.37
Rate for Payer: Cigna Commercial	$22.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$9.81
Rate for Payer: Qualcare PPO/HMO/WC	$6.69
Rate for Payer: UnitedHealthcare Community & State	$1.07
Rate for Payer: Wellpoint Medicaid Managed Care	$1.18

CATHETER OPTITORQUE 5FR JACKY

Facility

$275.00

Hospital Charge Code	2709007304
Hospital Revenue Code	272
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CATHETER OPTITORQUE 5FR JACKY

Facility

$275.00

Hospital Charge Code	2709007304
Hospital Revenue Code	272
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Oxford Commercial	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Commercial	$55.00
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

CATHETER OPTITORQUE 5FR TIGER

Facility

$275.00

Hospital Charge Code	2709007303
Hospital Revenue Code	272
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.50
Rate for Payer: Oxford Commercial	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Commercial	$55.00
Rate for Payer: UnitedHealthcare Community & State	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

CATHETER OPTITORQUE 5FR TIGER

Facility

$275.00

Hospital Charge Code	2709007303
Hospital Revenue Code	272
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

CATHETER OTW SPLIT 5913230

Facility

$1,755.00

Service Code	HCPCS C1750
Hospital Charge Code	270661418S
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

CATHETER OTW SPLIT 5913230

Facility

$1,925.00

Service Code	HCPCS C1750
Hospital Charge Code	270661418N
Hospital Revenue Code	278
Min. Negotiated Rate	$46.39
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$731.50
Rate for Payer: Aetna Medicare Advantage	$577.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Community & State	$46.39
Rate for Payer: Wellpoint Medicaid Managed Care	$51.01

CATHETER OTW SPLIT 5913230

Facility

$1,925.00

Service Code	HCPCS C1750
Hospital Charge Code	270661418N
Hospital Revenue Code	278
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$465.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

CATHETER OTW SPLIT 5913230

Facility

$1,755.00

Service Code	HCPCS C1750
Hospital Charge Code	270661418S
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

CATHETER OTW SPLIT 5913230

Facility

$1,755.00

Service Code	HCPCS C1750
Hospital Charge Code	270661418
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

CATHETER OTW SPLIT 5913230

Facility

$1,755.00

Service Code	HCPCS C1750
Hospital Charge Code	270661418
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

CATHETER OTW, XK, 19cm ST SPLI

Facility

$1,925.00

Hospital Charge Code	270CH0057
Hospital Revenue Code	272
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$288.75
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

CATHETER OTW, XK, 19cm ST SPLI

Facility

$1,925.00

Hospital Charge Code	270CH0057
Hospital Revenue Code	272
Min. Negotiated Rate	$46.39
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$731.50
Rate for Payer: Aetna Medicare Advantage	$577.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$577.50
Rate for Payer: Oxford Commercial	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Commercial	$385.00
Rate for Payer: UnitedHealthcare Community & State	$46.39
Rate for Payer: Wellpoint Medicaid Managed Care	$51.01

CATHETER OTW, XK, 23cm ST SPLI

Facility

$1,925.00

Hospital Charge Code	270CH0058
Hospital Revenue Code	272
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$288.75
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

CATHETER OTW, XK, 23cm ST SPLI

Facility

$1,925.00

Hospital Charge Code	270CH0058
Hospital Revenue Code	272
Min. Negotiated Rate	$46.39
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$731.50
Rate for Payer: Aetna Medicare Advantage	$577.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$577.50
Rate for Payer: Oxford Commercial	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Commercial	$385.00
Rate for Payer: UnitedHealthcare Community & State	$46.39
Rate for Payer: Wellpoint Medicaid Managed Care	$51.01

CATHETER OTW XK 27CM SPLIT

Facility

$1,825.00

Service Code	HCPCS C1750
Hospital Charge Code	270661404S
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

CATHETER OTW XK 27CM SPLIT

Facility

$1,825.00

Service Code	HCPCS C1750
Hospital Charge Code	270661404
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

CATHETER OTW XK 27CM SPLIT

Facility

$1,825.00

Service Code	HCPCS C1750
Hospital Charge Code	270661404
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

CATHETER OTW XK 27CM SPLIT

Facility

$1,825.00

Service Code	HCPCS C1750
Hospital Charge Code	270661404S
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

CATHETER OTW XK 27CM SPLIT

Facility

$1,925.00

Service Code	HCPCS C1750
Hospital Charge Code	270661404N
Hospital Revenue Code	278
Min. Negotiated Rate	$46.39
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$731.50
Rate for Payer: Aetna Medicare Advantage	$577.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Community & State	$46.39
Rate for Payer: Wellpoint Medicaid Managed Care	$51.01

Know your out-of-pocket cost for care.

All Charges