Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATHETER PERFORMA JUDKINS RIGH

Facility

$40.00

Service Code	HCPCS C1887
Hospital Charge Code	270658179
Hospital Revenue Code	278
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

CATHETER PERFORMA JUDKINS RIGH

Facility

$40.00

Hospital Charge Code	270658187
Hospital Revenue Code	278
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) NJ Health	$8.00
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	$9.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

CATHETER PERFORMA JUDKINS RIGH

Facility

$40.00

Hospital Charge Code	270658187
Hospital Revenue Code	278
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

CATHETER PERFORMA LT CORONARY

Facility

$40.00

Hospital Charge Code	270658262
Hospital Revenue Code	278
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) NJ Health	$8.00
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	$9.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

CATHETER PERFORMA LT CORONARY

Facility

$40.00

Hospital Charge Code	270658262
Hospital Revenue Code	278
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

CATHETER PERFORMA MULTIPURPOSE

Facility

$57.50

Hospital Charge Code	270658260
Hospital Revenue Code	278
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$28.75
Rate for Payer: Aetna Commercial	$21.85
Rate for Payer: Aetna Medicare Advantage	$17.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.66
Rate for Payer: Cigna Commercial	$28.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.65
Rate for Payer: Qualcare PPO/HMO/WC	$8.62
Rate for Payer: UnitedHealthcare Community & State	$1.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.52

CATHETER PERFORMA MULTIPURPOSE

Facility

$57.50

Hospital Charge Code	270658260
Hospital Revenue Code	278
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$13.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.91
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.65
Rate for Payer: Qualcare PPO/HMO/WC	$8.62

CATHETER PERFORMA RT CORONARY

Facility

$40.00

Hospital Charge Code	270658264
Hospital Revenue Code	278
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) NJ Health	$8.00
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	$9.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

CATHETER PERFORMA RT CORONARY

Facility

$40.00

Hospital Charge Code	270658264
Hospital Revenue Code	278
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$9.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.68
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.00

CATHETER PERFORMA ULTIMATE

Facility

$77.25

Service Code	HCPCS C1887
Hospital Charge Code	270657626
Hospital Revenue Code	278
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$18.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.59

CATHETER PERFORMA ULTIMATE

Facility

$77.25

Service Code	HCPCS C1887
Hospital Charge Code	270657625
Hospital Revenue Code	278
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$18.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.59

CATHETER PERFORMA ULTIMATE

Facility

$77.25

Service Code	HCPCS C1887
Hospital Charge Code	270657626
Hospital Revenue Code	278
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$38.62
Rate for Payer: Aetna Commercial	$29.36
Rate for Payer: Aetna Medicare Advantage	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.70
Rate for Payer: Cigna Commercial	$38.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.59
Rate for Payer: UnitedHealthcare Community & State	$1.86
Rate for Payer: Wellpoint Medicaid Managed Care	$2.05

CATHETER PERFORMA ULTIMATE

Facility

$77.25

Service Code	HCPCS C1887
Hospital Charge Code	270657625
Hospital Revenue Code	278
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$38.62
Rate for Payer: Aetna Commercial	$29.36
Rate for Payer: Aetna Medicare Advantage	$23.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.70
Rate for Payer: Cigna Commercial	$38.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.69
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$17.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.59
Rate for Payer: UnitedHealthcare Community & State	$1.86
Rate for Payer: Wellpoint Medicaid Managed Care	$2.05

CATHETER PERITONEAL 120CM

Facility

$1,495.00

Hospital Charge Code	270647031
Hospital Revenue Code	278
Min. Negotiated Rate	$224.25
Max. Negotiated Rate	$361.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$328.90
Rate for Payer: Qualcare PPO/HMO/WC	$224.25

CATHETER PERITONEAL 120CM

Facility

$1,495.00

Hospital Charge Code	270647031
Hospital Revenue Code	278
Min. Negotiated Rate	$36.03
Max. Negotiated Rate	$747.50
Rate for Payer: Aetna Commercial	$568.10
Rate for Payer: Aetna Medicare Advantage	$448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$381.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$381.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$381.23
Rate for Payer: Cigna Commercial	$747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$328.90
Rate for Payer: Qualcare PPO/HMO/WC	$224.25
Rate for Payer: UnitedHealthcare Community & State	$36.03
Rate for Payer: Wellpoint Medicaid Managed Care	$39.62

CATHETER PERITONEAL BARDPORT

Facility

$4,115.00

Service Code	HCPCS C1752
Hospital Charge Code	270660589
Hospital Revenue Code	278
Min. Negotiated Rate	$617.25
Max. Negotiated Rate	$995.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$823.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$995.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$905.30
Rate for Payer: Qualcare PPO/HMO/WC	$617.25

CATHETER PERITONEAL BARDPORT

Facility

$4,115.00

Service Code	HCPCS C1752
Hospital Charge Code	270660589
Hospital Revenue Code	278
Min. Negotiated Rate	$99.17
Max. Negotiated Rate	$2,057.50
Rate for Payer: Aetna Commercial	$1,563.70
Rate for Payer: Aetna Medicare Advantage	$1,234.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,049.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,049.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$823.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,049.33
Rate for Payer: Cigna Commercial	$2,057.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$995.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$905.30
Rate for Payer: Qualcare PPO/HMO/WC	$617.25
Rate for Payer: UnitedHealthcare Community & State	$99.17
Rate for Payer: Wellpoint Medicaid Managed Care	$109.05

CATHETER PERITONEAL W/SLITS

Facility

$880.00

Service Code	HCPCS C1752
Hospital Charge Code	270628769
Hospital Revenue Code	278
Min. Negotiated Rate	$21.21
Max. Negotiated Rate	$440.00
Rate for Payer: Aetna Commercial	$334.40
Rate for Payer: Aetna Medicare Advantage	$264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$176.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.40
Rate for Payer: Cigna Commercial	$440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$132.00
Rate for Payer: UnitedHealthcare Community & State	$21.21
Rate for Payer: Wellpoint Medicaid Managed Care	$23.32

CATHETER PERITONEAL W/SLITS

Facility

$880.00

Service Code	HCPCS C1752
Hospital Charge Code	270628769
Hospital Revenue Code	278
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$212.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$176.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$132.00

CATHETER PERITONEL IMPLANT

Facility

$880.00

Service Code	HCPCS C1729
Hospital Charge Code	270659526
Hospital Revenue Code	278
Min. Negotiated Rate	$21.21
Max. Negotiated Rate	$440.00
Rate for Payer: Aetna Commercial	$334.40
Rate for Payer: Aetna Medicare Advantage	$264.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$176.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.40
Rate for Payer: Cigna Commercial	$440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$132.00
Rate for Payer: UnitedHealthcare Community & State	$21.21
Rate for Payer: Wellpoint Medicaid Managed Care	$23.32

CATHETER PERITONEL IMPLANT

Facility

$880.00

Service Code	HCPCS C1729
Hospital Charge Code	270659526
Hospital Revenue Code	278
Min. Negotiated Rate	$132.00
Max. Negotiated Rate	$212.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$176.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$193.60
Rate for Payer: Qualcare PPO/HMO/WC	$132.00

CATHETER PHEMON 27 150 CM

Facility

$6,500.00

Service Code	HCPCS C1887
Hospital Charge Code	270685148S
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

CATHETER PHEMON 27 150 CM

Facility

$6,500.00

Service Code	HCPCS C1887
Hospital Charge Code	270685148S
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

CATHETER PHEMON 27 150 CM

Facility

$6,500.00

Service Code	HCPCS C1887
Hospital Charge Code	270685148
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

CATHETER PHEMON 27 150 CM

Facility

$6,500.00

Service Code	HCPCS C1887
Hospital Charge Code	270685148
Hospital Revenue Code	278
Min. Negotiated Rate	$156.65
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,430.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$156.65
Rate for Payer: Wellpoint Medicaid Managed Care	$172.25

Know your out-of-pocket cost for care.

All Charges