Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATHETER REPERFUSION 3MAX

Facility

$7,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682973N
Hospital Revenue Code	278
Min. Negotiated Rate	$179.54
Max. Negotiated Rate	$3,725.00
Rate for Payer: Aetna Commercial	$2,831.00
Rate for Payer: Aetna Medicare Advantage	$2,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,899.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,899.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,899.75
Rate for Payer: Cigna Commercial	$3,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,802.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,639.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.50
Rate for Payer: UnitedHealthcare Community & State	$179.54
Rate for Payer: Wellpoint Medicaid Managed Care	$197.43

CATHETER REPERFUSION 3MAX

Facility

$7,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682973
Hospital Revenue Code	278
Min. Negotiated Rate	$179.54
Max. Negotiated Rate	$3,725.00
Rate for Payer: Aetna Commercial	$2,831.00
Rate for Payer: Aetna Medicare Advantage	$2,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,899.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,899.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,899.75
Rate for Payer: Cigna Commercial	$3,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,802.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,639.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.50
Rate for Payer: UnitedHealthcare Community & State	$179.54
Rate for Payer: Wellpoint Medicaid Managed Care	$197.43

CATHETER REPERFUSION 3MAX

Facility

$7,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682973
Hospital Revenue Code	278
Min. Negotiated Rate	$1,117.50
Max. Negotiated Rate	$1,802.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,802.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,639.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.50

CATHETER REPERFUSION 4MAX

Facility

$7,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682972N
Hospital Revenue Code	278
Min. Negotiated Rate	$179.54
Max. Negotiated Rate	$3,725.00
Rate for Payer: Aetna Commercial	$2,831.00
Rate for Payer: Aetna Medicare Advantage	$2,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,899.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,899.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,899.75
Rate for Payer: Cigna Commercial	$3,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,802.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,639.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.50
Rate for Payer: UnitedHealthcare Community & State	$179.54
Rate for Payer: Wellpoint Medicaid Managed Care	$197.43

CATHETER REPERFUSION 4MAX

Facility

$7,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682972N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,117.50
Max. Negotiated Rate	$1,802.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,802.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,639.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.50

CATHETER REPERFUSION 4MAX

Facility

$7,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682972
Hospital Revenue Code	278
Min. Negotiated Rate	$179.54
Max. Negotiated Rate	$3,725.00
Rate for Payer: Aetna Commercial	$2,831.00
Rate for Payer: Aetna Medicare Advantage	$2,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,899.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,899.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,899.75
Rate for Payer: Cigna Commercial	$3,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,802.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,639.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.50
Rate for Payer: UnitedHealthcare Community & State	$179.54
Rate for Payer: Wellpoint Medicaid Managed Care	$197.43

CATHETER REPERFUSION 4MAX

Facility

$7,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682972
Hospital Revenue Code	278
Min. Negotiated Rate	$1,117.50
Max. Negotiated Rate	$1,802.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,802.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,639.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.50

CATHETER REPERFUSION ACE132

Facility

$11,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682971N
Hospital Revenue Code	278
Min. Negotiated Rate	$275.94
Max. Negotiated Rate	$5,725.00
Rate for Payer: Aetna Commercial	$4,351.00
Rate for Payer: Aetna Medicare Advantage	$3,435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,919.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,919.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,919.75
Rate for Payer: Cigna Commercial	$5,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,519.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,717.50
Rate for Payer: UnitedHealthcare Community & State	$275.94
Rate for Payer: Wellpoint Medicaid Managed Care	$303.43

CATHETER REPERFUSION ACE132

Facility

$11,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682971
Hospital Revenue Code	278
Min. Negotiated Rate	$1,717.50
Max. Negotiated Rate	$2,770.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,519.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,717.50

CATHETER REPERFUSION ACE132

Facility

$11,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682971
Hospital Revenue Code	278
Min. Negotiated Rate	$275.94
Max. Negotiated Rate	$5,725.00
Rate for Payer: Aetna Commercial	$4,351.00
Rate for Payer: Aetna Medicare Advantage	$3,435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,919.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,919.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,919.75
Rate for Payer: Cigna Commercial	$5,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,519.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,717.50
Rate for Payer: UnitedHealthcare Community & State	$275.94
Rate for Payer: Wellpoint Medicaid Managed Care	$303.43

CATHETER REPERFUSION ACE132

Facility

$11,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682971N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,717.50
Max. Negotiated Rate	$2,770.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,519.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,717.50

CATHETER REPERFUSION ACE64

Facility

$11,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682970N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.50
Max. Negotiated Rate	$2,891.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,629.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50

CATHETER REPERFUSION ACE64

Facility

$11,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682970N
Hospital Revenue Code	278
Min. Negotiated Rate	$288.00
Max. Negotiated Rate	$5,975.00
Rate for Payer: Aetna Commercial	$4,541.00
Rate for Payer: Aetna Medicare Advantage	$3,585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,047.25
Rate for Payer: Cigna Commercial	$5,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,629.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50
Rate for Payer: UnitedHealthcare Community & State	$288.00
Rate for Payer: Wellpoint Medicaid Managed Care	$316.68

CATHETER REPERFUSION ACE64

Facility

$11,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682970
Hospital Revenue Code	278
Min. Negotiated Rate	$288.00
Max. Negotiated Rate	$5,975.00
Rate for Payer: Aetna Commercial	$4,541.00
Rate for Payer: Aetna Medicare Advantage	$3,585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,047.25
Rate for Payer: Cigna Commercial	$5,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,629.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50
Rate for Payer: UnitedHealthcare Community & State	$288.00
Rate for Payer: Wellpoint Medicaid Managed Care	$316.68

CATHETER REPERFUSION ACE64

Facility

$11,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682970
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.50
Max. Negotiated Rate	$2,891.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,629.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50

CATHETER REPERFUSION ACE68

Facility

$11,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682969N
Hospital Revenue Code	278
Min. Negotiated Rate	$288.00
Max. Negotiated Rate	$5,975.00
Rate for Payer: Aetna Commercial	$4,541.00
Rate for Payer: Aetna Medicare Advantage	$3,585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,047.25
Rate for Payer: Cigna Commercial	$5,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,629.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50
Rate for Payer: UnitedHealthcare Community & State	$288.00
Rate for Payer: Wellpoint Medicaid Managed Care	$316.68

CATHETER REPERFUSION ACE68

Facility

$11,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682969N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.50
Max. Negotiated Rate	$2,891.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,629.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50

CATHETER REPERFUSION ACE68

Facility

$11,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682969
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.50
Max. Negotiated Rate	$2,891.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,629.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50

CATHETER REPERFUSION ACE68

Facility

$11,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682969
Hospital Revenue Code	278
Min. Negotiated Rate	$288.00
Max. Negotiated Rate	$5,975.00
Rate for Payer: Aetna Commercial	$4,541.00
Rate for Payer: Aetna Medicare Advantage	$3,585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,047.25
Rate for Payer: Cigna Commercial	$5,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,629.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50
Rate for Payer: UnitedHealthcare Community & State	$288.00
Rate for Payer: Wellpoint Medicaid Managed Care	$316.68

CATHETER REPERFUSION RED68

Facility

$13,975.00

Service Code	HCPCS C1757
Hospital Charge Code	270693922S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,096.25
Max. Negotiated Rate	$3,381.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,381.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,074.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25

CATHETER REPERFUSION RED68

Facility

$13,975.00

Service Code	HCPCS C1757
Hospital Charge Code	270693922S
Hospital Revenue Code	278
Min. Negotiated Rate	$336.80
Max. Negotiated Rate	$6,987.50
Rate for Payer: Aetna Commercial	$5,310.50
Rate for Payer: Aetna Medicare Advantage	$4,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,563.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,563.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,563.62
Rate for Payer: Cigna Commercial	$6,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,381.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,074.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25
Rate for Payer: UnitedHealthcare Community & State	$336.80
Rate for Payer: Wellpoint Medicaid Managed Care	$370.34

CATHETER REPERFUSION RED68

Facility

$13,975.00

Service Code	HCPCS C1757
Hospital Charge Code	270693922
Hospital Revenue Code	278
Min. Negotiated Rate	$2,096.25
Max. Negotiated Rate	$3,381.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,381.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,074.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25

CATHETER REPERFUSION RED68

Facility

$13,975.00

Service Code	HCPCS C1757
Hospital Charge Code	270693922
Hospital Revenue Code	278
Min. Negotiated Rate	$336.80
Max. Negotiated Rate	$6,987.50
Rate for Payer: Aetna Commercial	$5,310.50
Rate for Payer: Aetna Medicare Advantage	$4,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,563.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,563.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,563.62
Rate for Payer: Cigna Commercial	$6,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,381.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,074.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25
Rate for Payer: UnitedHealthcare Community & State	$336.80
Rate for Payer: Wellpoint Medicaid Managed Care	$370.34

CATHETER REPERF ZOOM 055 137CM

Facility

$12,425.00

Service Code	HCPCS C1757
Hospital Charge Code	270694792S
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 REPERF ZOOM 055 137CM

Facility

$12,425.00

Service Code	HCPCS C1757
Hospital Charge Code	270694792S
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

Know your out-of-pocket cost for care.

All Charges