Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATHETER SOLID CROWNORBITAL2MM

Facility

$15,975.00

Hospital Charge Code	270642015
Hospital Revenue Code	278
Min. Negotiated Rate	$385.00
Max. Negotiated Rate	$7,987.50
Rate for Payer: Aetna Commercial	$6,070.50
Rate for Payer: Aetna Medicare Advantage	$4,792.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,073.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,073.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,073.62
Rate for Payer: Cigna Commercial	$7,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,865.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,514.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,396.25
Rate for Payer: UnitedHealthcare Community & State	$385.00
Rate for Payer: Wellpoint Medicaid Managed Care	$423.34

CATHETER SOLID CROWNORBITAL2MM

Facility

$15,975.00

Hospital Charge Code	270642015
Hospital Revenue Code	278
Min. Negotiated Rate	$2,396.25
Max. Negotiated Rate	$3,865.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,865.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,514.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,396.25

CATHETER SOLID CROWN ORBITAL A

Facility

$15,975.00

Hospital Charge Code	270642501
Hospital Revenue Code	278
Min. Negotiated Rate	$385.00
Max. Negotiated Rate	$7,987.50
Rate for Payer: Aetna Commercial	$6,070.50
Rate for Payer: Aetna Medicare Advantage	$4,792.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,073.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,073.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,073.62
Rate for Payer: Cigna Commercial	$7,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,865.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,514.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,396.25
Rate for Payer: UnitedHealthcare Community & State	$385.00
Rate for Payer: Wellpoint Medicaid Managed Care	$423.34

CATHETER SOLID CROWN ORBITAL A

Facility

$15,975.00

Hospital Charge Code	270642501
Hospital Revenue Code	278
Min. Negotiated Rate	$2,396.25
Max. Negotiated Rate	$3,865.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,865.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,514.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,396.25

CATHETER SOLITAIRE 2 6x30 MM

Facility

$37,475.00

Service Code	HCPCS C1757
Hospital Charge Code	270685021
Hospital Revenue Code	278
Min. Negotiated Rate	$5,621.25
Max. Negotiated Rate	$9,068.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,068.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,244.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,621.25

CATHETER SOLITAIRE 2 6x30 MM

Facility

$37,475.00

Service Code	HCPCS C1757
Hospital Charge Code	270685021
Hospital Revenue Code	278
Min. Negotiated Rate	$903.15
Max. Negotiated Rate	$18,737.50
Rate for Payer: Aetna Commercial	$14,240.50
Rate for Payer: Aetna Medicare Advantage	$11,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,556.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,556.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,556.12
Rate for Payer: Cigna Commercial	$18,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,068.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,244.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,621.25
Rate for Payer: UnitedHealthcare Community & State	$903.15
Rate for Payer: Wellpoint Medicaid Managed Care	$993.09

CATHETER SOLITAIRE 3 4MMX20CM

Facility

$40,775.00

Service Code	HCPCS C1757
Hospital Charge Code	270685144
Hospital Revenue Code	278
Min. Negotiated Rate	$982.68
Max. Negotiated Rate	$20,387.50
Rate for Payer: Aetna Commercial	$15,494.50
Rate for Payer: Aetna Medicare Advantage	$12,232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,397.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,397.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,397.62
Rate for Payer: Cigna Commercial	$20,387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,867.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,970.50
Rate for Payer: Qualcare PPO/HMO/WC	$6,116.25
Rate for Payer: UnitedHealthcare Community & State	$982.68
Rate for Payer: Wellpoint Medicaid Managed Care	$1,080.54

CATHETER SOLITAIRE 3 4MMX20CM

Facility

$40,775.00

Service Code	HCPCS C1757
Hospital Charge Code	270685144
Hospital Revenue Code	278
Min. Negotiated Rate	$6,116.25
Max. Negotiated Rate	$9,867.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,867.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,970.50
Rate for Payer: Qualcare PPO/HMO/WC	$6,116.25

CATHETER SOLITAIRE 3 4MMX20CM

Facility

$40,775.00

Service Code	HCPCS C1757
Hospital Charge Code	270685144S
Hospital Revenue Code	278
Min. Negotiated Rate	$6,116.25
Max. Negotiated Rate	$9,867.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,867.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,970.50
Rate for Payer: Qualcare PPO/HMO/WC	$6,116.25

CATHETER SOLITAIRE 3 4MMX20CM

Facility

$40,775.00

Service Code	HCPCS C1757
Hospital Charge Code	270685144S
Hospital Revenue Code	278
Min. Negotiated Rate	$982.68
Max. Negotiated Rate	$20,387.50
Rate for Payer: Aetna Commercial	$15,494.50
Rate for Payer: Aetna Medicare Advantage	$12,232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,397.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,397.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,397.62
Rate for Payer: Cigna Commercial	$20,387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,867.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,970.50
Rate for Payer: Qualcare PPO/HMO/WC	$6,116.25
Rate for Payer: UnitedHealthcare Community & State	$982.68
Rate for Payer: Wellpoint Medicaid Managed Care	$1,080.54

CATHETER SOLITAIRE 3 6MMX40CM

Facility

$40,775.00

Service Code	HCPCS C1757
Hospital Charge Code	270685145
Hospital Revenue Code	278
Min. Negotiated Rate	$6,116.25
Max. Negotiated Rate	$9,867.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,867.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,970.50
Rate for Payer: Qualcare PPO/HMO/WC	$6,116.25

CATHETER SOLITAIRE 3 6MMX40CM

Facility

$40,775.00

Service Code	HCPCS C1757
Hospital Charge Code	270685145
Hospital Revenue Code	278
Min. Negotiated Rate	$982.68
Max. Negotiated Rate	$20,387.50
Rate for Payer: Aetna Commercial	$15,494.50
Rate for Payer: Aetna Medicare Advantage	$12,232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,397.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,397.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,397.62
Rate for Payer: Cigna Commercial	$20,387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,867.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,970.50
Rate for Payer: Qualcare PPO/HMO/WC	$6,116.25
Rate for Payer: UnitedHealthcare Community & State	$982.68
Rate for Payer: Wellpoint Medicaid Managed Care	$1,080.54

CATHETER SOLITAIRE 3 6MMX40CM

Facility

$40,775.00

Service Code	HCPCS C1757
Hospital Charge Code	270685145S
Hospital Revenue Code	278
Min. Negotiated Rate	$6,116.25
Max. Negotiated Rate	$9,867.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,867.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,970.50
Rate for Payer: Qualcare PPO/HMO/WC	$6,116.25

CATHETER SOLITAIRE 3 6MMX40CM

Facility

$40,775.00

Service Code	HCPCS C1757
Hospital Charge Code	270685145S
Hospital Revenue Code	278
Min. Negotiated Rate	$982.68
Max. Negotiated Rate	$20,387.50
Rate for Payer: Aetna Commercial	$15,494.50
Rate for Payer: Aetna Medicare Advantage	$12,232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,397.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,397.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,397.62
Rate for Payer: Cigna Commercial	$20,387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,867.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8,970.50
Rate for Payer: Qualcare PPO/HMO/WC	$6,116.25
Rate for Payer: UnitedHealthcare Community & State	$982.68
Rate for Payer: Wellpoint Medicaid Managed Care	$1,080.54

CATHETER SOS OMNI 1 5FR 0.035

Facility

$95.00

Hospital Charge Code	270CH0100
Hospital Revenue Code	272
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

CATHETER SOS OMNI 1 5FR 0.035

Facility

$95.00

Hospital Charge Code	270CH0100
Hospital Revenue Code	272
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$47.50
Rate for Payer: Aetna Commercial	$36.10
Rate for Payer: Aetna Medicare Advantage	$28.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.50
Rate for Payer: Oxford Commercial	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$19.00
Rate for Payer: UnitedHealthcare Community & State	$2.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.52

Catheter sos omni (3)5fr80 cm

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270623892
Hospital Revenue Code	278
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) NJ Health	$18.00
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	$21.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Community & State	$2.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

Catheter sos omni (3)5fr80 cm

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270623892
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$21.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CATHETER SOS OMNI (3) 5FR 80CM

Facility

$144.00

Hospital Charge Code	2703100925
Hospital Revenue Code	272
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$21.60
Rate for Payer: Qualcare PPO/HMO/WC	$21.60

CATHETER SOS OMNI (3) 5FR 80CM

Facility

$144.00

Hospital Charge Code	2703100925
Hospital Revenue Code	272
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna Commercial	$54.72
Rate for Payer: Aetna Medicare Advantage	$43.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.72
Rate for Payer: Cigna Commercial	$72.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.20
Rate for Payer: Oxford Commercial	$28.80
Rate for Payer: Qualcare PPO/HMO/WC	$21.60
Rate for Payer: UnitedHealthcare Commercial	$28.80
Rate for Payer: UnitedHealthcare Community & State	$3.47
Rate for Payer: Wellpoint Medicaid Managed Care	$3.82

CATHETER SOS OMNI II 5FR 0.035

Facility

$132.00

Hospital Charge Code	270CH0101
Hospital Revenue Code	272
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$66.00
Rate for Payer: Aetna Commercial	$50.16
Rate for Payer: Aetna Medicare Advantage	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.66
Rate for Payer: Cigna Commercial	$66.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.60
Rate for Payer: Oxford Commercial	$26.40
Rate for Payer: Qualcare PPO/HMO/WC	$19.80
Rate for Payer: UnitedHealthcare Commercial	$26.40
Rate for Payer: UnitedHealthcare Community & State	$3.18
Rate for Payer: Wellpoint Medicaid Managed Care	$3.50

CATHETER SOS OMNI II 5FR 0.035

Facility

$132.00

Hospital Charge Code	270CH0101
Hospital Revenue Code	272
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$19.80

CATHETER SPRINTER 3.25x12MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270684712
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

CATHETER SPRINTER 3.25x12MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270684712
Hospital Revenue Code	272
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

CATHETER SPRINTER 3.25x15MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270684711
Hospital Revenue Code	272
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

Know your out-of-pocket cost for care.

All Charges