Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH FOXCROSS PTA 8x60x80cm

Facility

$775.00

Hospital Charge Code	270644553C
Hospital Revenue Code	278
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$187.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$170.50
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

CATH FOXCROSS PTA 8x80x80cm

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270644580C
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

CATH FOXCROSS PTA 8x80x80cm

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270644580C
Hospital Revenue Code	278
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) NJ Health	$125.00
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	$151.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$137.50
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$15.06
Rate for Payer: Wellpoint Medicaid Managed Care	$16.56

CATH FOXCROSS PTA 9x40x80cm

Facility

$775.00

Hospital Charge Code	27064440
Hospital Revenue Code	278
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$187.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$170.50
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

CATH FOXCROSS PTA 9x40x80cm

Facility

$775.00

Hospital Charge Code	27064440
Hospital Revenue Code	278
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$294.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$170.50
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Community & State	$18.68
Rate for Payer: Wellpoint Medicaid Managed Care	$20.54

CATH FOXCRS PTA 5x100 10335100

Facility

$1,625.00

Hospital Charge Code	270642703V
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$393.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

CATH FOXCRS PTA 5x100 10335100

Facility

$1,625.00

Hospital Charge Code	270642703V
Hospital Revenue Code	278
Min. Negotiated Rate	$39.16
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Community & State	$39.16
Rate for Payer: Wellpoint Medicaid Managed Care	$43.06

CATH FOX PTA 4x12x150 8397502

Facility

$1,175.00

Service Code	HCPCS C1725
Hospital Charge Code	270643927C
Hospital Revenue Code	278
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$284.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

CATH FOX PTA 4x12x150 8397502

Facility

$1,175.00

Service Code	HCPCS C1725
Hospital Charge Code	270643927C
Hospital Revenue Code	278
Min. Negotiated Rate	$28.32
Max. Negotiated Rate	$587.50
Rate for Payer: Aetna Commercial	$446.50
Rate for Payer: Aetna Medicare Advantage	$352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.62
Rate for Payer: Cigna Commercial	$587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.25
Rate for Payer: UnitedHealthcare Community & State	$28.32
Rate for Payer: Wellpoint Medicaid Managed Care	$31.14

CATH FOX PTA 5mm x120mm x150cm

Facility

$1,750.00

Service Code	HCPCS C1725
Hospital Charge Code	270643698
Hospital Revenue Code	278
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

CATH FOX PTA 5mm x120mm x150cm

Facility

$1,750.00

Service Code	HCPCS C1725
Hospital Charge Code	270643698
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

CATH FOX PTA 5X20MM

Facility

$1,075.00

Hospital Charge Code	270634856C
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

CATH FOX PTA 5X20MM

Facility

$1,075.00

Hospital Charge Code	270634856C
Hospital Revenue Code	278
Min. Negotiated Rate	$25.91
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$408.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25
Rate for Payer: UnitedHealthcare Community & State	$25.91
Rate for Payer: Wellpoint Medicaid Managed Care	$28.49

CATH FOX PTA 5x20mm UA12005

Facility

$843.25

Hospital Charge Code	270634856
Hospital Revenue Code	278
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$421.62
Rate for Payer: Aetna Commercial	$320.44
Rate for Payer: Aetna Medicare Advantage	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.03
Rate for Payer: Cigna Commercial	$421.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.51
Rate for Payer: Qualcare PPO/HMO/WC	$126.49
Rate for Payer: UnitedHealthcare Community & State	$20.32
Rate for Payer: Wellpoint Medicaid Managed Care	$22.35

CATH FOX PTA 5x20mm UA12005

Facility

$1,075.00

Hospital Charge Code	270634856V
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

CATH FOX PTA 5x20mm UA12005

Facility

$1,075.00

Hospital Charge Code	270634856V
Hospital Revenue Code	278
Min. Negotiated Rate	$25.91
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$408.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25
Rate for Payer: UnitedHealthcare Community & State	$25.91
Rate for Payer: Wellpoint Medicaid Managed Care	$28.49

CATH FOX PTA 5x20mm UA12005

Facility

$843.25

Hospital Charge Code	270634856
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.51
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 5x40mm UA24005

Facility

$843.25

Hospital Charge Code	270634774
Hospital Revenue Code	278
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$421.62
Rate for Payer: Aetna Commercial	$320.44
Rate for Payer: Aetna Medicare Advantage	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.03
Rate for Payer: Cigna Commercial	$421.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.51
Rate for Payer: Qualcare PPO/HMO/WC	$126.49
Rate for Payer: UnitedHealthcare Community & State	$20.32
Rate for Payer: Wellpoint Medicaid Managed Care	$22.35

CATH FOX PTA 5x40mm UA24005

Facility

$843.25

Hospital Charge Code	270634774V
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.51
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 5x40mm UA24005

Facility

$843.25

Hospital Charge Code	270634774
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.51
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 5x40mm UA24005

Facility

$843.25

Hospital Charge Code	270634774V
Hospital Revenue Code	278
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$421.62
Rate for Payer: Aetna Commercial	$320.44
Rate for Payer: Aetna Medicare Advantage	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.03
Rate for Payer: Cigna Commercial	$421.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.51
Rate for Payer: Qualcare PPO/HMO/WC	$126.49
Rate for Payer: UnitedHealthcare Community & State	$20.32
Rate for Payer: Wellpoint Medicaid Managed Care	$22.35

CATH FOX PTA 5x80mm UA28005

Facility

$843.25

Hospital Charge Code	270635335V
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.51
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 5x80mm UA28005

Facility

$843.25

Hospital Charge Code	270635335V
Hospital Revenue Code	278
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$421.62
Rate for Payer: Aetna Commercial	$320.44
Rate for Payer: Aetna Medicare Advantage	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.03
Rate for Payer: Cigna Commercial	$421.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.51
Rate for Payer: Qualcare PPO/HMO/WC	$126.49
Rate for Payer: UnitedHealthcare Community & State	$20.32
Rate for Payer: Wellpoint Medicaid Managed Care	$22.35

CATH FOX PTA 5x80mm UA28005

Facility

$843.25

Hospital Charge Code	270635335
Hospital Revenue Code	278
Min. Negotiated Rate	$126.49
Max. Negotiated Rate	$204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.51
Rate for Payer: Qualcare PPO/HMO/WC	$126.49

CATH FOX PTA 5x80mm UA28005

Facility

$843.25

Hospital Charge Code	270635335
Hospital Revenue Code	278
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$421.62
Rate for Payer: Aetna Commercial	$320.44
Rate for Payer: Aetna Medicare Advantage	$252.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.03
Rate for Payer: Cigna Commercial	$421.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$185.51
Rate for Payer: Qualcare PPO/HMO/WC	$126.49
Rate for Payer: UnitedHealthcare Community & State	$20.32
Rate for Payer: Wellpoint Medicaid Managed Care	$22.35

Know your out-of-pocket cost for care.

All Charges