Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH FOX PTA 6x120x150 8398402

Facility

$1,175.00

Service Code	HCPCS C1725
Hospital Charge Code	270643975C
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 6x120x150 8398402

Facility

$1,175.00

Service Code	HCPCS C1725
Hospital Charge Code	270643975C
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 6x20mm UA12006

Facility

$843.25

Hospital Charge Code	270634855V
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 6x20mm UA12006

Facility

$843.25

Hospital Charge Code	270634855V
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 6x20mm UA12006

Facility

$843.25

Hospital Charge Code	270634854
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 6x20mm UA12006

Facility

$843.25

Hospital Charge Code	270634854
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 6x20mm UA12006

Facility

$843.25

Hospital Charge Code	270634854V
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 6x20mm UA12006

Facility

$843.25

Hospital Charge Code	270634854V
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 7x20mm UA12007

Facility

$843.25

Hospital Charge Code	270634855
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 7x20mm UA12007

Facility

$843.25

Hospital Charge Code	270634855
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 7x24mm UA24007

Facility

$843.25

Hospital Charge Code	270635418V
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 7x24mm UA24007

Facility

$843.25

Hospital Charge Code	270635418
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 7x24mm UA24007

Facility

$843.25

Hospital Charge Code	270635418V
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 7x24mm UA24007

Facility

$843.25

Hospital Charge Code	270635418
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 8x40mm UA14008

Facility

$843.25

Hospital Charge Code	270634775V
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 8x40mm UA14008

Facility

$843.25

Hospital Charge Code	270634775
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 8x40mm UA14008

Facility

$843.25

Hospital Charge Code	270634775V
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 8x40mm UA14008

Facility

$843.25

Hospital Charge Code	270634775
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 SV 2.5x120cm

Facility

$975.00

Hospital Charge Code	270644104C
Hospital Revenue Code	278
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$370.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$214.50
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Community & State	$23.50
Rate for Payer: Wellpoint Medicaid Managed Care	$25.84

CATH FOX PTA SV 2.5x120cm

Facility

$975.00

Hospital Charge Code	270644104C
Hospital Revenue Code	278
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$235.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$214.50
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

CATH FOX PTA SV 2.5x40x150cm

Facility

$975.00

Hospital Charge Code	270644013C
Hospital Revenue Code	278
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$235.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$214.50
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

CATH FOX PTA SV 2.5x40x150cm

Facility

$975.00

Hospital Charge Code	270644013C
Hospital Revenue Code	278
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$370.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$214.50
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Community & State	$23.50
Rate for Payer: Wellpoint Medicaid Managed Care	$25.84

CATH FOX PTA SV 2.5x80x150cm

Facility

$975.00

Hospital Charge Code	270644514C
Hospital Revenue Code	278
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$370.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$214.50
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Community & State	$23.50
Rate for Payer: Wellpoint Medicaid Managed Care	$25.84

CATH FOX PTA SV 2.5x80x150cm

Facility

$975.00

Hospital Charge Code	270644514C
Hospital Revenue Code	278
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$235.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$214.50
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

CATH FOX PTA SV 2x120x150cm

Facility

$975.00

Hospital Charge Code	270644513C
Hospital Revenue Code	278
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$370.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$214.50
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Community & State	$23.50
Rate for Payer: Wellpoint Medicaid Managed Care	$25.84

Know your out-of-pocket cost for care.

All Charges