Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-TRANS BALLN ANG F/P-BI

Facility

$8,231.00

Service Code	HCPCS 3722450
Hospital Charge Code	2690515
Hospital Revenue Code	361
Min. Negotiated Rate	$1,234.65
Max. Negotiated Rate	$1,234.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.65

IR-TRANS BALLN ANG F/P-BI

Facility

$44,000.00

Service Code	HCPCS 3722450
Hospital Charge Code	7411802
Hospital Revenue Code	361
Min. Negotiated Rate	$1,060.40
Max. Negotiated Rate	$22,000.00
Rate for Payer: Aetna Commercial	$16,720.00
Rate for Payer: Aetna Medicare Advantage	$13,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,220.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,220.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,220.00
Rate for Payer: Cigna Commercial	$22,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,600.00
Rate for Payer: UnitedHealthcare Community & State	$1,060.40
Rate for Payer: Wellpoint Medicaid Managed Care	$1,166.00

IR-TRANS BALLN ANG F/P-BI

Facility

$8,231.00

Service Code	HCPCS 3722450
Hospital Charge Code	2690515
Hospital Revenue Code	361
Min. Negotiated Rate	$198.37
Max. Negotiated Rate	$4,115.50
Rate for Payer: Aetna Commercial	$3,127.78
Rate for Payer: Aetna Medicare Advantage	$2,469.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,098.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,098.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,098.91
Rate for Payer: Cigna Commercial	$4,115.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,469.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,234.65
Rate for Payer: UnitedHealthcare Community & State	$198.37
Rate for Payer: Wellpoint Medicaid Managed Care	$218.12

IR-TRANS BALLN ANG F/P-LT

Facility

$27,397.00

Service Code	HCPCS 37224LT
Hospital Charge Code	321037224L
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR-TRANS BALLN ANG F/P-LT

Facility

$27,397.00

Service Code	HCPCS 37224LT
Hospital Charge Code	7411924
Hospital Revenue Code	361
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

IR-TRANS BALLN ANG F/P-LT

Facility

$27,397.00

Service Code	HCPCS 37224LT
Hospital Charge Code	366837224L
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR-TRANS BALLN ANG F/P-LT

Facility

$27,397.00

Service Code	HCPCS 37224LT
Hospital Charge Code	366837224L
Hospital Revenue Code	361
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

IR-TRANS BALLN ANG F/P-LT

Facility

$27,397.00

Service Code	HCPCS 37224LT
Hospital Charge Code	2691360
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR-TRANS BALLN ANG F/P-LT

Facility

$27,397.00

Service Code	HCPCS 37224LT
Hospital Charge Code	321037224L
Hospital Revenue Code	361
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

IR-TRANS BALLN ANG F/P-LT

Facility

$27,397.00

Service Code	HCPCS 37224LT
Hospital Charge Code	2691360
Hospital Revenue Code	361
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

IR-TRANS BALLN ANG F/P-LT

Facility

$27,397.00

Service Code	HCPCS 37224LT
Hospital Charge Code	7411924
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR-TRANS BALLN ANG F/P-RT

Facility

$27,397.00

Service Code	HCPCS 37224RT
Hospital Charge Code	321037224R
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR-TRANS BALLN ANG F/P-RT

Facility

$27,397.00

Service Code	HCPCS 37224RT
Hospital Charge Code	366837224R
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR-TRANS BALLN ANG F/P-RT

Facility

$27,397.00

Service Code	HCPCS 37224RT
Hospital Charge Code	366837224R
Hospital Revenue Code	361
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

IR-TRANS BALLN ANG F/P-RT

Facility

$27,397.00

Service Code	HCPCS 37224RT
Hospital Charge Code	321037224R
Hospital Revenue Code	361
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

IR-TRANS BALLN ANG F/P-RT

Facility

$27,397.00

Service Code	HCPCS 37224RT
Hospital Charge Code	7411925
Hospital Revenue Code	361
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

IR-TRANS BALLN ANG F/P-RT

Facility

$27,397.00

Service Code	HCPCS 37224RT
Hospital Charge Code	2691365
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR-TRANS BALLN ANG F/P-RT

Facility

$27,397.00

Service Code	HCPCS 37224RT
Hospital Charge Code	2691365
Hospital Revenue Code	361
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

IR-TRANS BALLN ANG F/P-RT

Facility

$27,397.00

Service Code	HCPCS 37224RT
Hospital Charge Code	7411925
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR-TRANS BALLN ANG ILI-BI

Facility

$27,397.00

Service Code	HCPCS 3722050
Hospital Charge Code	2690495
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR-TRANS BALLN ANG ILI-BI

Facility

$27,397.00

Service Code	HCPCS 3722050
Hospital Charge Code	2690495
Hospital Revenue Code	361
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

IR-TRANS BALLN ANG ILI-BI

Facility

$27,397.00

Service Code	HCPCS 3722050
Hospital Charge Code	411037220B
Hospital Revenue Code	361
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

IR-TRANS BALLN ANG ILI-BI

Facility

$27,397.00

Service Code	HCPCS 3722050
Hospital Charge Code	321037220B
Hospital Revenue Code	361
Min. Negotiated Rate	$660.27
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,219.10
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$660.27
Rate for Payer: Wellpoint Medicaid Managed Care	$726.02

IR-TRANS BALLN ANG ILI-BI

Facility

$27,397.00

Service Code	HCPCS 3722050
Hospital Charge Code	3668372205
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR-TRANS BALLN ANG ILI-BI

Facility

$27,397.00

Service Code	HCPCS 3722050
Hospital Charge Code	321037220B
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

Know your out-of-pocket cost for care.

All Charges