Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

IR-TRANS BALLN ANG R/V-BI

Facility

$8,231.00

Service Code	HCPCS 3547150
Hospital Charge Code	2690405
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 R/V-LT

Facility

$8,231.00

Service Code	HCPCS 35471LT
Hospital Charge Code	2691105
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 R/V-LT

Facility

$8,231.00

Service Code	HCPCS 35471LT
Hospital Charge Code	2691105
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 R/V-RT

Facility

$8,231.00

Service Code	HCPCS 35471RT
Hospital Charge Code	2691110
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 R/V-RT

Facility

$8,231.00

Service Code	HCPCS 35471RT
Hospital Charge Code	2691110
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 TIB-BI

Facility

$61,616.39

Service Code	HCPCS 3722850
Hospital Charge Code	2690540
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

IR-TRANS BALLN ANG TIB-BI

Facility

$61,616.39

Service Code	HCPCS 3722850
Hospital Charge Code	321037228B
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

IR-TRANS BALLN ANG TIB-BI

Facility

$61,616.39

Service Code	HCPCS 3722850
Hospital Charge Code	321037228B
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

IR-TRANS BALLN ANG TIB-BI

Facility

$61,616.39

Service Code	HCPCS 3722850
Hospital Charge Code	7411807
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

IR-TRANS BALLN ANG TIB-BI

Facility

$61,616.39

Service Code	HCPCS 3722850
Hospital Charge Code	7411807
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

IR-TRANS BALLN ANG TIB-BI

Facility

$61,616.39

Service Code	HCPCS 3722850
Hospital Charge Code	2690540
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

IR-TRANS BALLN ANG TIB-LT

Facility

$61,616.39

Service Code	HCPCS 37228LT
Hospital Charge Code	366837228L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

IR-TRANS BALLN ANG TIB-LT

Facility

$61,616.39

Service Code	HCPCS 37228LT
Hospital Charge Code	366837228L
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

IR-TRANS BALLN ANG TIB-LT

Facility

$61,616.39

Service Code	HCPCS 37228LT
Hospital Charge Code	321037228L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

IR-TRANS BALLN ANG TIB-LT

Facility

$61,616.39

Service Code	HCPCS 37228LT
Hospital Charge Code	321037228L
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

IR-TRANS BALLN ANG TIB-LT

Facility

$61,616.39

Service Code	HCPCS 37228LT
Hospital Charge Code	2691410
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

IR-TRANS BALLN ANG TIB-LT

Facility

$61,616.39

Service Code	HCPCS 37228LT
Hospital Charge Code	7411934
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

IR-TRANS BALLN ANG TIB-LT

Facility

$61,616.39

Service Code	HCPCS 37228LT
Hospital Charge Code	2691410
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

IR-TRANS BALLN ANG TIB-LT

Facility

$61,616.39

Service Code	HCPCS 37228LT
Hospital Charge Code	7411934
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

IR-TRANS BALLN ANG TIB-RT

Facility

$61,616.39

Service Code	HCPCS 37228RT
Hospital Charge Code	7411935
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

IR-TRANS BALLN ANG TIB-RT

Facility

$61,616.39

Service Code	HCPCS 37228RT
Hospital Charge Code	366837228R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

IR-TRANS BALLN ANG TIB-RT

Facility

$61,616.39

Service Code	HCPCS 37228RT
Hospital Charge Code	7411935
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

IR-TRANS BALLN ANG TIB-RT

Facility

$61,616.39

Service Code	HCPCS 37228RT
Hospital Charge Code	366837228R
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

IR-TRANS BALLN ANG TIB-RT

Facility

$61,616.39

Service Code	HCPCS 37228RT
Hospital Charge Code	2691415
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

IR-TRANS BALLN ANG TIB-RT

Facility

$61,616.39

Service Code	HCPCS 37228RT
Hospital Charge Code	2691415
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

Know your out-of-pocket cost for care.

All Charges