Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLN EC 7x60mm AB35W07060135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644403C
Hospital Revenue Code	278
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$258.82
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.84
Rate for Payer: Qualcare PPO/HMO/WC	$102.17
Rate for Payer: UnitedHealthcare Community & State	$16.41
Rate for Payer: Wellpoint Medicaid Managed Care	$18.05

BALLN EC 7x60mm AB35W07060135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644403C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.84
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 7x80mm AB35W07080135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644470C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.84
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 7x80mm AB35W07080135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644470C
Hospital Revenue Code	278
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$258.82
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.84
Rate for Payer: Qualcare PPO/HMO/WC	$102.17
Rate for Payer: UnitedHealthcare Community & State	$16.41
Rate for Payer: Wellpoint Medicaid Managed Care	$18.05

BALLN EC 8x20mm AB35W08020080

Facility

$857.50

Service Code	HCPCS C1725
Hospital Charge Code	270644473C
Hospital Revenue Code	278
Min. Negotiated Rate	$128.62
Max. Negotiated Rate	$207.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$188.65
Rate for Payer: Qualcare PPO/HMO/WC	$128.62

BALLN EC 8x20mm AB35W08020080

Facility

$857.50

Service Code	HCPCS C1725
Hospital Charge Code	270644473C
Hospital Revenue Code	278
Min. Negotiated Rate	$20.67
Max. Negotiated Rate	$428.75
Rate for Payer: Aetna Commercial	$325.85
Rate for Payer: Aetna Medicare Advantage	$257.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.66
Rate for Payer: Cigna Commercial	$428.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$188.65
Rate for Payer: Qualcare PPO/HMO/WC	$128.62
Rate for Payer: UnitedHealthcare Community & State	$20.67
Rate for Payer: Wellpoint Medicaid Managed Care	$22.72

BALLN EC 8X60X80 AB35W08060080

Facility

$725.00

Hospital Charge Code	270644036V
Hospital Revenue Code	278
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Community & State	$17.47
Rate for Payer: Wellpoint Medicaid Managed Care	$19.21

BALLN EC 8X60X80 AB35W08060080

Facility

$725.00

Hospital Charge Code	270644036V
Hospital Revenue Code	278
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$175.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

BALLN EC PT 6x60 AB35W06060135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270639644C
Hospital Revenue Code	278
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$258.82
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.84
Rate for Payer: Qualcare PPO/HMO/WC	$102.17
Rate for Payer: UnitedHealthcare Community & State	$16.41
Rate for Payer: Wellpoint Medicaid Managed Care	$18.05

BALLN EC PT 6x60 AB35W06060135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270639644C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$149.84
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALL NIN OTW 2 5x15 563FX125

Facility

$1,099.45

Hospital Charge Code	270638555
Hospital Revenue Code	272
Min. Negotiated Rate	$26.50
Max. Negotiated Rate	$549.73
Rate for Payer: Aetna Commercial	$417.79
Rate for Payer: Aetna Medicare Advantage	$329.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.36
Rate for Payer: Cigna Commercial	$549.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$329.83
Rate for Payer: Oxford Commercial	$219.89
Rate for Payer: Qualcare PPO/HMO/WC	$164.92
Rate for Payer: UnitedHealthcare Commercial	$219.89
Rate for Payer: UnitedHealthcare Community & State	$26.50
Rate for Payer: Wellpoint Medicaid Managed Care	$29.14

BALL NIN OTW 2 5x15 563FX125

Facility

$1,099.45

Hospital Charge Code	270638555C
Hospital Revenue Code	278
Min. Negotiated Rate	$164.92
Max. Negotiated Rate	$266.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$219.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$241.88
Rate for Payer: Qualcare PPO/HMO/WC	$164.92

BALL NIN OTW 2 5x15 563FX125

Facility

$1,099.45

Hospital Charge Code	270638555
Hospital Revenue Code	272
Min. Negotiated Rate	$164.92
Max. Negotiated Rate	$164.92
Rate for Payer: Qualcare PPO/HMO/WC	$164.92

BALL NIN OTW 2 5x15 563FX125

Facility

$1,099.45

Hospital Charge Code	270638555C
Hospital Revenue Code	278
Min. Negotiated Rate	$26.50
Max. Negotiated Rate	$549.73
Rate for Payer: Aetna Commercial	$417.79
Rate for Payer: Aetna Medicare Advantage	$329.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$219.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.36
Rate for Payer: Cigna Commercial	$549.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$241.88
Rate for Payer: Qualcare PPO/HMO/WC	$164.92
Rate for Payer: UnitedHealthcare Community & State	$26.50
Rate for Payer: Wellpoint Medicaid Managed Care	$29.14

BALLN MAV MN 2.25x15 389281522

Facility

$1,295.00

Hospital Charge Code	270639395C
Hospital Revenue Code	278
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$647.50
Rate for Payer: Aetna Commercial	$492.10
Rate for Payer: Aetna Medicare Advantage	$388.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.23
Rate for Payer: Cigna Commercial	$647.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$284.90
Rate for Payer: Qualcare PPO/HMO/WC	$194.25
Rate for Payer: UnitedHealthcare Community & State	$31.21
Rate for Payer: Wellpoint Medicaid Managed Care	$34.32

BALLN MAV MN 2.25x15 389281522

Facility

$1,295.00

Hospital Charge Code	270639395C
Hospital Revenue Code	278
Min. Negotiated Rate	$194.25
Max. Negotiated Rate	$313.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$284.90
Rate for Payer: Qualcare PPO/HMO/WC	$194.25

BALLN MAV MON 2.75X9 389280927

Facility

$1,475.00

Hospital Charge Code	270639396
Hospital Revenue Code	278
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$356.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$324.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

BALLN MAV MON 2.75X9 389280927

Facility

$1,475.00

Hospital Charge Code	270639396
Hospital Revenue Code	278
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$324.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$39.09

BALLN MAV MON 3.5x20 389282035

Facility

$1,295.00

Hospital Charge Code	270639400C
Hospital Revenue Code	278
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$647.50
Rate for Payer: Aetna Commercial	$492.10
Rate for Payer: Aetna Medicare Advantage	$388.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.23
Rate for Payer: Cigna Commercial	$647.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$284.90
Rate for Payer: Qualcare PPO/HMO/WC	$194.25
Rate for Payer: UnitedHealthcare Community & State	$31.21
Rate for Payer: Wellpoint Medicaid Managed Care	$34.32

BALLN MAV MON 3.5x20 389282035

Facility

$1,295.00

Hospital Charge Code	270639400C
Hospital Revenue Code	278
Min. Negotiated Rate	$194.25
Max. Negotiated Rate	$313.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$284.90
Rate for Payer: Qualcare PPO/HMO/WC	$194.25

BALLN NCR 3x210 AB14W035210150

Facility

$1,852.20

Service Code	HCPCS C1725
Hospital Charge Code	270644346C
Hospital Revenue Code	278
Min. Negotiated Rate	$277.83
Max. Negotiated Rate	$448.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$370.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$448.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$407.48
Rate for Payer: Qualcare PPO/HMO/WC	$277.83

BALLN NCR 3x210 AB14W035210150

Facility

$1,852.20

Service Code	HCPCS C1725
Hospital Charge Code	270644346C
Hospital Revenue Code	278
Min. Negotiated Rate	$44.64
Max. Negotiated Rate	$926.10
Rate for Payer: Aetna Commercial	$703.84
Rate for Payer: Aetna Medicare Advantage	$555.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$472.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$472.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$370.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$472.31
Rate for Payer: Cigna Commercial	$926.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$448.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$407.48
Rate for Payer: Qualcare PPO/HMO/WC	$277.83
Rate for Payer: UnitedHealthcare Community & State	$44.64
Rate for Payer: Wellpoint Medicaid Managed Care	$49.08

BALLN NIN OTW 2 75x15 563FX127

Facility

$1,099.45

Hospital Charge Code	270638319
Hospital Revenue Code	278
Min. Negotiated Rate	$26.50
Max. Negotiated Rate	$549.73
Rate for Payer: Aetna Commercial	$417.79
Rate for Payer: Aetna Medicare Advantage	$329.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$219.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.36
Rate for Payer: Cigna Commercial	$549.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$241.88
Rate for Payer: Qualcare PPO/HMO/WC	$164.92
Rate for Payer: UnitedHealthcare Community & State	$26.50
Rate for Payer: Wellpoint Medicaid Managed Care	$29.14

BALLN NIN OTW 2 75x15 563FX127

Facility

$1,099.45

Hospital Charge Code	270638319
Hospital Revenue Code	278
Min. Negotiated Rate	$164.92
Max. Negotiated Rate	$266.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$219.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$241.88
Rate for Payer: Qualcare PPO/HMO/WC	$164.92

BALLN OCCLN LG 30 LDOB63510030

Facility

$1,016.85

Hospital Charge Code	270633658
Hospital Revenue Code	278
Min. Negotiated Rate	$152.53
Max. Negotiated Rate	$246.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$203.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$223.71
Rate for Payer: Qualcare PPO/HMO/WC	$152.53

Know your out-of-pocket cost for care.

All Charges