Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLN VOY RX 2.75x15 101139515

Facility

$1,275.00

Hospital Charge Code	270643078C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$280.50
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLN VOY RX 2.75x15 101139515

Facility

$1,275.00

Hospital Charge Code	270643078C
Hospital Revenue Code	278
Min. Negotiated Rate	$30.73
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$484.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$280.50
Rate for Payer: Qualcare PPO/HMO/WC	$191.25
Rate for Payer: UnitedHealthcare Community & State	$30.73
Rate for Payer: Wellpoint Medicaid Managed Care	$33.79

BALLN VOY RX 3.5x15 101139815

Facility

$1,275.00

Hospital Charge Code	270643211C
Hospital Revenue Code	278
Min. Negotiated Rate	$30.73
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$484.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$280.50
Rate for Payer: Qualcare PPO/HMO/WC	$191.25
Rate for Payer: UnitedHealthcare Community & State	$30.73
Rate for Payer: Wellpoint Medicaid Managed Care	$33.79

BALLN VOY RX 3.5x15 101139815

Facility

$1,275.00

Hospital Charge Code	270643211C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$280.50
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLONCATHOCCLSCEPTERC4X20MM

Facility

$8,125.00

Service Code	HCPCS C2628
Hospital Charge Code	270693919S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$1,966.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,787.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75

BALLONCATHOCCLSCEPTERC4X20MM

Facility

$8,125.00

Service Code	HCPCS C2628
Hospital Charge Code	270693919S
Hospital Revenue Code	278
Min. Negotiated Rate	$195.81
Max. Negotiated Rate	$4,062.50
Rate for Payer: Aetna Commercial	$3,087.50
Rate for Payer: Aetna Medicare Advantage	$2,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,071.88
Rate for Payer: Cigna Commercial	$4,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,787.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75
Rate for Payer: UnitedHealthcare Community & State	$195.81
Rate for Payer: Wellpoint Medicaid Managed Care	$215.31

BALLON DIL 5.5x2x150 379165520

Facility

$1,957.00

Hospital Charge Code	270629568
Hospital Revenue Code	278
Min. Negotiated Rate	$293.55
Max. Negotiated Rate	$473.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$391.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$473.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$430.54
Rate for Payer: Qualcare PPO/HMO/WC	$293.55

BALLON DIL 5.5x2x150 379165520

Facility

$1,957.00

Hospital Charge Code	270629568
Hospital Revenue Code	278
Min. Negotiated Rate	$47.16
Max. Negotiated Rate	$978.50
Rate for Payer: Aetna Commercial	$743.66
Rate for Payer: Aetna Medicare Advantage	$587.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$499.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$499.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$391.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$499.04
Rate for Payer: Cigna Commercial	$978.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$473.59
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$430.54
Rate for Payer: Qualcare PPO/HMO/WC	$293.55
Rate for Payer: UnitedHealthcare Community & State	$47.16
Rate for Payer: Wellpoint Medicaid Managed Care	$51.86

BALLON DIL 5.5x2x150 379165520

Facility

$1,972.76

Hospital Charge Code	270629568V
Hospital Revenue Code	278
Min. Negotiated Rate	$295.91
Max. Negotiated Rate	$477.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$394.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$477.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$434.01
Rate for Payer: Qualcare PPO/HMO/WC	$295.91

BALLON DIL 5.5x2x150 379165520

Facility

$1,972.76

Hospital Charge Code	270629568V
Hospital Revenue Code	278
Min. Negotiated Rate	$47.54
Max. Negotiated Rate	$986.38
Rate for Payer: Aetna Commercial	$749.65
Rate for Payer: Aetna Medicare Advantage	$591.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$394.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.05
Rate for Payer: Cigna Commercial	$986.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$477.41
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$434.01
Rate for Payer: Qualcare PPO/HMO/WC	$295.91
Rate for Payer: UnitedHealthcare Community & State	$47.54
Rate for Payer: Wellpoint Medicaid Managed Care	$52.28

BALLON NCRS PTA AB14W020020150

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270643974C
Hospital Revenue Code	278
Min. Negotiated Rate	$230.79
Max. Negotiated Rate	$372.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79

BALLON NCRS PTA AB14W020020150

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270643974C
Hospital Revenue Code	278
Min. Negotiated Rate	$37.08
Max. Negotiated Rate	$769.30
Rate for Payer: Aetna Commercial	$584.67
Rate for Payer: Aetna Medicare Advantage	$461.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.34
Rate for Payer: Cigna Commercial	$769.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79
Rate for Payer: UnitedHealthcare Community & State	$37.08
Rate for Payer: Wellpoint Medicaid Managed Care	$40.77

BALLON NCRS PTA AB14W020040150

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270644200C
Hospital Revenue Code	278
Min. Negotiated Rate	$230.79
Max. Negotiated Rate	$372.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79

BALLON NCRS PTA AB14W020040150

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270644200C
Hospital Revenue Code	278
Min. Negotiated Rate	$37.08
Max. Negotiated Rate	$769.30
Rate for Payer: Aetna Commercial	$584.67
Rate for Payer: Aetna Medicare Advantage	$461.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.34
Rate for Payer: Cigna Commercial	$769.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79
Rate for Payer: UnitedHealthcare Community & State	$37.08
Rate for Payer: Wellpoint Medicaid Managed Care	$40.77

BALLON NCRS PTA AB14W020120150

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270644365C
Hospital Revenue Code	278
Min. Negotiated Rate	$230.79
Max. Negotiated Rate	$372.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79

BALLON NCRS PTA AB14W020120150

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270644365C
Hospital Revenue Code	278
Min. Negotiated Rate	$37.08
Max. Negotiated Rate	$769.30
Rate for Payer: Aetna Commercial	$584.67
Rate for Payer: Aetna Medicare Advantage	$461.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.34
Rate for Payer: Cigna Commercial	$769.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79
Rate for Payer: UnitedHealthcare Community & State	$37.08
Rate for Payer: Wellpoint Medicaid Managed Care	$40.77

BALLON NCRS PTA AB14W020150150

Facility

$1,852.20

Service Code	HCPCS C1725
Hospital Charge Code	270644445C
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

BALLON NCRS PTA AB14W020150150

Facility

$1,852.20

Service Code	HCPCS C1725
Hospital Charge Code	270644445C
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

BALLON NCRS PTA AB14W020210150

Facility

$1,852.20

Service Code	HCPCS C1725
Hospital Charge Code	270644444C
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

BALLON NCRS PTA AB14W020210150

Facility

$1,852.20

Service Code	HCPCS C1725
Hospital Charge Code	270644444C
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

BALLON NCRS PTA AB14W025020150

Facility

$1,734.60

Service Code	HCPCS C1725
Hospital Charge Code	270644446C
Hospital Revenue Code	278
Min. Negotiated Rate	$41.80
Max. Negotiated Rate	$867.30
Rate for Payer: Aetna Commercial	$659.15
Rate for Payer: Aetna Medicare Advantage	$520.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$442.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$442.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$346.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$442.32
Rate for Payer: Cigna Commercial	$867.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$419.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$381.61
Rate for Payer: Qualcare PPO/HMO/WC	$260.19
Rate for Payer: UnitedHealthcare Community & State	$41.80
Rate for Payer: Wellpoint Medicaid Managed Care	$45.97

BALLON NCRS PTA AB14W025020150

Facility

$1,734.60

Service Code	HCPCS C1725
Hospital Charge Code	270644446C
Hospital Revenue Code	278
Min. Negotiated Rate	$260.19
Max. Negotiated Rate	$419.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$346.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$419.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$381.61
Rate for Payer: Qualcare PPO/HMO/WC	$260.19

BALLON NCRS PTA AB14W025040150

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270643677C
Hospital Revenue Code	278
Min. Negotiated Rate	$37.08
Max. Negotiated Rate	$769.30
Rate for Payer: Aetna Commercial	$584.67
Rate for Payer: Aetna Medicare Advantage	$461.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.34
Rate for Payer: Cigna Commercial	$769.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79
Rate for Payer: UnitedHealthcare Community & State	$37.08
Rate for Payer: Wellpoint Medicaid Managed Care	$40.77

BALLON NCRS PTA AB14W025040150

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270643677C
Hospital Revenue Code	278
Min. Negotiated Rate	$230.79
Max. Negotiated Rate	$372.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79

BALLON NCRS PTA AB14W025040150

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270643677A
Hospital Revenue Code	278
Min. Negotiated Rate	$37.08
Max. Negotiated Rate	$769.30
Rate for Payer: Aetna Commercial	$584.67
Rate for Payer: Aetna Medicare Advantage	$461.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.34
Rate for Payer: Cigna Commercial	$769.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79
Rate for Payer: UnitedHealthcare Community & State	$37.08
Rate for Payer: Wellpoint Medicaid Managed Care	$40.77

Know your out-of-pocket cost for care.

All Charges