Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON 12-18MM 75CM

Facility

$1,538.70

Hospital Charge Code	270665633
Hospital Revenue Code	278
Min. Negotiated Rate	$230.81
Max. Negotiated Rate	$372.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.51
Rate for Payer: Qualcare PPO/HMO/WC	$230.81

BALLOON 12-18MM 75CM

Facility

$1,538.70

Hospital Charge Code	270665633
Hospital Revenue Code	278
Min. Negotiated Rate	$37.08
Max. Negotiated Rate	$769.35
Rate for Payer: Aetna Commercial	$584.71
Rate for Payer: Aetna Medicare Advantage	$461.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.37
Rate for Payer: Cigna Commercial	$769.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.37
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.51
Rate for Payer: Qualcare PPO/HMO/WC	$230.81
Rate for Payer: UnitedHealthcare Community & State	$37.08
Rate for Payer: Wellpoint Medicaid Managed Care	$40.78

BALLOON 3.50MM X 08MM

Facility

$500.00

Hospital Charge Code	270645270
Hospital Revenue Code	279
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.25

BALLOON 3.50MM X 08MM

Facility

$500.00

Hospital Charge Code	270645270
Hospital Revenue Code	279
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

BALLOON 3 APPLICATION RADIAL

Facility

$225.60

Hospital Charge Code	270680194
Hospital Revenue Code	272
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$112.80
Rate for Payer: Aetna Commercial	$85.73
Rate for Payer: Aetna Medicare Advantage	$67.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.53
Rate for Payer: Cigna Commercial	$112.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.68
Rate for Payer: Oxford Commercial	$45.12
Rate for Payer: Qualcare PPO/HMO/WC	$33.84
Rate for Payer: UnitedHealthcare Commercial	$45.12
Rate for Payer: UnitedHealthcare Community & State	$5.44
Rate for Payer: Wellpoint Medicaid Managed Care	$5.98

BALLOON 3 APPLICATION RADIAL

Facility

$225.60

Hospital Charge Code	270680194
Hospital Revenue Code	272
Min. Negotiated Rate	$33.84
Max. Negotiated Rate	$33.84
Rate for Payer: Qualcare PPO/HMO/WC	$33.84

BALLOON 3 APPLICATOR LINEAR

Facility

$323.00

Hospital Charge Code	270680193
Hospital Revenue Code	272
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$48.45
Rate for Payer: Qualcare PPO/HMO/WC	$48.45

BALLOON 3 APPLICATOR LINEAR

Facility

$323.00

Hospital Charge Code	270680193
Hospital Revenue Code	272
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$161.50
Rate for Payer: Aetna Commercial	$122.74
Rate for Payer: Aetna Medicare Advantage	$96.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.36
Rate for Payer: Cigna Commercial	$161.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.90
Rate for Payer: Oxford Commercial	$64.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.45
Rate for Payer: UnitedHealthcare Commercial	$64.60
Rate for Payer: UnitedHealthcare Community & State	$7.78
Rate for Payer: Wellpoint Medicaid Managed Care	$8.56

BALLOON 40 12 X 40 CM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690306
Hospital Revenue Code	278
Min. Negotiated Rate	$31.93
Max. Negotiated Rate	$662.50
Rate for Payer: Aetna Commercial	$503.50
Rate for Payer: Aetna Medicare Advantage	$397.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.88
Rate for Payer: Cigna Commercial	$662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.50
Rate for Payer: Qualcare PPO/HMO/WC	$198.75
Rate for Payer: UnitedHealthcare Community & State	$31.93
Rate for Payer: Wellpoint Medicaid Managed Care	$35.11

BALLOON 40 12 X 40 CM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690306
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$320.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.50
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

BALLOON 5x100x135 3903250101

Facility

$2,225.00

Hospital Charge Code	270637615V
Hospital Revenue Code	278
Min. Negotiated Rate	$333.75
Max. Negotiated Rate	$538.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$445.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$538.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$489.50
Rate for Payer: Qualcare PPO/HMO/WC	$333.75

BALLOON 5x100x135 3903250101

Facility

$2,225.00

Hospital Charge Code	270637615V
Hospital Revenue Code	278
Min. Negotiated Rate	$53.62
Max. Negotiated Rate	$1,112.50
Rate for Payer: Aetna Commercial	$845.50
Rate for Payer: Aetna Medicare Advantage	$667.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$567.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$567.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$445.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$567.38
Rate for Payer: Cigna Commercial	$1,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$538.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$489.50
Rate for Payer: Qualcare PPO/HMO/WC	$333.75
Rate for Payer: UnitedHealthcare Community & State	$53.62
Rate for Payer: Wellpoint Medicaid Managed Care	$58.96

BALLOON 6x100x135 3903260101

Facility

$2,325.00

Hospital Charge Code	270638408V
Hospital Revenue Code	278
Min. Negotiated Rate	$348.75
Max. Negotiated Rate	$562.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$562.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$511.50
Rate for Payer: Qualcare PPO/HMO/WC	$348.75

BALLOON 6x100x135 3903260101

Facility

$2,325.00

Hospital Charge Code	270638408V
Hospital Revenue Code	278
Min. Negotiated Rate	$56.03
Max. Negotiated Rate	$1,162.50
Rate for Payer: Aetna Commercial	$883.50
Rate for Payer: Aetna Medicare Advantage	$697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$592.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$592.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$592.88
Rate for Payer: Cigna Commercial	$1,162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$562.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$511.50
Rate for Payer: Qualcare PPO/HMO/WC	$348.75
Rate for Payer: UnitedHealthcare Community & State	$56.03
Rate for Payer: Wellpoint Medicaid Managed Care	$61.61

BALLOON 6x20x80 3903160208

Facility

$2,325.00

Hospital Charge Code	270637627V
Hospital Revenue Code	278
Min. Negotiated Rate	$56.03
Max. Negotiated Rate	$1,162.50
Rate for Payer: Aetna Commercial	$883.50
Rate for Payer: Aetna Medicare Advantage	$697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$592.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$592.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$592.88
Rate for Payer: Cigna Commercial	$1,162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$562.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$511.50
Rate for Payer: Qualcare PPO/HMO/WC	$348.75
Rate for Payer: UnitedHealthcare Community & State	$56.03
Rate for Payer: Wellpoint Medicaid Managed Care	$61.61

BALLOON 6x20x80 3903160208

Facility

$2,325.00

Hospital Charge Code	270637627V
Hospital Revenue Code	278
Min. Negotiated Rate	$348.75
Max. Negotiated Rate	$562.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$562.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$511.50
Rate for Payer: Qualcare PPO/HMO/WC	$348.75

BALLOON ACHALASIA 30MM

Facility

$3,140.00

Hospital Charge Code	270662264
Hospital Revenue Code	278
Min. Negotiated Rate	$75.67
Max. Negotiated Rate	$1,570.00
Rate for Payer: Aetna Commercial	$1,193.20
Rate for Payer: Aetna Medicare Advantage	$942.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$800.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$800.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$628.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$800.70
Rate for Payer: Cigna Commercial	$1,570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$759.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$690.80
Rate for Payer: Qualcare PPO/HMO/WC	$471.00
Rate for Payer: UnitedHealthcare Community & State	$75.67
Rate for Payer: Wellpoint Medicaid Managed Care	$83.21

BALLOON ACHALASIA 30MM

Facility

$3,140.00

Hospital Charge Code	270662264
Hospital Revenue Code	278
Min. Negotiated Rate	$471.00
Max. Negotiated Rate	$759.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$628.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$759.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$690.80
Rate for Payer: Qualcare PPO/HMO/WC	$471.00

BALLOON ACHALASIA 30MM

Facility

$3,140.00

Hospital Charge Code	270662265
Hospital Revenue Code	278
Min. Negotiated Rate	$75.67
Max. Negotiated Rate	$1,570.00
Rate for Payer: Aetna Commercial	$1,193.20
Rate for Payer: Aetna Medicare Advantage	$942.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$800.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$800.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$628.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$800.70
Rate for Payer: Cigna Commercial	$1,570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$759.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$690.80
Rate for Payer: Qualcare PPO/HMO/WC	$471.00
Rate for Payer: UnitedHealthcare Community & State	$75.67
Rate for Payer: Wellpoint Medicaid Managed Care	$83.21

BALLOON ACHALASIA 30MM

Facility

$3,140.00

Hospital Charge Code	270662265
Hospital Revenue Code	278
Min. Negotiated Rate	$471.00
Max. Negotiated Rate	$759.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$628.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$759.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$690.80
Rate for Payer: Qualcare PPO/HMO/WC	$471.00

BALLOON ADANTE 4.0x40 2021640

Facility

$1,875.00

Hospital Charge Code	270631409V
Hospital Revenue Code	278
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$712.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$281.25
Rate for Payer: UnitedHealthcare Community & State	$45.19
Rate for Payer: Wellpoint Medicaid Managed Care	$49.69

BALLOON ADANTE 4.0x40 2021640

Facility

$1,875.00

Hospital Charge Code	270631409V
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$453.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

BALLOON ADANTE 4.0x40 2021640

Facility

$1,860.00

Hospital Charge Code	270631409
Hospital Revenue Code	278
Min. Negotiated Rate	$44.83
Max. Negotiated Rate	$930.00
Rate for Payer: Aetna Commercial	$706.80
Rate for Payer: Aetna Medicare Advantage	$558.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$474.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$474.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$372.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$474.30
Rate for Payer: Cigna Commercial	$930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$409.20
Rate for Payer: Qualcare PPO/HMO/WC	$279.00
Rate for Payer: UnitedHealthcare Community & State	$44.83
Rate for Payer: Wellpoint Medicaid Managed Care	$49.29

BALLOON ADANTE 4.0x40 2021640

Facility

$1,860.00

Hospital Charge Code	270631409
Hospital Revenue Code	278
Min. Negotiated Rate	$279.00
Max. Negotiated Rate	$450.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$372.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$409.20
Rate for Payer: Qualcare PPO/HMO/WC	$279.00

BALLOON ADMIRAL EXTR 10x40

Facility

$1,650.00

Hospital Charge Code	270639026V
Hospital Revenue Code	278
Min. Negotiated Rate	$39.77
Max. Negotiated Rate	$825.00
Rate for Payer: Aetna Commercial	$627.00
Rate for Payer: Aetna Medicare Advantage	$495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$420.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$420.75
Rate for Payer: Cigna Commercial	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$247.50
Rate for Payer: UnitedHealthcare Community & State	$39.77
Rate for Payer: Wellpoint Medicaid Managed Care	$43.73

Know your out-of-pocket cost for care.

All Charges