Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON ADMIRAL EXTR 10x40

Facility

$1,650.00

Hospital Charge Code	270639026V
Hospital Revenue Code	278
Min. Negotiated Rate	$247.50
Max. Negotiated Rate	$399.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$330.00
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

BALLOON ADMIRAL EXTR 4x20

Facility

$1,700.00

Hospital Charge Code	270639024V
Hospital Revenue Code	278
Min. Negotiated Rate	$40.97
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$646.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$374.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Community & State	$40.97
Rate for Payer: Wellpoint Medicaid Managed Care	$45.05

BALLOON ADMIRAL EXTR 4x20

Facility

$1,700.00

Hospital Charge Code	270639024V
Hospital Revenue Code	278
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$411.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$374.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

BALLOON ADMIRAL EXTR 7x40

Facility

$1,700.00

Hospital Charge Code	270639028V
Hospital Revenue Code	278
Min. Negotiated Rate	$40.97
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$646.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$374.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Community & State	$40.97
Rate for Payer: Wellpoint Medicaid Managed Care	$45.05

BALLOON ADMIRAL EXTR 7x40

Facility

$1,700.00

Hospital Charge Code	270639028V
Hospital Revenue Code	278
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$411.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$374.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

BALLOON ADMIRAL EXTR 8x40

Facility

$1,700.00

Hospital Charge Code	270639025V
Hospital Revenue Code	278
Min. Negotiated Rate	$40.97
Max. Negotiated Rate	$850.00
Rate for Payer: Aetna Commercial	$646.00
Rate for Payer: Aetna Medicare Advantage	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$433.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$433.50
Rate for Payer: Cigna Commercial	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$374.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00
Rate for Payer: UnitedHealthcare Community & State	$40.97
Rate for Payer: Wellpoint Medicaid Managed Care	$45.05

BALLOON ADMIRAL EXTR 8x40

Facility

$1,700.00

Hospital Charge Code	270639025V
Hospital Revenue Code	278
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$411.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$411.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$374.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.00

BALLOON ADMIRAL INP 4x120x130

Facility

$7,800.00

Service Code	HCPCS C1725
Hospital Charge Code	270675910
Hospital Revenue Code	278
Min. Negotiated Rate	$1,170.00
Max. Negotiated Rate	$1,887.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,887.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,716.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.00

BALLOON ADMIRAL INP 4x120x130

Facility

$7,800.00

Service Code	HCPCS C1725
Hospital Charge Code	270675910N
Hospital Revenue Code	278
Min. Negotiated Rate	$187.98
Max. Negotiated Rate	$3,900.00
Rate for Payer: Aetna Commercial	$2,964.00
Rate for Payer: Aetna Medicare Advantage	$2,340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,989.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,989.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,989.00
Rate for Payer: Cigna Commercial	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,887.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,716.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.00
Rate for Payer: UnitedHealthcare Community & State	$187.98
Rate for Payer: Wellpoint Medicaid Managed Care	$206.70

BALLOON ADMIRAL INP 4x120x130

Facility

$7,800.00

Service Code	HCPCS C1725
Hospital Charge Code	270675910N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,170.00
Max. Negotiated Rate	$1,887.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,887.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,716.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.00

BALLOON ADMIRAL INP 4x120x130

Facility

$7,800.00

Service Code	HCPCS C1725
Hospital Charge Code	270675910
Hospital Revenue Code	278
Min. Negotiated Rate	$187.98
Max. Negotiated Rate	$3,900.00
Rate for Payer: Aetna Commercial	$2,964.00
Rate for Payer: Aetna Medicare Advantage	$2,340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,989.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,989.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,989.00
Rate for Payer: Cigna Commercial	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,887.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,716.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.00
Rate for Payer: UnitedHealthcare Community & State	$187.98
Rate for Payer: Wellpoint Medicaid Managed Care	$206.70

BALLOON ADMIRAL INP 4x40x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270674218
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,551.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

BALLOON ADMIRAL INP 4x40x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270674218N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,551.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

BALLOON ADMIRAL INP 4x40x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270674218S
Hospital Revenue Code	278
Min. Negotiated Rate	$169.91
Max. Negotiated Rate	$3,525.00
Rate for Payer: Aetna Commercial	$2,679.00
Rate for Payer: Aetna Medicare Advantage	$2,115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,551.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Community & State	$169.91
Rate for Payer: Wellpoint Medicaid Managed Care	$186.82

BALLOON ADMIRAL INP 4x40x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270674218S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,551.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

BALLOON ADMIRAL INP 4x40x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270674218N
Hospital Revenue Code	278
Min. Negotiated Rate	$169.91
Max. Negotiated Rate	$3,525.00
Rate for Payer: Aetna Commercial	$2,679.00
Rate for Payer: Aetna Medicare Advantage	$2,115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,551.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Community & State	$169.91
Rate for Payer: Wellpoint Medicaid Managed Care	$186.82

BALLOON ADMIRAL INP 4x40x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270674218
Hospital Revenue Code	278
Min. Negotiated Rate	$169.91
Max. Negotiated Rate	$3,525.00
Rate for Payer: Aetna Commercial	$2,679.00
Rate for Payer: Aetna Medicare Advantage	$2,115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,551.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Community & State	$169.91
Rate for Payer: Wellpoint Medicaid Managed Care	$186.82

BALLOON ADMIRAL INP 4x60x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677073
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,551.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

BALLOON ADMIRAL INP 4x60x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677073
Hospital Revenue Code	278
Min. Negotiated Rate	$169.91
Max. Negotiated Rate	$3,525.00
Rate for Payer: Aetna Commercial	$2,679.00
Rate for Payer: Aetna Medicare Advantage	$2,115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,551.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Community & State	$169.91
Rate for Payer: Wellpoint Medicaid Managed Care	$186.82

BALLOON ADMIRAL INP 4x60x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677073S
Hospital Revenue Code	278
Min. Negotiated Rate	$169.91
Max. Negotiated Rate	$3,525.00
Rate for Payer: Aetna Commercial	$2,679.00
Rate for Payer: Aetna Medicare Advantage	$2,115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,551.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Community & State	$169.91
Rate for Payer: Wellpoint Medicaid Managed Care	$186.82

BALLOON ADMIRAL INP 4x60x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677073S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,551.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

BALLOON ADMIRAL INP 4x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270674219S
Hospital Revenue Code	278
Min. Negotiated Rate	$169.91
Max. Negotiated Rate	$3,525.00
Rate for Payer: Aetna Commercial	$2,679.00
Rate for Payer: Aetna Medicare Advantage	$2,115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,551.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Community & State	$169.91
Rate for Payer: Wellpoint Medicaid Managed Care	$186.82

BALLOON ADMIRAL INP 4x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270674219S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,551.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

BALLOON ADMIRAL INP 4x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270674219N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,551.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

BALLOON ADMIRAL INP 4x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270674219
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,551.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

Know your out-of-pocket cost for care.

All Charges