Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON AMPHIRION DEEP 2.5x210

Facility

$1,875.00

Service Code	HCPCS C1725
Hospital Charge Code	270642536
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 AMPHIRION DEEP 2.5x80

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	270636981
Hospital Revenue Code	278
Min. Negotiated Rate	$39.16
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Community & State	$39.16
Rate for Payer: Wellpoint Medicaid Managed Care	$43.06

BALLOON AMPHIRION DEEP 2.5x80

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	270636981
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$393.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

BALLOON AMPHIRION DEEP 2x120

Facility

$1,615.00

Service Code	HCPCS C1725
Hospital Charge Code	270636980
Hospital Revenue Code	278
Min. Negotiated Rate	$38.92
Max. Negotiated Rate	$807.50
Rate for Payer: Aetna Commercial	$613.70
Rate for Payer: Aetna Medicare Advantage	$484.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$411.82
Rate for Payer: Cigna Commercial	$807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$355.30
Rate for Payer: Qualcare PPO/HMO/WC	$242.25
Rate for Payer: UnitedHealthcare Community & State	$38.92
Rate for Payer: Wellpoint Medicaid Managed Care	$42.80

BALLOON AMPHIRION DEEP 2x120

Facility

$1,615.00

Service Code	HCPCS C1725
Hospital Charge Code	270636980
Hospital Revenue Code	278
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$390.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$355.30
Rate for Payer: Qualcare PPO/HMO/WC	$242.25

BALLOON AMPHIRION DEEP 2x150

Facility

$2,050.00

Hospital Charge Code	270642988
Hospital Revenue Code	272
Min. Negotiated Rate	$49.41
Max. Negotiated Rate	$1,025.00
Rate for Payer: Aetna Commercial	$779.00
Rate for Payer: Aetna Medicare Advantage	$615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.75
Rate for Payer: Cigna Commercial	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$615.00
Rate for Payer: Oxford Commercial	$410.00
Rate for Payer: Qualcare PPO/HMO/WC	$307.50
Rate for Payer: UnitedHealthcare Commercial	$410.00
Rate for Payer: UnitedHealthcare Community & State	$49.41
Rate for Payer: Wellpoint Medicaid Managed Care	$54.33

BALLOON AMPHIRION DEEP 2x150

Facility

$2,050.00

Hospital Charge Code	270642988
Hospital Revenue Code	272
Min. Negotiated Rate	$307.50
Max. Negotiated Rate	$307.50
Rate for Payer: Qualcare PPO/HMO/WC	$307.50

BALLOON AMPHIRION DEEP2x40X150

Facility

$1,525.00

Service Code	HCPCS C1725
Hospital Charge Code	270636988
Hospital Revenue Code	278
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$762.50
Rate for Payer: Aetna Commercial	$579.50
Rate for Payer: Aetna Medicare Advantage	$457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$388.88
Rate for Payer: Cigna Commercial	$762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$335.50
Rate for Payer: Qualcare PPO/HMO/WC	$228.75
Rate for Payer: UnitedHealthcare Community & State	$36.75
Rate for Payer: Wellpoint Medicaid Managed Care	$40.41

BALLOON AMPHIRION DEEP2x40X150

Facility

$1,525.00

Service Code	HCPCS C1725
Hospital Charge Code	270636988
Hospital Revenue Code	278
Min. Negotiated Rate	$228.75
Max. Negotiated Rate	$369.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$335.50
Rate for Payer: Qualcare PPO/HMO/WC	$228.75

BALLOON AMPHIRION DEEP 2x80

Facility

$1,525.00

Service Code	HCPCS C1725
Hospital Charge Code	270636979
Hospital Revenue Code	278
Min. Negotiated Rate	$228.75
Max. Negotiated Rate	$369.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$335.50
Rate for Payer: Qualcare PPO/HMO/WC	$228.75

BALLOON AMPHIRION DEEP 2x80

Facility

$1,525.00

Service Code	HCPCS C1725
Hospital Charge Code	270636979
Hospital Revenue Code	278
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$762.50
Rate for Payer: Aetna Commercial	$579.50
Rate for Payer: Aetna Medicare Advantage	$457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$305.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$388.88
Rate for Payer: Cigna Commercial	$762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$335.50
Rate for Payer: Qualcare PPO/HMO/WC	$228.75
Rate for Payer: UnitedHealthcare Community & State	$36.75
Rate for Payer: Wellpoint Medicaid Managed Care	$40.41

BALLOON AMPHIRION DEEP 3.5X120

Facility

$1,800.00

Hospital Charge Code	270636986
Hospital Revenue Code	278
Min. Negotiated Rate	$43.38
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$684.00
Rate for Payer: Aetna Medicare Advantage	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.00
Rate for Payer: Cigna Commercial	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$396.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00
Rate for Payer: UnitedHealthcare Community & State	$43.38
Rate for Payer: Wellpoint Medicaid Managed Care	$47.70

BALLOON AMPHIRION DEEP 3.5X120

Facility

$1,800.00

Hospital Charge Code	270636986
Hospital Revenue Code	278
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$435.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$396.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00

BALLOON AMPHIRION DEEP 3.5x210

Facility

$2,050.00

Hospital Charge Code	270642537C
Hospital Revenue Code	278
Min. Negotiated Rate	$49.41
Max. Negotiated Rate	$1,025.00
Rate for Payer: Aetna Commercial	$779.00
Rate for Payer: Aetna Medicare Advantage	$615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.75
Rate for Payer: Cigna Commercial	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$496.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$451.00
Rate for Payer: Qualcare PPO/HMO/WC	$307.50
Rate for Payer: UnitedHealthcare Community & State	$49.41
Rate for Payer: Wellpoint Medicaid Managed Care	$54.33

BALLOON AMPHIRION DEEP 3.5x210

Facility

$2,050.00

Hospital Charge Code	270642537
Hospital Revenue Code	272
Min. Negotiated Rate	$49.41
Max. Negotiated Rate	$1,025.00
Rate for Payer: Aetna Commercial	$779.00
Rate for Payer: Aetna Medicare Advantage	$615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.75
Rate for Payer: Cigna Commercial	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$615.00
Rate for Payer: Oxford Commercial	$410.00
Rate for Payer: Qualcare PPO/HMO/WC	$307.50
Rate for Payer: UnitedHealthcare Commercial	$410.00
Rate for Payer: UnitedHealthcare Community & State	$49.41
Rate for Payer: Wellpoint Medicaid Managed Care	$54.33

BALLOON AMPHIRION DEEP 3.5x210

Facility

$2,050.00

Hospital Charge Code	270642537C
Hospital Revenue Code	278
Min. Negotiated Rate	$307.50
Max. Negotiated Rate	$496.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$496.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$451.00
Rate for Payer: Qualcare PPO/HMO/WC	$307.50

BALLOON AMPHIRION DEEP 3.5x210

Facility

$2,050.00

Hospital Charge Code	270642537
Hospital Revenue Code	272
Min. Negotiated Rate	$307.50
Max. Negotiated Rate	$307.50
Rate for Payer: Qualcare PPO/HMO/WC	$307.50

BALLOON AMPHIRION DEEP 3.5x80

Facility

$1,615.00

Hospital Charge Code	270636985
Hospital Revenue Code	272
Min. Negotiated Rate	$38.92
Max. Negotiated Rate	$807.50
Rate for Payer: Aetna Commercial	$613.70
Rate for Payer: Aetna Medicare Advantage	$484.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$411.82
Rate for Payer: Cigna Commercial	$807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.50
Rate for Payer: Oxford Commercial	$323.00
Rate for Payer: Qualcare PPO/HMO/WC	$242.25
Rate for Payer: UnitedHealthcare Commercial	$323.00
Rate for Payer: UnitedHealthcare Community & State	$38.92
Rate for Payer: Wellpoint Medicaid Managed Care	$42.80

BALLOON AMPHIRION DEEP 3.5x80

Facility

$1,615.00

Hospital Charge Code	270636985
Hospital Revenue Code	272
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$242.25
Rate for Payer: Qualcare PPO/HMO/WC	$242.25

BALLOON AMPHIRION DEEP 3x40

Facility

$1,615.00

Service Code	HCPCS C1725
Hospital Charge Code	270636989
Hospital Revenue Code	278
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$390.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$355.30
Rate for Payer: Qualcare PPO/HMO/WC	$242.25

BALLOON AMPHIRION DEEP 3x40

Facility

$1,615.00

Service Code	HCPCS C1725
Hospital Charge Code	270636989
Hospital Revenue Code	278
Min. Negotiated Rate	$38.92
Max. Negotiated Rate	$807.50
Rate for Payer: Aetna Commercial	$613.70
Rate for Payer: Aetna Medicare Advantage	$484.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$411.82
Rate for Payer: Cigna Commercial	$807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$355.30
Rate for Payer: Qualcare PPO/HMO/WC	$242.25
Rate for Payer: UnitedHealthcare Community & State	$38.92
Rate for Payer: Wellpoint Medicaid Managed Care	$42.80

BALLOON AMPHIRION DEEP 4x40

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	270636991
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$393.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

BALLOON AMPHIRION DEEP 4x40

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	270636991
Hospital Revenue Code	278
Min. Negotiated Rate	$39.16
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Community & State	$39.16
Rate for Payer: Wellpoint Medicaid Managed Care	$43.06

BALLOON AMPHIRION DEEP 4x80

Facility

$1,525.00

Hospital Charge Code	270636992
Hospital Revenue Code	272
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$762.50
Rate for Payer: Aetna Commercial	$579.50
Rate for Payer: Aetna Medicare Advantage	$457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$388.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$388.88
Rate for Payer: Cigna Commercial	$762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$457.50
Rate for Payer: Oxford Commercial	$305.00
Rate for Payer: Qualcare PPO/HMO/WC	$228.75
Rate for Payer: UnitedHealthcare Commercial	$305.00
Rate for Payer: UnitedHealthcare Community & State	$36.75
Rate for Payer: Wellpoint Medicaid Managed Care	$40.41

BALLOON AMPHIRION DEEP 4x80

Facility

$1,525.00

Hospital Charge Code	270636992
Hospital Revenue Code	272
Min. Negotiated Rate	$228.75
Max. Negotiated Rate	$228.75
Rate for Payer: Qualcare PPO/HMO/WC	$228.75

Know your out-of-pocket cost for care.

All Charges