Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON AMPIRION DEEP 4x150cm

Facility

$1,875.00

Hospital Charge Code	270643515
Hospital Revenue Code	272
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) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$562.50
Rate for Payer: Oxford Commercial	$375.00
Rate for Payer: Qualcare PPO/HMO/WC	$281.25
Rate for Payer: UnitedHealthcare Commercial	$375.00
Rate for Payer: UnitedHealthcare Community & State	$45.19
Rate for Payer: Wellpoint Medicaid Managed Care	$49.69

BALLOON AMPIRION DEEP 4x150cm

Facility

$1,875.00

Hospital Charge Code	270643515
Hospital Revenue Code	272
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$281.25
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

BALLOON ATLAS 12MMX60MM

Facility

$0.01

Service Code	HCPCS C1725
Hospital Charge Code	270695869Z
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BALLOON ATLAS 12MMX60MM

Facility

$0.01

Service Code	HCPCS C1725
Hospital Charge Code	270695869Z
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

BALLOON ATLAS 14MMX40MM

Facility

$0.01

Service Code	HCPCS C1725
Hospital Charge Code	270695883Z
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

BALLOON ATLAS 14MMX40MM

Facility

$0.01

Service Code	HCPCS C1725
Hospital Charge Code	270695883Z
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BALLOON ATLAS 14MMX60MM

Facility

$0.01

Service Code	HCPCS C1725
Hospital Charge Code	270695870Z
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

BALLOON ATLAS 14MMX60MM

Facility

$0.01

Service Code	HCPCS C1725
Hospital Charge Code	270695870Z
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BALLOON ATLAS 16MMX60MM

Facility

$0.01

Service Code	HCPCS C1725
Hospital Charge Code	270695872Z
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BALLOON ATLAS 16MMX60MM

Facility

$0.01

Service Code	HCPCS C1725
Hospital Charge Code	270695872Z
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

BALLOON ATLAS 18MMX40MM

Facility

$0.01

Service Code	HCPCS C1725
Hospital Charge Code	270695884Z
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

BALLOON ATLAS 18MMX40MM

Facility

$0.01

Service Code	HCPCS C1725
Hospital Charge Code	270695884Z
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BALLOON ATLAS 18MMX60MM

Facility

$0.01

Service Code	HCPCS C1725
Hospital Charge Code	270695871Z
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BALLOON ATLAS 18MMX60MM

Facility

$0.01

Service Code	HCPCS C1725
Hospital Charge Code	270695871Z
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

BALLOON ATLAS 20MMX40MM

Facility

$0.01

Service Code	HCPCS C1725
Hospital Charge Code	270695885Z
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BALLOON ATLAS 20MMX40MM

Facility

$0.01

Service Code	HCPCS C1725
Hospital Charge Code	270695885Z
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

BALLOON ATLAS 22MMX40MM

Facility

$0.01

Service Code	HCPCS C1725
Hospital Charge Code	270695886Z
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

BALLOON ATLAS 22MMX40MM

Facility

$0.01

Service Code	HCPCS C1725
Hospital Charge Code	270695886Z
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

BALLOON ATLAS GOLD 14X 40

Facility

$1,750.00

Service Code	HCPCS C1725
Hospital Charge Code	270690356
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

BALLOON ATLAS GOLD 14X 40

Facility

$1,750.00

Service Code	HCPCS C1725
Hospital Charge Code	270690356
Hospital Revenue Code	278
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

BALLOON ATLAS GOLD 16 X 40

Facility

$1,750.00

Service Code	HCPCS C1725
Hospital Charge Code	270690357
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

BALLOON ATLAS GOLD 16 X 40

Facility

$1,750.00

Service Code	HCPCS C1725
Hospital Charge Code	270690357
Hospital Revenue Code	278
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

BALLOON ATLAS PTA 26x4x75cm

Facility

$2,975.00

Hospital Charge Code	270639796
Hospital Revenue Code	272
Min. Negotiated Rate	$71.70
Max. Negotiated Rate	$1,487.50
Rate for Payer: Aetna Commercial	$1,130.50
Rate for Payer: Aetna Medicare Advantage	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.62
Rate for Payer: Cigna Commercial	$1,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$892.50
Rate for Payer: Oxford Commercial	$595.00
Rate for Payer: Qualcare PPO/HMO/WC	$446.25
Rate for Payer: UnitedHealthcare Commercial	$595.00
Rate for Payer: UnitedHealthcare Community & State	$71.70
Rate for Payer: Wellpoint Medicaid Managed Care	$78.84

BALLOON ATLAS PTA 26x4x75cm

Facility

$2,975.00

Hospital Charge Code	270639796
Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$446.25
Rate for Payer: Qualcare PPO/HMO/WC	$446.25

BALLOON ATTAIN CLARITY

Facility

$500.00

Hospital Charge Code	270675268
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

Know your out-of-pocket cost for care.

All Charges