Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON CATH ADMI 18 7x60x130

Facility

$7,050.00

Hospital Charge Code	270705327
Hospital Revenue Code	279
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,057.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

BALLOON CATH ADMI 18 7x60x130

Facility

$7,050.00

Hospital Charge Code	270705323
Hospital Revenue Code	279
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) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,115.00
Rate for Payer: Oxford Commercial	$1,410.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Commercial	$1,410.00
Rate for Payer: UnitedHealthcare Community & State	$169.91
Rate for Payer: Wellpoint Medicaid Managed Care	$186.82

BALLOON CATH ADMI 18 7x60x130

Facility

$7,050.00

Hospital Charge Code	270705323
Hospital Revenue Code	279
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,057.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

BALLOON CATH ADMI 18 7x60x130

Facility

$7,050.00

Hospital Charge Code	270705327
Hospital Revenue Code	279
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) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,115.00
Rate for Payer: Oxford Commercial	$1,410.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Commercial	$1,410.00
Rate for Payer: UnitedHealthcare Community & State	$169.91
Rate for Payer: Wellpoint Medicaid Managed Care	$186.82

BALLOON CATH AORTIC OCCLUSION

Facility

$2,225.00

Hospital Charge Code	270679692
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 CATH AORTIC OCCLUSION

Facility

$2,225.00

Hospital Charge Code	270679692
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 CATH DRUG COATED

Facility

$17,125.00

Hospital Charge Code	270703593
Hospital Revenue Code	278
Min. Negotiated Rate	$412.71
Max. Negotiated Rate	$8,562.50
Rate for Payer: Aetna Commercial	$6,507.50
Rate for Payer: Aetna Medicare Advantage	$5,137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,366.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,366.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,366.88
Rate for Payer: Cigna Commercial	$8,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,144.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,767.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,568.75
Rate for Payer: UnitedHealthcare Community & State	$412.71
Rate for Payer: Wellpoint Medicaid Managed Care	$453.81

BALLOON CATH DRUG COATED

Facility

$17,125.00

Hospital Charge Code	270703593
Hospital Revenue Code	278
Min. Negotiated Rate	$2,568.75
Max. Negotiated Rate	$4,144.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,144.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$3,767.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,568.75

BALLOON CATHETER 3.0 X 80 CM

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270684596
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

BALLOON CATHETER 3.0 X 80 CM

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270684596
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

BALLOON CATHETER 5x80MM 5F

Facility

$1,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270672790
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BALLOON CATHETER 5x80MM 5F

Facility

$1,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270672790
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

BALLOON CATH EXTRACTOR 12-15MM

Facility

$740.00

Service Code	HCPCS C1769
Hospital Charge Code	270646920
Hospital Revenue Code	272
Min. Negotiated Rate	$17.83
Max. Negotiated Rate	$370.00
Rate for Payer: Aetna Commercial	$281.20
Rate for Payer: Aetna Medicare Advantage	$222.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.70
Rate for Payer: Cigna Commercial	$370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.00
Rate for Payer: Oxford Commercial	$148.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.00
Rate for Payer: UnitedHealthcare Commercial	$148.00
Rate for Payer: UnitedHealthcare Community & State	$17.83
Rate for Payer: Wellpoint Medicaid Managed Care	$19.61

BALLOON CATH EXTRACTOR 12-15MM

Facility

$740.00

Service Code	HCPCS C1769
Hospital Charge Code	270646920
Hospital Revenue Code	272
Min. Negotiated Rate	$111.00
Max. Negotiated Rate	$111.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.00

BALLOON CATH LUTONIX 5x100MM

Facility

$8,250.00

Service Code	HCPCS C2623
Hospital Charge Code	270675783S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

BALLOON CATH LUTONIX 5x100MM

Facility

$8,250.00

Service Code	HCPCS C2623
Hospital Charge Code	270675783N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

BALLOON CATH LUTONIX 5x100MM

Facility

$8,250.00

Service Code	HCPCS C2623
Hospital Charge Code	270675783N
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

BALLOON CATH LUTONIX 5x100MM

Facility

$8,250.00

Service Code	HCPCS C2623
Hospital Charge Code	270675783S
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

BALLOON CATH LUTONIX 5x100MM

Facility

$8,250.00

Service Code	HCPCS C2623
Hospital Charge Code	270675783
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

BALLOON CATH LUTONIX 5x100MM

Facility

$8,250.00

Service Code	HCPCS C2623
Hospital Charge Code	270675783
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

BALLOON CATH LUTONIX 5x150MM

Facility

$9,750.00

Service Code	HCPCS C2623
Hospital Charge Code	270677796N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$2,359.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,145.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

BALLOON CATH LUTONIX 5x150MM

Facility

$9,750.00

Service Code	HCPCS C2623
Hospital Charge Code	270677796
Hospital Revenue Code	278
Min. Negotiated Rate	$234.97
Max. Negotiated Rate	$4,875.00
Rate for Payer: Aetna Commercial	$3,705.00
Rate for Payer: Aetna Medicare Advantage	$2,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,486.25
Rate for Payer: Cigna Commercial	$4,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,145.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50
Rate for Payer: UnitedHealthcare Community & State	$234.97
Rate for Payer: Wellpoint Medicaid Managed Care	$258.38

BALLOON CATH LUTONIX 5x150MM

Facility

$9,750.00

Service Code	HCPCS C2623
Hospital Charge Code	270677796N
Hospital Revenue Code	278
Min. Negotiated Rate	$234.97
Max. Negotiated Rate	$4,875.00
Rate for Payer: Aetna Commercial	$3,705.00
Rate for Payer: Aetna Medicare Advantage	$2,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,486.25
Rate for Payer: Cigna Commercial	$4,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,145.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50
Rate for Payer: UnitedHealthcare Community & State	$234.97
Rate for Payer: Wellpoint Medicaid Managed Care	$258.38

BALLOON CATH LUTONIX 5x150MM

Facility

$9,750.00

Service Code	HCPCS C2623
Hospital Charge Code	270677796
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$2,359.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,145.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

BALLOON CATH LUTONIX 5x60MM

Facility

$8,250.00

Service Code	HCPCS C2623
Hospital Charge Code	270675784
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

Know your out-of-pocket cost for care.

All Charges