Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOONCATHOCCLSCEPTERC4X15MM

Facility

$7,000.00

Service Code	HCPCS C2628
Hospital Charge Code	270693918S
Hospital Revenue Code	278
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$168.70
Rate for Payer: Wellpoint Medicaid Managed Care	$185.50

BALLOONCATHOCCLSCEPTERC4X15MM

Facility

$7,000.00

Service Code	HCPCS C2628
Hospital Charge Code	270693918S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,540.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

BALLOONCATHOCCLSCEPTERXC4X11MM

Facility

$9,775.00

Service Code	HCPCS C2628
Hospital Charge Code	270693920S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,466.25
Max. Negotiated Rate	$2,365.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,365.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,150.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,466.25

BALLOONCATHOCCLSCEPTERXC4X11MM

Facility

$9,775.00

Service Code	HCPCS C2628
Hospital Charge Code	270693920S
Hospital Revenue Code	278
Min. Negotiated Rate	$235.58
Max. Negotiated Rate	$4,887.50
Rate for Payer: Aetna Commercial	$3,714.50
Rate for Payer: Aetna Medicare Advantage	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,492.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,492.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,955.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,492.62
Rate for Payer: Cigna Commercial	$4,887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,365.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,150.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,466.25
Rate for Payer: UnitedHealthcare Community & State	$235.58
Rate for Payer: Wellpoint Medicaid Managed Care	$259.04

BALLOON CATH OTW 4x120MM 150CM

Facility

$1,866.90

Hospital Charge Code	270674896
Hospital Revenue Code	278
Min. Negotiated Rate	$44.99
Max. Negotiated Rate	$933.45
Rate for Payer: Aetna Commercial	$709.42
Rate for Payer: Aetna Medicare Advantage	$560.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$476.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$476.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$373.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$476.06
Rate for Payer: Cigna Commercial	$933.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$410.72
Rate for Payer: Qualcare PPO/HMO/WC	$280.04
Rate for Payer: UnitedHealthcare Community & State	$44.99
Rate for Payer: Wellpoint Medicaid Managed Care	$49.47

BALLOON CATH OTW 4x120MM 150CM

Facility

$1,866.90

Hospital Charge Code	270674896
Hospital Revenue Code	278
Min. Negotiated Rate	$280.04
Max. Negotiated Rate	$451.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$373.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.79
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$410.72
Rate for Payer: Qualcare PPO/HMO/WC	$280.04

BALLOON CATH OTW 5x220MM

Facility

$1,770.00

Service Code	HCPCS C1725
Hospital Charge Code	270672789
Hospital Revenue Code	278
Min. Negotiated Rate	$265.50
Max. Negotiated Rate	$428.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$354.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$428.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$389.40
Rate for Payer: Qualcare PPO/HMO/WC	$265.50

BALLOON CATH OTW 5x220MM

Facility

$1,770.00

Service Code	HCPCS C1725
Hospital Charge Code	270672789
Hospital Revenue Code	278
Min. Negotiated Rate	$42.66
Max. Negotiated Rate	$885.00
Rate for Payer: Aetna Commercial	$672.60
Rate for Payer: Aetna Medicare Advantage	$531.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$451.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$451.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$354.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$451.35
Rate for Payer: Cigna Commercial	$885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$428.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$389.40
Rate for Payer: Qualcare PPO/HMO/WC	$265.50
Rate for Payer: UnitedHealthcare Community & State	$42.66
Rate for Payer: Wellpoint Medicaid Managed Care	$46.91

BALLOON CATH OTW 6x220MM 150CM

Facility

$1,770.00

Hospital Charge Code	270676073
Hospital Revenue Code	278
Min. Negotiated Rate	$265.50
Max. Negotiated Rate	$428.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$354.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$428.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$389.40
Rate for Payer: Qualcare PPO/HMO/WC	$265.50

BALLOON CATH OTW 6x220MM 150CM

Facility

$1,770.00

Hospital Charge Code	270676073
Hospital Revenue Code	278
Min. Negotiated Rate	$42.66
Max. Negotiated Rate	$885.00
Rate for Payer: Aetna Commercial	$672.60
Rate for Payer: Aetna Medicare Advantage	$531.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$451.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$451.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$354.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$451.35
Rate for Payer: Cigna Commercial	$885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$428.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$389.40
Rate for Payer: Qualcare PPO/HMO/WC	$265.50
Rate for Payer: UnitedHealthcare Community & State	$42.66
Rate for Payer: Wellpoint Medicaid Managed Care	$46.91

BALLOON CATH SDS 5FR 4x2 135cm

Facility

$1,080.00

Hospital Charge Code	270635772
Hospital Revenue Code	272
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00

BALLOON CATH SDS 5FR 4x2 135cm

Facility

$1,080.00

Hospital Charge Code	270635772
Hospital Revenue Code	272
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna Commercial	$410.40
Rate for Payer: Aetna Medicare Advantage	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.40
Rate for Payer: Cigna Commercial	$540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.00
Rate for Payer: Oxford Commercial	$216.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00
Rate for Payer: UnitedHealthcare Commercial	$216.00
Rate for Payer: UnitedHealthcare Community & State	$26.03
Rate for Payer: Wellpoint Medicaid Managed Care	$28.62

BALLOON CATH SDS 5FR 4x4 135cm

Facility

$1,080.00

Hospital Charge Code	270637377V
Hospital Revenue Code	278
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$261.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$237.60
Rate for Payer: Qualcare PPO/HMO/WC	$162.00

BALLOON CATH SDS 5FR 4x4 135cm

Facility

$857.50

Service Code	HCPCS C1725
Hospital Charge Code	270637377
Hospital Revenue Code	278
Min. Negotiated Rate	$20.67
Max. Negotiated Rate	$428.75
Rate for Payer: Aetna Commercial	$325.85
Rate for Payer: Aetna Medicare Advantage	$257.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.66
Rate for Payer: Cigna Commercial	$428.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$188.65
Rate for Payer: Qualcare PPO/HMO/WC	$128.62
Rate for Payer: UnitedHealthcare Community & State	$20.67
Rate for Payer: Wellpoint Medicaid Managed Care	$22.72

BALLOON CATH SDS 5FR 4x4 135cm

Facility

$1,080.00

Hospital Charge Code	270637377V
Hospital Revenue Code	278
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna Commercial	$410.40
Rate for Payer: Aetna Medicare Advantage	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.40
Rate for Payer: Cigna Commercial	$540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.36
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$237.60
Rate for Payer: Qualcare PPO/HMO/WC	$162.00
Rate for Payer: UnitedHealthcare Community & State	$26.03
Rate for Payer: Wellpoint Medicaid Managed Care	$28.62

BALLOON CATH SDS 5FR 4x4 135cm

Facility

$857.50

Service Code	HCPCS C1725
Hospital Charge Code	270637377
Hospital Revenue Code	278
Min. Negotiated Rate	$128.62
Max. Negotiated Rate	$207.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$188.65
Rate for Payer: Qualcare PPO/HMO/WC	$128.62

BALLOON CATH SDS 5FR 5x2 135cm

Facility

$1,080.00

Hospital Charge Code	270637557
Hospital Revenue Code	272
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna Commercial	$410.40
Rate for Payer: Aetna Medicare Advantage	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.40
Rate for Payer: Cigna Commercial	$540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.00
Rate for Payer: Oxford Commercial	$216.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00
Rate for Payer: UnitedHealthcare Commercial	$216.00
Rate for Payer: UnitedHealthcare Community & State	$26.03
Rate for Payer: Wellpoint Medicaid Managed Care	$28.62

BALLOON CATH SDS 5FR 5x2 135cm

Facility

$1,080.00

Hospital Charge Code	270637557
Hospital Revenue Code	272
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00

BALLOON CATH SDS 5FR 6x2 135cm

Facility

$1,080.00

Hospital Charge Code	270634525
Hospital Revenue Code	272
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00

BALLOON CATH SDS 5FR 6x2 135cm

Facility

$1,080.00

Hospital Charge Code	270634525
Hospital Revenue Code	272
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna Commercial	$410.40
Rate for Payer: Aetna Medicare Advantage	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.40
Rate for Payer: Cigna Commercial	$540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.00
Rate for Payer: Oxford Commercial	$216.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00
Rate for Payer: UnitedHealthcare Commercial	$216.00
Rate for Payer: UnitedHealthcare Community & State	$26.03
Rate for Payer: Wellpoint Medicaid Managed Care	$28.62

BALLOON CATH SDS 5FR 6x4 135cm

Facility

$857.50

Hospital Charge Code	270635574
Hospital Revenue Code	272
Min. Negotiated Rate	$20.67
Max. Negotiated Rate	$428.75
Rate for Payer: Aetna Commercial	$325.85
Rate for Payer: Aetna Medicare Advantage	$257.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.66
Rate for Payer: Cigna Commercial	$428.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$257.25
Rate for Payer: Oxford Commercial	$171.50
Rate for Payer: Qualcare PPO/HMO/WC	$128.62
Rate for Payer: UnitedHealthcare Commercial	$171.50
Rate for Payer: UnitedHealthcare Community & State	$20.67
Rate for Payer: Wellpoint Medicaid Managed Care	$22.72

BALLOON CATH SDS 5FR 6x4 135cm

Facility

$857.50

Hospital Charge Code	270635574
Hospital Revenue Code	272
Min. Negotiated Rate	$128.62
Max. Negotiated Rate	$128.62
Rate for Payer: Qualcare PPO/HMO/WC	$128.62

BALLOON CATH SDS 5FR 7x2 75cm

Facility

$1,020.00

Hospital Charge Code	270637951
Hospital Revenue Code	272
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$153.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.00

BALLOON CATH SDS 5FR 7x2 75cm

Facility

$1,020.00

Hospital Charge Code	270637951
Hospital Revenue Code	272
Min. Negotiated Rate	$24.58
Max. Negotiated Rate	$510.00
Rate for Payer: Aetna Commercial	$387.60
Rate for Payer: Aetna Medicare Advantage	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$260.10
Rate for Payer: Cigna Commercial	$510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$306.00
Rate for Payer: Oxford Commercial	$204.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.00
Rate for Payer: UnitedHealthcare Commercial	$204.00
Rate for Payer: UnitedHealthcare Community & State	$24.58
Rate for Payer: Wellpoint Medicaid Managed Care	$27.03

BALLOON CATH SDS 5FR 7x4 135cm

Facility

$857.50

Hospital Charge Code	270635773
Hospital Revenue Code	278
Min. Negotiated Rate	$128.62
Max. Negotiated Rate	$207.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.51
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$188.65
Rate for Payer: Qualcare PPO/HMO/WC	$128.62

Know your out-of-pocket cost for care.

All Charges