Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON CATH SDS 5FR 7x4 135cm

Facility

$857.50

Hospital Charge Code	270635773
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 6FR 8x4 135cm

Facility

$1,080.00

Hospital Charge Code	270635774
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 6FR 8x4 135cm

Facility

$1,080.00

Hospital Charge Code	270635774
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 7FR 8x6 75cm

Facility

$857.50

Hospital Charge Code	270639322
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 7FR 8x6 75cm

Facility

$857.50

Hospital Charge Code	270639322
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 7FR 9x2 135cm

Facility

$1,080.00

Hospital Charge Code	270635775
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 7FR 9x2 135cm

Facility

$1,080.00

Hospital Charge Code	270635775
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 SL OTW 4x150MM

Facility

$1,642.85

Service Code	HCPCS C1725
Hospital Charge Code	270670064
Hospital Revenue Code	278
Min. Negotiated Rate	$39.59
Max. Negotiated Rate	$821.42
Rate for Payer: Aetna Commercial	$624.28
Rate for Payer: Aetna Medicare Advantage	$492.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$418.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$418.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$328.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$418.93
Rate for Payer: Cigna Commercial	$821.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$397.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$361.43
Rate for Payer: Qualcare PPO/HMO/WC	$246.43
Rate for Payer: UnitedHealthcare Community & State	$39.59
Rate for Payer: Wellpoint Medicaid Managed Care	$43.54

BALLOON CATH SL OTW 4x150MM

Facility

$1,642.85

Service Code	HCPCS C1725
Hospital Charge Code	270670064
Hospital Revenue Code	278
Min. Negotiated Rate	$246.43
Max. Negotiated Rate	$397.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$328.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$397.57
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$361.43
Rate for Payer: Qualcare PPO/HMO/WC	$246.43

BALLOON CATH SYNERGY 10-2 75cm

Facility

$1,355.00

Hospital Charge Code	270625144
Hospital Revenue Code	272
Min. Negotiated Rate	$203.25
Max. Negotiated Rate	$203.25
Rate for Payer: Qualcare PPO/HMO/WC	$203.25

BALLOON CATH SYNERGY 10-2 75cm

Facility

$1,355.00

Hospital Charge Code	270625144
Hospital Revenue Code	272
Min. Negotiated Rate	$32.66
Max. Negotiated Rate	$677.50
Rate for Payer: Aetna Commercial	$514.90
Rate for Payer: Aetna Medicare Advantage	$406.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.52
Rate for Payer: Cigna Commercial	$677.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.50
Rate for Payer: Oxford Commercial	$271.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.25
Rate for Payer: UnitedHealthcare Commercial	$271.00
Rate for Payer: UnitedHealthcare Community & State	$32.66
Rate for Payer: Wellpoint Medicaid Managed Care	$35.91

BALLOON CATH SYNERGY 4-2 75cm

Facility

$1,355.00

Hospital Charge Code	270625129
Hospital Revenue Code	272
Min. Negotiated Rate	$32.66
Max. Negotiated Rate	$677.50
Rate for Payer: Aetna Commercial	$514.90
Rate for Payer: Aetna Medicare Advantage	$406.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.52
Rate for Payer: Cigna Commercial	$677.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.50
Rate for Payer: Oxford Commercial	$271.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.25
Rate for Payer: UnitedHealthcare Commercial	$271.00
Rate for Payer: UnitedHealthcare Community & State	$32.66
Rate for Payer: Wellpoint Medicaid Managed Care	$35.91

BALLOON CATH SYNERGY 4-2 75cm

Facility

$1,355.00

Hospital Charge Code	270625129
Hospital Revenue Code	272
Min. Negotiated Rate	$203.25
Max. Negotiated Rate	$203.25
Rate for Payer: Qualcare PPO/HMO/WC	$203.25

BALLOON CATH SYNERGY 4-4 75cm

Facility

$1,355.00

Hospital Charge Code	270625130
Hospital Revenue Code	272
Min. Negotiated Rate	$32.66
Max. Negotiated Rate	$677.50
Rate for Payer: Aetna Commercial	$514.90
Rate for Payer: Aetna Medicare Advantage	$406.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.52
Rate for Payer: Cigna Commercial	$677.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.50
Rate for Payer: Oxford Commercial	$271.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.25
Rate for Payer: UnitedHealthcare Commercial	$271.00
Rate for Payer: UnitedHealthcare Community & State	$32.66
Rate for Payer: Wellpoint Medicaid Managed Care	$35.91

BALLOON CATH SYNERGY 4-4 75cm

Facility

$1,355.00

Hospital Charge Code	270625130
Hospital Revenue Code	272
Min. Negotiated Rate	$203.25
Max. Negotiated Rate	$203.25
Rate for Payer: Qualcare PPO/HMO/WC	$203.25

BALLOON CATH SYNERGY 5-2 75cm

Facility

$1,355.00

Hospital Charge Code	270625131
Hospital Revenue Code	272
Min. Negotiated Rate	$203.25
Max. Negotiated Rate	$203.25
Rate for Payer: Qualcare PPO/HMO/WC	$203.25

BALLOON CATH SYNERGY 5-2 75cm

Facility

$1,355.00

Hospital Charge Code	270625131
Hospital Revenue Code	272
Min. Negotiated Rate	$32.66
Max. Negotiated Rate	$677.50
Rate for Payer: Aetna Commercial	$514.90
Rate for Payer: Aetna Medicare Advantage	$406.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.52
Rate for Payer: Cigna Commercial	$677.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$406.50
Rate for Payer: Oxford Commercial	$271.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.25
Rate for Payer: UnitedHealthcare Commercial	$271.00
Rate for Payer: UnitedHealthcare Community & State	$32.66
Rate for Payer: Wellpoint Medicaid Managed Care	$35.91

BALLOON CATH SYNERGY 5-4 75cm

Facility

$875.00

Hospital Charge Code	270625133
Hospital Revenue Code	272
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

BALLOON CATH SYNERGY 5-4 75cm

Facility

$875.00

Hospital Charge Code	270625133
Hospital Revenue Code	272
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$21.09
Rate for Payer: Wellpoint Medicaid Managed Care	$23.19

BALLOON CATH SYNERGY 6-2 135cm

Facility

$1,430.00

Hospital Charge Code	270625136
Hospital Revenue Code	272
Min. Negotiated Rate	$34.46
Max. Negotiated Rate	$715.00
Rate for Payer: Aetna Commercial	$543.40
Rate for Payer: Aetna Medicare Advantage	$429.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$364.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$364.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$364.65
Rate for Payer: Cigna Commercial	$715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$429.00
Rate for Payer: Oxford Commercial	$286.00
Rate for Payer: Qualcare PPO/HMO/WC	$214.50
Rate for Payer: UnitedHealthcare Commercial	$286.00
Rate for Payer: UnitedHealthcare Community & State	$34.46
Rate for Payer: Wellpoint Medicaid Managed Care	$37.90

BALLOON CATH SYNERGY 6-2 135cm

Facility

$1,430.00

Hospital Charge Code	270625136
Hospital Revenue Code	272
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$214.50
Rate for Payer: Qualcare PPO/HMO/WC	$214.50

BALLOON CATH SYNERGY 6-2 75cm

Facility

$875.00

Hospital Charge Code	270625135
Hospital Revenue Code	272
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

BALLOON CATH SYNERGY 6-2 75cm

Facility

$875.00

Hospital Charge Code	270625135
Hospital Revenue Code	272
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$21.09
Rate for Payer: Wellpoint Medicaid Managed Care	$23.19

BALLOON CATH SYNERGY 6-4 135cm

Facility

$1,930.00

Hospital Charge Code	270625138
Hospital Revenue Code	272
Min. Negotiated Rate	$46.51
Max. Negotiated Rate	$965.00
Rate for Payer: Aetna Commercial	$733.40
Rate for Payer: Aetna Medicare Advantage	$579.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$492.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$492.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$492.15
Rate for Payer: Cigna Commercial	$965.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$579.00
Rate for Payer: Oxford Commercial	$386.00
Rate for Payer: Qualcare PPO/HMO/WC	$289.50
Rate for Payer: UnitedHealthcare Commercial	$386.00
Rate for Payer: UnitedHealthcare Community & State	$46.51
Rate for Payer: Wellpoint Medicaid Managed Care	$51.15

BALLOON CATH SYNERGY 6-4 135cm

Facility

$1,930.00

Hospital Charge Code	270625138
Hospital Revenue Code	272
Min. Negotiated Rate	$289.50
Max. Negotiated Rate	$289.50
Rate for Payer: Qualcare PPO/HMO/WC	$289.50

Know your out-of-pocket cost for care.

All Charges