Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON CATH XXL 14-4/5.8/75cm

Facility

$1,300.00

Service Code	HCPCS C1725
Hospital Charge Code	270624069S
Hospital Revenue Code	278
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$314.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$286.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00

BALLOON CATH XXL 14-6/5.8/75cm

Facility

$1,300.00

Service Code	HCPCS C1725
Hospital Charge Code	270626886
Hospital Revenue Code	278
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$314.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$286.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00

BALLOON CATH XXL 14-6/5.8/75cm

Facility

$1,300.00

Service Code	HCPCS C1725
Hospital Charge Code	270626886
Hospital Revenue Code	278
Min. Negotiated Rate	$31.33
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Commercial	$494.00
Rate for Payer: Aetna Medicare Advantage	$390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.50
Rate for Payer: Cigna Commercial	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$286.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00
Rate for Payer: UnitedHealthcare Community & State	$31.33
Rate for Payer: Wellpoint Medicaid Managed Care	$34.45

BALLOON CATH XXL 16-2/5.8/75E

Facility

$1,697.50

Hospital Charge Code	270621572
Hospital Revenue Code	272
Min. Negotiated Rate	$40.91
Max. Negotiated Rate	$848.75
Rate for Payer: Aetna Commercial	$645.05
Rate for Payer: Aetna Medicare Advantage	$509.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$432.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$432.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$432.86
Rate for Payer: Cigna Commercial	$848.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$509.25
Rate for Payer: Oxford Commercial	$339.50
Rate for Payer: Qualcare PPO/HMO/WC	$254.62
Rate for Payer: UnitedHealthcare Commercial	$339.50
Rate for Payer: UnitedHealthcare Community & State	$40.91
Rate for Payer: Wellpoint Medicaid Managed Care	$44.98

BALLOON CATH XXL 16-2/5.8/75E

Facility

$1,697.50

Hospital Charge Code	270621572
Hospital Revenue Code	272
Min. Negotiated Rate	$254.62
Max. Negotiated Rate	$254.62
Rate for Payer: Qualcare PPO/HMO/WC	$254.62

BALLOON CATH XXL 16-4/5.8/75cm

Facility

$1,432.75

Service Code	HCPCS C1725
Hospital Charge Code	270624070
Hospital Revenue Code	278
Min. Negotiated Rate	$214.91
Max. Negotiated Rate	$346.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$315.20
Rate for Payer: Qualcare PPO/HMO/WC	$214.91

BALLOON CATH XXL 16-4/5.8/75cm

Facility

$1,432.75

Service Code	HCPCS C1725
Hospital Charge Code	270624070
Hospital Revenue Code	278
Min. Negotiated Rate	$34.53
Max. Negotiated Rate	$716.38
Rate for Payer: Aetna Commercial	$544.45
Rate for Payer: Aetna Medicare Advantage	$429.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.35
Rate for Payer: Cigna Commercial	$716.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$315.20
Rate for Payer: Qualcare PPO/HMO/WC	$214.91
Rate for Payer: UnitedHealthcare Community & State	$34.53
Rate for Payer: Wellpoint Medicaid Managed Care	$37.97

BALLOON CATH XXL 16-6/5.8/75cm

Facility

$1,564.00

Service Code	HCPCS C1725
Hospital Charge Code	270626887
Hospital Revenue Code	278
Min. Negotiated Rate	$37.69
Max. Negotiated Rate	$782.00
Rate for Payer: Aetna Commercial	$594.32
Rate for Payer: Aetna Medicare Advantage	$469.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$398.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$398.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$312.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$398.82
Rate for Payer: Cigna Commercial	$782.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$344.08
Rate for Payer: Qualcare PPO/HMO/WC	$234.60
Rate for Payer: UnitedHealthcare Community & State	$37.69
Rate for Payer: Wellpoint Medicaid Managed Care	$41.45

BALLOON CATH XXL 16-6/5.8/75cm

Facility

$1,564.00

Service Code	HCPCS C1725
Hospital Charge Code	270626887
Hospital Revenue Code	278
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$378.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$312.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.49
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$344.08
Rate for Payer: Qualcare PPO/HMO/WC	$234.60

BALLOON CATH XXL 18-4/5.8/75cm

Facility

$1,432.75

Service Code	HCPCS C1725
Hospital Charge Code	270627285
Hospital Revenue Code	278
Min. Negotiated Rate	$34.53
Max. Negotiated Rate	$716.38
Rate for Payer: Aetna Commercial	$544.45
Rate for Payer: Aetna Medicare Advantage	$429.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.35
Rate for Payer: Cigna Commercial	$716.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$315.20
Rate for Payer: Qualcare PPO/HMO/WC	$214.91
Rate for Payer: UnitedHealthcare Community & State	$34.53
Rate for Payer: Wellpoint Medicaid Managed Care	$37.97

BALLOON CATH XXL 18-4/5.8/75cm

Facility

$1,432.75

Service Code	HCPCS C1725
Hospital Charge Code	270627285
Hospital Revenue Code	278
Min. Negotiated Rate	$214.91
Max. Negotiated Rate	$346.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.73
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$315.20
Rate for Payer: Qualcare PPO/HMO/WC	$214.91

BALLOON CERVICAL RIPENING 18FR

Facility

$14.05

Hospital Charge Code	270654379
Hospital Revenue Code	272
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$7.03
Rate for Payer: Aetna Commercial	$5.34
Rate for Payer: Aetna Medicare Advantage	$4.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.58
Rate for Payer: Cigna Commercial	$7.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.21
Rate for Payer: Oxford Commercial	$2.81
Rate for Payer: Qualcare PPO/HMO/WC	$2.11
Rate for Payer: UnitedHealthcare Commercial	$2.81
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

BALLOON CERVICAL RIPENING 18FR

Facility

$14.05

Hospital Charge Code	270654379
Hospital Revenue Code	272
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$2.11
Rate for Payer: Qualcare PPO/HMO/WC	$2.11

BALLOON CHOCOLATE 4 X 80 MM

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270687486
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 CHOCOLATE 4 X 80 MM

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270687486
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 COATED 24FR 5CM 12CM

Facility

$17,125.00

Hospital Charge Code	270703746
Hospital Revenue Code	272
Min. Negotiated Rate	$2,568.75
Max. Negotiated Rate	$2,568.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,568.75

BALLOON COATED 24FR 5CM 12CM

Facility

$17,125.00

Hospital Charge Code	270703746
Hospital Revenue Code	272
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) PPO	$4,366.88
Rate for Payer: Cigna Commercial	$8,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,137.50
Rate for Payer: Oxford Commercial	$3,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,568.75
Rate for Payer: UnitedHealthcare Commercial	$3,425.00
Rate for Payer: UnitedHealthcare Community & State	$412.71
Rate for Payer: Wellpoint Medicaid Managed Care	$453.81

BALLOON CODA 10FR 120cm .035

Facility

$1,810.00

Hospital Charge Code	270638236
Hospital Revenue Code	272
Min. Negotiated Rate	$271.50
Max. Negotiated Rate	$271.50
Rate for Payer: Qualcare PPO/HMO/WC	$271.50

BALLOON CODA 10FR 120cm .035

Facility

$1,810.00

Hospital Charge Code	270638236
Hospital Revenue Code	272
Min. Negotiated Rate	$43.62
Max. Negotiated Rate	$905.00
Rate for Payer: Aetna Commercial	$687.80
Rate for Payer: Aetna Medicare Advantage	$543.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.55
Rate for Payer: Cigna Commercial	$905.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$543.00
Rate for Payer: Oxford Commercial	$362.00
Rate for Payer: Qualcare PPO/HMO/WC	$271.50
Rate for Payer: UnitedHealthcare Commercial	$362.00
Rate for Payer: UnitedHealthcare Community & State	$43.62
Rate for Payer: Wellpoint Medicaid Managed Care	$47.97

BALLOON CODA 10X120 035 G31236

Facility

$1,810.00

Hospital Charge Code	270638236V
Hospital Revenue Code	278
Min. Negotiated Rate	$271.50
Max. Negotiated Rate	$438.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$362.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$438.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$398.20
Rate for Payer: Qualcare PPO/HMO/WC	$271.50

BALLOON CODA 10X120 035 G31236

Facility

$1,810.00

Hospital Charge Code	270638236V
Hospital Revenue Code	278
Min. Negotiated Rate	$43.62
Max. Negotiated Rate	$905.00
Rate for Payer: Aetna Commercial	$687.80
Rate for Payer: Aetna Medicare Advantage	$543.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$362.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.55
Rate for Payer: Cigna Commercial	$905.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$438.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$398.20
Rate for Payer: Qualcare PPO/HMO/WC	$271.50
Rate for Payer: UnitedHealthcare Community & State	$43.62
Rate for Payer: Wellpoint Medicaid Managed Care	$47.97

BALLOON CONQUEST 6 X 40 MM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690213
Hospital Revenue Code	278
Min. Negotiated Rate	$31.93
Max. Negotiated Rate	$662.50
Rate for Payer: Aetna Commercial	$503.50
Rate for Payer: Aetna Medicare Advantage	$397.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.88
Rate for Payer: Cigna Commercial	$662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.50
Rate for Payer: Qualcare PPO/HMO/WC	$198.75
Rate for Payer: UnitedHealthcare Community & State	$31.93
Rate for Payer: Wellpoint Medicaid Managed Care	$35.11

BALLOON CONQUEST 6 X 40 MM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690213
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$320.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.50
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

BALLOON CONQUEST 7 X 40 MM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690214
Hospital Revenue Code	278
Min. Negotiated Rate	$31.93
Max. Negotiated Rate	$662.50
Rate for Payer: Aetna Commercial	$503.50
Rate for Payer: Aetna Medicare Advantage	$397.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.88
Rate for Payer: Cigna Commercial	$662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.50
Rate for Payer: Qualcare PPO/HMO/WC	$198.75
Rate for Payer: UnitedHealthcare Community & State	$31.93
Rate for Payer: Wellpoint Medicaid Managed Care	$35.11

BALLOON CONQUEST 7 X 40 MM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690214
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$320.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$291.50
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

Know your out-of-pocket cost for care.

All Charges