Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON C PANTERA LEO 5.0/30

Facility

$350.00

Service Code	HCPCS C1874
Hospital Charge Code	270700913
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$77.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 5.0/30

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700913S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 5.0/30

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700913S
Hospital Revenue Code	272
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Oxford Commercial	$70.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$70.00
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

BALLOON C PANTERA LEO 5.0/30

Facility

$350.00

Service Code	HCPCS C1874
Hospital Charge Code	270700913
Hospital Revenue Code	278
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$77.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

BALLOON CRD 4198030S

Facility

$1,237.65

Hospital Charge Code	270625962
Hospital Revenue Code	272
Min. Negotiated Rate	$29.83
Max. Negotiated Rate	$618.83
Rate for Payer: Aetna Commercial	$470.31
Rate for Payer: Aetna Medicare Advantage	$371.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$315.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$315.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$315.60
Rate for Payer: Cigna Commercial	$618.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$371.30
Rate for Payer: Oxford Commercial	$247.53
Rate for Payer: Qualcare PPO/HMO/WC	$185.65
Rate for Payer: UnitedHealthcare Commercial	$247.53
Rate for Payer: UnitedHealthcare Community & State	$29.83
Rate for Payer: Wellpoint Medicaid Managed Care	$32.80

BALLOON CRD 4198030S

Facility

$1,237.65

Hospital Charge Code	270625962
Hospital Revenue Code	272
Min. Negotiated Rate	$185.65
Max. Negotiated Rate	$185.65
Rate for Payer: Qualcare PPO/HMO/WC	$185.65

BALLOON CRD OPTA 6 4 80 6040S

Facility

$1,180.00

Hospital Charge Code	270622876
Hospital Revenue Code	272
Min. Negotiated Rate	$177.00
Max. Negotiated Rate	$177.00
Rate for Payer: Qualcare PPO/HMO/WC	$177.00

BALLOON CRD OPTA 6 4 80 6040S

Facility

$1,180.00

Hospital Charge Code	270622876
Hospital Revenue Code	272
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$590.00
Rate for Payer: Aetna Commercial	$448.40
Rate for Payer: Aetna Medicare Advantage	$354.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$300.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$300.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$300.90
Rate for Payer: Cigna Commercial	$590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$354.00
Rate for Payer: Oxford Commercial	$236.00
Rate for Payer: Qualcare PPO/HMO/WC	$177.00
Rate for Payer: UnitedHealthcare Commercial	$236.00
Rate for Payer: UnitedHealthcare Community & State	$28.44
Rate for Payer: Wellpoint Medicaid Managed Care	$31.27

BALLOON CRD OPTA 7 4 80 7040S

Facility

$1,180.00

Hospital Charge Code	270622877
Hospital Revenue Code	272
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$590.00
Rate for Payer: Aetna Commercial	$448.40
Rate for Payer: Aetna Medicare Advantage	$354.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$300.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$300.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$300.90
Rate for Payer: Cigna Commercial	$590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$354.00
Rate for Payer: Oxford Commercial	$236.00
Rate for Payer: Qualcare PPO/HMO/WC	$177.00
Rate for Payer: UnitedHealthcare Commercial	$236.00
Rate for Payer: UnitedHealthcare Community & State	$28.44
Rate for Payer: Wellpoint Medicaid Managed Care	$31.27

BALLOON CRD OPTA 7 4 80 7040S

Facility

$1,180.00

Hospital Charge Code	270622877
Hospital Revenue Code	272
Min. Negotiated Rate	$177.00
Max. Negotiated Rate	$177.00
Rate for Payer: Qualcare PPO/HMO/WC	$177.00

BALLOON CRE 6MM 7-8MM

Facility

$1,075.00

Hospital Charge Code	270672230
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

BALLOON CRE 6MM 7-8MM

Facility

$1,075.00

Hospital Charge Code	270672230
Hospital Revenue Code	278
Min. Negotiated Rate	$25.91
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$408.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25
Rate for Payer: UnitedHealthcare Community & State	$25.91
Rate for Payer: Wellpoint Medicaid Managed Care	$28.49

BALLOON CRE FIXED WIRE 15-18mm

Facility

$942.00

Service Code	HCPCS C1726
Hospital Charge Code	270619881
Hospital Revenue Code	278
Min. Negotiated Rate	$141.30
Max. Negotiated Rate	$227.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$207.24
Rate for Payer: Qualcare PPO/HMO/WC	$141.30

BALLOON CRE FIXED WIRE 15-18mm

Facility

$942.00

Service Code	HCPCS C1726
Hospital Charge Code	270619881
Hospital Revenue Code	278
Min. Negotiated Rate	$22.70
Max. Negotiated Rate	$471.00
Rate for Payer: Aetna Commercial	$357.96
Rate for Payer: Aetna Medicare Advantage	$282.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.21
Rate for Payer: Cigna Commercial	$471.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$207.24
Rate for Payer: Qualcare PPO/HMO/WC	$141.30
Rate for Payer: UnitedHealthcare Community & State	$22.70
Rate for Payer: Wellpoint Medicaid Managed Care	$24.96

BALLOON CRE FIXED WIRE 6-8

Facility

$936.70

Hospital Charge Code	270654301
Hospital Revenue Code	272
Min. Negotiated Rate	$140.50
Max. Negotiated Rate	$140.50
Rate for Payer: Qualcare PPO/HMO/WC	$140.50

BALLOON CRE FIXED WIRE 6-8

Facility

$936.70

Hospital Charge Code	270654301
Hospital Revenue Code	272
Min. Negotiated Rate	$22.57
Max. Negotiated Rate	$468.35
Rate for Payer: Aetna Commercial	$355.95
Rate for Payer: Aetna Medicare Advantage	$281.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$238.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$238.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$238.86
Rate for Payer: Cigna Commercial	$468.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.01
Rate for Payer: Oxford Commercial	$187.34
Rate for Payer: Qualcare PPO/HMO/WC	$140.50
Rate for Payer: UnitedHealthcare Commercial	$187.34
Rate for Payer: UnitedHealthcare Community & State	$22.57
Rate for Payer: Wellpoint Medicaid Managed Care	$24.82

BALLOON CRE FIX WIRE 8-10

Facility

$939.05

Hospital Charge Code	270653652
Hospital Revenue Code	270
Min. Negotiated Rate	$140.86
Max. Negotiated Rate	$140.86
Rate for Payer: Qualcare PPO/HMO/WC	$140.86

BALLOON CRE FIX WIRE 8-10

Facility

$939.05

Hospital Charge Code	270653652
Hospital Revenue Code	270
Min. Negotiated Rate	$22.63
Max. Negotiated Rate	$469.52
Rate for Payer: Aetna Commercial	$356.84
Rate for Payer: Aetna Medicare Advantage	$281.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$239.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$239.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$239.46
Rate for Payer: Cigna Commercial	$469.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.71
Rate for Payer: Oxford Commercial	$187.81
Rate for Payer: Qualcare PPO/HMO/WC	$140.86
Rate for Payer: UnitedHealthcare Commercial	$187.81
Rate for Payer: UnitedHealthcare Community & State	$22.63
Rate for Payer: Wellpoint Medicaid Managed Care	$24.88

BALLOON CRE PULM 10-12MM

Facility

$1,538.20

Hospital Charge Code	270677585
Hospital Revenue Code	278
Min. Negotiated Rate	$230.73
Max. Negotiated Rate	$372.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.40
Rate for Payer: Qualcare PPO/HMO/WC	$230.73

BALLOON CRE PULM 10-12MM

Facility

$1,538.20

Hospital Charge Code	270677585
Hospital Revenue Code	278
Min. Negotiated Rate	$37.07
Max. Negotiated Rate	$769.10
Rate for Payer: Aetna Commercial	$584.52
Rate for Payer: Aetna Medicare Advantage	$461.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.24
Rate for Payer: Cigna Commercial	$769.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.40
Rate for Payer: Qualcare PPO/HMO/WC	$230.73
Rate for Payer: UnitedHealthcare Community & State	$37.07
Rate for Payer: Wellpoint Medicaid Managed Care	$40.76

BALLOON CRE PULM 8-10MM

Facility

$1,538.20

Hospital Charge Code	270677584
Hospital Revenue Code	278
Min. Negotiated Rate	$37.07
Max. Negotiated Rate	$769.10
Rate for Payer: Aetna Commercial	$584.52
Rate for Payer: Aetna Medicare Advantage	$461.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.24
Rate for Payer: Cigna Commercial	$769.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.40
Rate for Payer: Qualcare PPO/HMO/WC	$230.73
Rate for Payer: UnitedHealthcare Community & State	$37.07
Rate for Payer: Wellpoint Medicaid Managed Care	$40.76

BALLOON CRE PULM 8-10MM

Facility

$1,538.20

Hospital Charge Code	270677584
Hospital Revenue Code	278
Min. Negotiated Rate	$230.73
Max. Negotiated Rate	$372.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.40
Rate for Payer: Qualcare PPO/HMO/WC	$230.73

BALLOON CRE RX 3cm 10-11-12

Facility

$1,475.00

Service Code	HCPCS C1726
Hospital Charge Code	270683531
Hospital Revenue Code	278
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$356.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$324.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

BALLOON CRE RX 3cm 10-11-12

Facility

$1,475.00

Service Code	HCPCS C1726
Hospital Charge Code	270683531
Hospital Revenue Code	278
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$324.50
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$39.09

BALLOON CRE RX 3cm 12-13.5-15

Facility

$1,395.00

Hospital Charge Code	270704195
Hospital Revenue Code	279
Min. Negotiated Rate	$33.62
Max. Negotiated Rate	$697.50
Rate for Payer: Aetna Commercial	$530.10
Rate for Payer: Aetna Medicare Advantage	$418.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$355.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$355.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$355.73
Rate for Payer: Cigna Commercial	$697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$418.50
Rate for Payer: Oxford Commercial	$279.00
Rate for Payer: Qualcare PPO/HMO/WC	$209.25
Rate for Payer: UnitedHealthcare Commercial	$279.00
Rate for Payer: UnitedHealthcare Community & State	$33.62
Rate for Payer: Wellpoint Medicaid Managed Care	$36.97

Know your out-of-pocket cost for care.

All Charges