Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

BALLOON CRE RX 3cm 8-9-10

Facility

$1,475.00

Service Code	HCPCS C1726
Hospital Charge Code	270683530
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 8-9-10

Facility

$1,475.00

Service Code	HCPCS C1726
Hospital Charge Code	270683530
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

BALLOONCRE WG 10-12mm 240cm

Facility

$1,070.00

Hospital Charge Code	270664035
Hospital Revenue Code	272
Min. Negotiated Rate	$25.79
Max. Negotiated Rate	$535.00
Rate for Payer: Aetna Commercial	$406.60
Rate for Payer: Aetna Medicare Advantage	$321.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.85
Rate for Payer: Cigna Commercial	$535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.00
Rate for Payer: Oxford Commercial	$214.00
Rate for Payer: Qualcare PPO/HMO/WC	$160.50
Rate for Payer: UnitedHealthcare Commercial	$214.00
Rate for Payer: UnitedHealthcare Community & State	$25.79
Rate for Payer: Wellpoint Medicaid Managed Care	$28.36

BALLOONCRE WG 10-12mm 240cm

Facility

$1,070.00

Hospital Charge Code	270664035
Hospital Revenue Code	272
Min. Negotiated Rate	$160.50
Max. Negotiated Rate	$160.50
Rate for Payer: Qualcare PPO/HMO/WC	$160.50

BALLOONCRE WG 12-15mm 240cm

Facility

$1,070.00

Hospital Charge Code	270664036
Hospital Revenue Code	272
Min. Negotiated Rate	$160.50
Max. Negotiated Rate	$160.50
Rate for Payer: Qualcare PPO/HMO/WC	$160.50

BALLOONCRE WG 12-15mm 240cm

Facility

$1,070.00

Hospital Charge Code	270664036
Hospital Revenue Code	272
Min. Negotiated Rate	$25.79
Max. Negotiated Rate	$535.00
Rate for Payer: Aetna Commercial	$406.60
Rate for Payer: Aetna Medicare Advantage	$321.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.85
Rate for Payer: Cigna Commercial	$535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.00
Rate for Payer: Oxford Commercial	$214.00
Rate for Payer: Qualcare PPO/HMO/WC	$160.50
Rate for Payer: UnitedHealthcare Commercial	$214.00
Rate for Payer: UnitedHealthcare Community & State	$25.79
Rate for Payer: Wellpoint Medicaid Managed Care	$28.36

BALLOONCRE WG 6-8mm240cm

Facility

$1,070.00

Hospital Charge Code	270654307
Hospital Revenue Code	272
Min. Negotiated Rate	$160.50
Max. Negotiated Rate	$160.50
Rate for Payer: Qualcare PPO/HMO/WC	$160.50

BALLOONCRE WG 6-8mm240cm

Facility

$1,070.00

Hospital Charge Code	270654307
Hospital Revenue Code	272
Min. Negotiated Rate	$25.79
Max. Negotiated Rate	$535.00
Rate for Payer: Aetna Commercial	$406.60
Rate for Payer: Aetna Medicare Advantage	$321.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.85
Rate for Payer: Cigna Commercial	$535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.00
Rate for Payer: Oxford Commercial	$214.00
Rate for Payer: Qualcare PPO/HMO/WC	$160.50
Rate for Payer: UnitedHealthcare Commercial	$214.00
Rate for Payer: UnitedHealthcare Community & State	$25.79
Rate for Payer: Wellpoint Medicaid Managed Care	$28.36

BALLOON CRE WG 8-10mm

Facility

$1,070.00

Service Code	HCPCS C1725
Hospital Charge Code	270627706
Hospital Revenue Code	278
Min. Negotiated Rate	$160.50
Max. Negotiated Rate	$258.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$235.40
Rate for Payer: Qualcare PPO/HMO/WC	$160.50

BALLOON CRE WG 8-10mm

Facility

$1,070.00

Service Code	HCPCS C1725
Hospital Charge Code	270627706
Hospital Revenue Code	278
Min. Negotiated Rate	$25.79
Max. Negotiated Rate	$535.00
Rate for Payer: Aetna Commercial	$406.60
Rate for Payer: Aetna Medicare Advantage	$321.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.85
Rate for Payer: Cigna Commercial	$535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$235.40
Rate for Payer: Qualcare PPO/HMO/WC	$160.50
Rate for Payer: UnitedHealthcare Community & State	$25.79
Rate for Payer: Wellpoint Medicaid Managed Care	$28.36

BALLOONCRE WG 8-10Mm 240cm

Facility

$1,070.00

Hospital Charge Code	270658593
Hospital Revenue Code	272
Min. Negotiated Rate	$25.79
Max. Negotiated Rate	$535.00
Rate for Payer: Aetna Commercial	$406.60
Rate for Payer: Aetna Medicare Advantage	$321.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.85
Rate for Payer: Cigna Commercial	$535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$321.00
Rate for Payer: Oxford Commercial	$214.00
Rate for Payer: Qualcare PPO/HMO/WC	$160.50
Rate for Payer: UnitedHealthcare Commercial	$214.00
Rate for Payer: UnitedHealthcare Community & State	$25.79
Rate for Payer: Wellpoint Medicaid Managed Care	$28.36

BALLOONCRE WG 8-10Mm 240cm

Facility

$1,070.00

Hospital Charge Code	270658593
Hospital Revenue Code	272
Min. Negotiated Rate	$160.50
Max. Negotiated Rate	$160.50
Rate for Payer: Qualcare PPO/HMO/WC	$160.50

BALLOON CRE WG COLONIC 18-20MM

Facility

$1,195.00

Service Code	HCPCS C1729
Hospital Charge Code	270654316
Hospital Revenue Code	278
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$597.50
Rate for Payer: Aetna Commercial	$454.10
Rate for Payer: Aetna Medicare Advantage	$358.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$304.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$304.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$239.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$304.73
Rate for Payer: Cigna Commercial	$597.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$289.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$262.90
Rate for Payer: Qualcare PPO/HMO/WC	$179.25
Rate for Payer: UnitedHealthcare Community & State	$28.80
Rate for Payer: Wellpoint Medicaid Managed Care	$31.67

BALLOON CRE WG COLONIC 18-20MM

Facility

$1,195.00

Service Code	HCPCS C1729
Hospital Charge Code	270654316
Hospital Revenue Code	278
Min. Negotiated Rate	$179.25
Max. Negotiated Rate	$289.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$239.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$289.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$262.90
Rate for Payer: Qualcare PPO/HMO/WC	$179.25

BALLOON CRE WG PYLORIC 18-20mm

Facility

$1,070.00

Service Code	HCPCS C1725
Hospital Charge Code	270654304
Hospital Revenue Code	278
Min. Negotiated Rate	$160.50
Max. Negotiated Rate	$258.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$235.40
Rate for Payer: Qualcare PPO/HMO/WC	$160.50

BALLOON CRE WG PYLORIC 18-20mm

Facility

$1,070.00

Service Code	HCPCS C1725
Hospital Charge Code	270654304
Hospital Revenue Code	278
Min. Negotiated Rate	$25.79
Max. Negotiated Rate	$535.00
Rate for Payer: Aetna Commercial	$406.60
Rate for Payer: Aetna Medicare Advantage	$321.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.85
Rate for Payer: Cigna Commercial	$535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$235.40
Rate for Payer: Qualcare PPO/HMO/WC	$160.50
Rate for Payer: UnitedHealthcare Community & State	$25.79
Rate for Payer: Wellpoint Medicaid Managed Care	$28.36

BALLOON CRYO 4x100

Facility

$4,500.00

Hospital Charge Code	270638597
Hospital Revenue Code	272
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,350.00
Rate for Payer: Oxford Commercial	$900.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$900.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

BALLOON CRYO 4x100

Facility

$4,500.00

Hospital Charge Code	270638597
Hospital Revenue Code	272
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

BALLOON CUTTING 4x1.5x140cm

Facility

$3,517.50

Hospital Charge Code	270642206
Hospital Revenue Code	278
Min. Negotiated Rate	$84.77
Max. Negotiated Rate	$1,758.75
Rate for Payer: Aetna Commercial	$1,336.65
Rate for Payer: Aetna Medicare Advantage	$1,055.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$896.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$896.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$703.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$896.96
Rate for Payer: Cigna Commercial	$1,758.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$773.85
Rate for Payer: Qualcare PPO/HMO/WC	$527.62
Rate for Payer: UnitedHealthcare Community & State	$84.77
Rate for Payer: Wellpoint Medicaid Managed Care	$93.21

BALLOON CUTTING 4x1.5x140cm

Facility

$4,113.50

Hospital Charge Code	270642206C
Hospital Revenue Code	278
Min. Negotiated Rate	$617.02
Max. Negotiated Rate	$995.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$822.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$995.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$904.97
Rate for Payer: Qualcare PPO/HMO/WC	$617.02

BALLOON CUTTING 4x1.5x140cm

Facility

$3,517.50

Hospital Charge Code	270642206
Hospital Revenue Code	278
Min. Negotiated Rate	$527.62
Max. Negotiated Rate	$851.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$703.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$773.85
Rate for Payer: Qualcare PPO/HMO/WC	$527.62

BALLOON CUTTING 4x1.5x140cm

Facility

$4,113.50

Hospital Charge Code	270642206C
Hospital Revenue Code	278
Min. Negotiated Rate	$99.14
Max. Negotiated Rate	$2,056.75
Rate for Payer: Aetna Commercial	$1,563.13
Rate for Payer: Aetna Medicare Advantage	$1,234.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,048.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,048.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$822.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,048.94
Rate for Payer: Cigna Commercial	$2,056.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$995.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$904.97
Rate for Payer: Qualcare PPO/HMO/WC	$617.02
Rate for Payer: UnitedHealthcare Community & State	$99.14
Rate for Payer: Wellpoint Medicaid Managed Care	$109.01

BALLOON CUTTING 5x2x135cm

Facility

$3,517.50

Service Code	HCPCS C1725
Hospital Charge Code	270642207
Hospital Revenue Code	278
Min. Negotiated Rate	$84.77
Max. Negotiated Rate	$1,758.75
Rate for Payer: Aetna Commercial	$1,336.65
Rate for Payer: Aetna Medicare Advantage	$1,055.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$896.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$896.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$703.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$896.96
Rate for Payer: Cigna Commercial	$1,758.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$773.85
Rate for Payer: Qualcare PPO/HMO/WC	$527.62
Rate for Payer: UnitedHealthcare Community & State	$84.77
Rate for Payer: Wellpoint Medicaid Managed Care	$93.21

BALLOON CUTTING 5x2x135cm

Facility

$3,517.50

Service Code	HCPCS C1725
Hospital Charge Code	270642207
Hospital Revenue Code	278
Min. Negotiated Rate	$527.62
Max. Negotiated Rate	$851.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$703.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.24
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$773.85
Rate for Payer: Qualcare PPO/HMO/WC	$527.62

Know your out-of-pocket cost for care.

All Charges