Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON CUTTING 6x2x135cm

Facility

$3,517.50

Service Code	HCPCS C1725
Hospital Charge Code	270642209
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 6x2x135cm

Facility

$3,517.50

Service Code	HCPCS C1725
Hospital Charge Code	270642209
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 6x90cm

Facility

$3,517.50

Service Code	HCPCS C1725
Hospital Charge Code	270633879
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 6x90cm

Facility

$3,517.50

Service Code	HCPCS C1725
Hospital Charge Code	270633879
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 6X90CM

Facility

$4,330.00

Hospital Charge Code	270633879C
Hospital Revenue Code	278
Min. Negotiated Rate	$104.35
Max. Negotiated Rate	$2,165.00
Rate for Payer: Aetna Commercial	$1,645.40
Rate for Payer: Aetna Medicare Advantage	$1,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,104.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,104.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$866.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,104.15
Rate for Payer: Cigna Commercial	$2,165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,047.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$952.60
Rate for Payer: Qualcare PPO/HMO/WC	$649.50
Rate for Payer: UnitedHealthcare Community & State	$104.35
Rate for Payer: Wellpoint Medicaid Managed Care	$114.75

BALLOON CUTTING 6X90CM

Facility

$4,330.00

Hospital Charge Code	270633879C
Hospital Revenue Code	278
Min. Negotiated Rate	$649.50
Max. Negotiated Rate	$1,047.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$866.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,047.86
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$952.60
Rate for Payer: Qualcare PPO/HMO/WC	$649.50

BALLOON CUTTING 7x90cm

Facility

$3,517.50

Hospital Charge Code	270633880
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 7x90cm

Facility

$3,517.50

Hospital Charge Code	270633880
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 7X90CM

Facility

$3,517.50

Service Code	HCPCS C1725
Hospital Charge Code	270633880C
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 7X90CM

Facility

$4,113.50

Service Code	HCPCS C1725
Hospital Charge Code	270633880N
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 7X90CM

Facility

$3,517.50

Service Code	HCPCS C1725
Hospital Charge Code	270633880C
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 7X90CM

Facility

$4,113.50

Service Code	HCPCS C1725
Hospital Charge Code	270633880N
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 DEEP 3x40 AME030040152

Facility

$2,025.00

Hospital Charge Code	270636989V
Hospital Revenue Code	278
Min. Negotiated Rate	$48.80
Max. Negotiated Rate	$1,012.50
Rate for Payer: Aetna Commercial	$769.50
Rate for Payer: Aetna Medicare Advantage	$607.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$516.38
Rate for Payer: Cigna Commercial	$1,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$445.50
Rate for Payer: Qualcare PPO/HMO/WC	$303.75
Rate for Payer: UnitedHealthcare Community & State	$48.80
Rate for Payer: Wellpoint Medicaid Managed Care	$53.66

BALLOON DEEP 3x40 AME030040152

Facility

$2,025.00

Hospital Charge Code	270636989V
Hospital Revenue Code	278
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$490.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$445.50
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

BALLOON DEEP 3x80 AME030080152

Facility

$2,025.00

Hospital Charge Code	270636983V
Hospital Revenue Code	278
Min. Negotiated Rate	$48.80
Max. Negotiated Rate	$1,012.50
Rate for Payer: Aetna Commercial	$769.50
Rate for Payer: Aetna Medicare Advantage	$607.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$516.38
Rate for Payer: Cigna Commercial	$1,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$445.50
Rate for Payer: Qualcare PPO/HMO/WC	$303.75
Rate for Payer: UnitedHealthcare Community & State	$48.80
Rate for Payer: Wellpoint Medicaid Managed Care	$53.66

BALLOON DEEP 3x80 AME030080152

Facility

$2,025.00

Hospital Charge Code	270636983V
Hospital Revenue Code	278
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$490.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$445.50
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

BALLOON DEEP 4x40 AME040040152

Facility

$2,025.00

Hospital Charge Code	270636991V
Hospital Revenue Code	278
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$490.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$445.50
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

BALLOON DEEP 4x40 AME040040152

Facility

$2,025.00

Hospital Charge Code	270636991V
Hospital Revenue Code	278
Min. Negotiated Rate	$48.80
Max. Negotiated Rate	$1,012.50
Rate for Payer: Aetna Commercial	$769.50
Rate for Payer: Aetna Medicare Advantage	$607.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$516.38
Rate for Payer: Cigna Commercial	$1,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$445.50
Rate for Payer: Qualcare PPO/HMO/WC	$303.75
Rate for Payer: UnitedHealthcare Community & State	$48.80
Rate for Payer: Wellpoint Medicaid Managed Care	$53.66

BALLOON DEEP 4x80 AME040080152

Facility

$2,025.00

Hospital Charge Code	270636992V
Hospital Revenue Code	278
Min. Negotiated Rate	$303.75
Max. Negotiated Rate	$490.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$445.50
Rate for Payer: Qualcare PPO/HMO/WC	$303.75

BALLOON DEEP 4x80 AME040080152

Facility

$2,025.00

Hospital Charge Code	270636992V
Hospital Revenue Code	278
Min. Negotiated Rate	$48.80
Max. Negotiated Rate	$1,012.50
Rate for Payer: Aetna Commercial	$769.50
Rate for Payer: Aetna Medicare Advantage	$607.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$516.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$516.38
Rate for Payer: Cigna Commercial	$1,012.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.05
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$445.50
Rate for Payer: Qualcare PPO/HMO/WC	$303.75
Rate for Payer: UnitedHealthcare Community & State	$48.80
Rate for Payer: Wellpoint Medicaid Managed Care	$53.66

BALLOON DIL URET STRICTURE

Facility

$1,218.45

Service Code	HCPCS 50706
Hospital Charge Code	7411620
Hospital Revenue Code	361
Min. Negotiated Rate	$29.36
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$463.01
Rate for Payer: Aetna Medicare Advantage	$365.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$310.70
Rate for Payer: Cigna Commercial	$609.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$365.54
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$182.77
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$29.36
Rate for Payer: Wellpoint Medicaid Managed Care	$32.29

BALLOON DIL URET STRICTURE

Facility

$1,218.45

Service Code	HCPCS 50706
Hospital Charge Code	411050706
Hospital Revenue Code	361
Min. Negotiated Rate	$182.77
Max. Negotiated Rate	$182.77
Rate for Payer: Qualcare PPO/HMO/WC	$182.77

BALLOON DIL URET STRICTURE

Facility

$1,218.45

Service Code	HCPCS 50706
Hospital Charge Code	2600245
Hospital Revenue Code	361
Min. Negotiated Rate	$29.36
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$463.01
Rate for Payer: Aetna Medicare Advantage	$365.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$310.70
Rate for Payer: Cigna Commercial	$609.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$365.54
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$182.77
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$29.36
Rate for Payer: Wellpoint Medicaid Managed Care	$32.29

BALLOON DIL URET STRICTURE

Facility

$1,218.45

Service Code	HCPCS 50706
Hospital Charge Code	366850706
Hospital Revenue Code	361
Min. Negotiated Rate	$182.77
Max. Negotiated Rate	$182.77
Rate for Payer: Qualcare PPO/HMO/WC	$182.77

BALLOON DIL URET STRICTURE

Facility

$1,218.45

Service Code	HCPCS 50706
Hospital Charge Code	366850706
Hospital Revenue Code	361
Min. Negotiated Rate	$29.36
Max. Negotiated Rate	$2,220.00
Rate for Payer: Aetna Commercial	$463.01
Rate for Payer: Aetna Medicare Advantage	$365.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$310.70
Rate for Payer: Cigna Commercial	$609.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$365.54
Rate for Payer: Oxford Commercial	$1,487.00
Rate for Payer: Qualcare PPO/HMO/WC	$182.77
Rate for Payer: UnitedHealthcare Commercial	$2,220.00
Rate for Payer: UnitedHealthcare Community & State	$29.36
Rate for Payer: Wellpoint Medicaid Managed Care	$32.29

Know your out-of-pocket cost for care.

All Charges