Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON DIL URET STRICTURE

Facility

$1,218.45

Service Code	HCPCS 50706
Hospital Charge Code	321050706
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	$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	321050706
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	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 E FLEXIBLE ENDOSCOPIC

Facility

$145.20

Hospital Charge Code	270677312
Hospital Revenue Code	272
Min. Negotiated Rate	$21.78
Max. Negotiated Rate	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$21.78

BALLOON E FLEXIBLE ENDOSCOPIC

Facility

$145.20

Hospital Charge Code	270677312
Hospital Revenue Code	272
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$72.60
Rate for Payer: Aetna Commercial	$55.18
Rate for Payer: Aetna Medicare Advantage	$43.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.03
Rate for Payer: Cigna Commercial	$72.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.56
Rate for Payer: Oxford Commercial	$29.04
Rate for Payer: Qualcare PPO/HMO/WC	$21.78
Rate for Payer: UnitedHealthcare Commercial	$29.04
Rate for Payer: UnitedHealthcare Community & State	$3.50
Rate for Payer: Wellpoint Medicaid Managed Care	$3.85

BALLOON ENDOCAVITY 2x14CM NSLF

Facility

$171.00

Hospital Charge Code	270640972
Hospital Revenue Code	272
Min. Negotiated Rate	$25.65
Max. Negotiated Rate	$25.65
Rate for Payer: Qualcare PPO/HMO/WC	$25.65

BALLOON ENDOCAVITY 2x14CM NSLF

Facility

$171.00

Hospital Charge Code	270640972
Hospital Revenue Code	272
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna Commercial	$64.98
Rate for Payer: Aetna Medicare Advantage	$51.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.60
Rate for Payer: Cigna Commercial	$85.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.30
Rate for Payer: Oxford Commercial	$34.20
Rate for Payer: Qualcare PPO/HMO/WC	$25.65
Rate for Payer: UnitedHealthcare Commercial	$34.20
Rate for Payer: UnitedHealthcare Community & State	$4.12
Rate for Payer: Wellpoint Medicaid Managed Care	$4.53

BALLOON EQUALIZER 7FR 65cm

Facility

$1,236.00

Hospital Charge Code	270623289
Hospital Revenue Code	278
Min. Negotiated Rate	$29.79
Max. Negotiated Rate	$618.00
Rate for Payer: Aetna Commercial	$469.68
Rate for Payer: Aetna Medicare Advantage	$370.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$315.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$315.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$247.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$315.18
Rate for Payer: Cigna Commercial	$618.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$271.92
Rate for Payer: Qualcare PPO/HMO/WC	$185.40
Rate for Payer: UnitedHealthcare Community & State	$29.79
Rate for Payer: Wellpoint Medicaid Managed Care	$32.75

BALLOON EQUALIZER 7FR 65cm

Facility

$1,236.00

Hospital Charge Code	270623289
Hospital Revenue Code	278
Min. Negotiated Rate	$185.40
Max. Negotiated Rate	$299.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$247.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.11
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$271.92
Rate for Payer: Qualcare PPO/HMO/WC	$185.40

BALLOON EQUILIZER

Facility

$1,493.50

Hospital Charge Code	270655409
Hospital Revenue Code	278
Min. Negotiated Rate	$35.99
Max. Negotiated Rate	$746.75
Rate for Payer: Aetna Commercial	$567.53
Rate for Payer: Aetna Medicare Advantage	$448.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$298.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$380.84
Rate for Payer: Cigna Commercial	$746.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$328.57
Rate for Payer: Qualcare PPO/HMO/WC	$224.03
Rate for Payer: UnitedHealthcare Community & State	$35.99
Rate for Payer: Wellpoint Medicaid Managed Care	$39.58

BALLOON EQUILIZER

Facility

$1,493.50

Hospital Charge Code	270655409
Hospital Revenue Code	278
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$361.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$298.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.43
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$328.57
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

BALLOON EUPHORA 1.5X10MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694587S
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

BALLOON EUPHORA 1.5X10MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694587
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

BALLOON EUPHORA 1.5X10MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694587
Hospital Revenue Code	278
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

BALLOON EUPHORA 1.5X10MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694587S
Hospital Revenue Code	278
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

BALLOON EUPHORA 1.5X12MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694510S
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

BALLOON EUPHORA 1.5X12MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694510S
Hospital Revenue Code	278
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

BALLOON EUPHORA 1.5X12MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694510
Hospital Revenue Code	278
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

BALLOON EUPHORA 1.5X12MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694510
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

BALLOON EUPHORA 1.5X15MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694588
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

BALLOON EUPHORA 1.5X15MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694588S
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

BALLOON EUPHORA 1.5X15MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694588S
Hospital Revenue Code	278
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

BALLOON EUPHORA 1.5X15MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694588
Hospital Revenue Code	278
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$104.50
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$12.59

Know your out-of-pocket cost for care.

All Charges