Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON FIDELITY I/A 8FR 25CC

Facility

$4,935.00

Hospital Charge Code	270657679
Hospital Revenue Code	278
Min. Negotiated Rate	$118.93
Max. Negotiated Rate	$2,467.50
Rate for Payer: Aetna Commercial	$1,875.30
Rate for Payer: Aetna Medicare Advantage	$1,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,258.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,258.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$987.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,258.42
Rate for Payer: Cigna Commercial	$2,467.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,194.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,085.70
Rate for Payer: Qualcare PPO/HMO/WC	$740.25
Rate for Payer: UnitedHealthcare Community & State	$118.93
Rate for Payer: Wellpoint Medicaid Managed Care	$130.78

BALLOON FIDELITY I/A 8FR 25CC

Facility

$4,935.00

Hospital Charge Code	270657679
Hospital Revenue Code	278
Min. Negotiated Rate	$740.25
Max. Negotiated Rate	$1,194.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$987.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,194.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,085.70
Rate for Payer: Qualcare PPO/HMO/WC	$740.25

BALLOON FORMULA 418 RENAL

Facility

$6,000.00

Hospital Charge Code	270660269
Hospital Revenue Code	272
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$900.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

BALLOON FORMULA 418 RENAL

Facility

$6,000.00

Hospital Charge Code	270660269
Hospital Revenue Code	272
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,800.00
Rate for Payer: Oxford Commercial	$1,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Commercial	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$144.60
Rate for Payer: Wellpoint Medicaid Managed Care	$159.00

BALLOON FOR RADIAL SCOPE OEA37

Facility

$72.32

Hospital Charge Code	270632769
Hospital Revenue Code	272
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$36.16
Rate for Payer: Aetna Commercial	$27.48
Rate for Payer: Aetna Medicare Advantage	$21.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.44
Rate for Payer: Cigna Commercial	$36.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.70
Rate for Payer: Oxford Commercial	$14.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.85
Rate for Payer: UnitedHealthcare Commercial	$14.46
Rate for Payer: UnitedHealthcare Community & State	$1.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.92

BALLOON FOR RADIAL SCOPE OEA37

Facility

$72.32

Hospital Charge Code	270632769
Hospital Revenue Code	272
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$10.85
Rate for Payer: Qualcare PPO/HMO/WC	$10.85

BALLOON FORTREX OTW 10x40x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677320N
Hospital Revenue Code	278
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$399.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$231.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Community & State	$25.30
Rate for Payer: Wellpoint Medicaid Managed Care	$27.82

BALLOON FORTREX OTW 10x40x80CM

Facility

$818.30

Service Code	HCPCS C1725
Hospital Charge Code	270677320
Hospital Revenue Code	278
Min. Negotiated Rate	$19.72
Max. Negotiated Rate	$409.15
Rate for Payer: Aetna Commercial	$310.95
Rate for Payer: Aetna Medicare Advantage	$245.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.67
Rate for Payer: Cigna Commercial	$409.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$180.03
Rate for Payer: Qualcare PPO/HMO/WC	$122.75
Rate for Payer: UnitedHealthcare Community & State	$19.72
Rate for Payer: Wellpoint Medicaid Managed Care	$21.68

BALLOON FORTREX OTW 10x40x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677320N
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$231.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

BALLOON FORTREX OTW 10x40x80CM

Facility

$818.30

Service Code	HCPCS C1725
Hospital Charge Code	270677320
Hospital Revenue Code	278
Min. Negotiated Rate	$122.75
Max. Negotiated Rate	$198.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$180.03
Rate for Payer: Qualcare PPO/HMO/WC	$122.75

BALLOON FORTREX OTW 10x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677321N
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$231.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

BALLOON FORTREX OTW 10x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677321N
Hospital Revenue Code	278
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$399.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$231.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Community & State	$25.30
Rate for Payer: Wellpoint Medicaid Managed Care	$27.82

BALLOON FORTREX OTW 10x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677321
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$231.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

BALLOON FORTREX OTW 10x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677321
Hospital Revenue Code	278
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$399.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$231.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Community & State	$25.30
Rate for Payer: Wellpoint Medicaid Managed Care	$27.82

BALLOON FORTREX OTW 12x40x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677322N
Hospital Revenue Code	278
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$399.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$231.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Community & State	$25.30
Rate for Payer: Wellpoint Medicaid Managed Care	$27.82

BALLOON FORTREX OTW 12x40x80CM

Facility

$818.30

Service Code	HCPCS C1725
Hospital Charge Code	270677322
Hospital Revenue Code	278
Min. Negotiated Rate	$122.75
Max. Negotiated Rate	$198.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$180.03
Rate for Payer: Qualcare PPO/HMO/WC	$122.75

BALLOON FORTREX OTW 12x40x80CM

Facility

$818.30

Service Code	HCPCS C1725
Hospital Charge Code	270677322
Hospital Revenue Code	278
Min. Negotiated Rate	$19.72
Max. Negotiated Rate	$409.15
Rate for Payer: Aetna Commercial	$310.95
Rate for Payer: Aetna Medicare Advantage	$245.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.67
Rate for Payer: Cigna Commercial	$409.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.03
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$180.03
Rate for Payer: Qualcare PPO/HMO/WC	$122.75
Rate for Payer: UnitedHealthcare Community & State	$19.72
Rate for Payer: Wellpoint Medicaid Managed Care	$21.68

BALLOON FORTREX OTW 12x40x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677322N
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$231.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

BALLOON FORTREX OTW 12x80x80C

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682553N
Hospital Revenue Code	278
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$514.50
Rate for Payer: Aetna Commercial	$391.02
Rate for Payer: Aetna Medicare Advantage	$308.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.39
Rate for Payer: Cigna Commercial	$514.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$226.38
Rate for Payer: Qualcare PPO/HMO/WC	$154.35
Rate for Payer: UnitedHealthcare Community & State	$24.80
Rate for Payer: Wellpoint Medicaid Managed Care	$27.27

BALLOON FORTREX OTW 12x80x80C

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682553N
Hospital Revenue Code	278
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$249.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$226.38
Rate for Payer: Qualcare PPO/HMO/WC	$154.35

BALLOON FORTREX OTW 12x80x80C

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682553
Hospital Revenue Code	278
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$249.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$226.38
Rate for Payer: Qualcare PPO/HMO/WC	$154.35

BALLOON FORTREX OTW 12x80x80C

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682553
Hospital Revenue Code	278
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$514.50
Rate for Payer: Aetna Commercial	$391.02
Rate for Payer: Aetna Medicare Advantage	$308.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.39
Rate for Payer: Cigna Commercial	$514.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.02
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$226.38
Rate for Payer: Qualcare PPO/HMO/WC	$154.35
Rate for Payer: UnitedHealthcare Community & State	$24.80
Rate for Payer: Wellpoint Medicaid Managed Care	$27.27

BALLOON FORTREX OTW 12x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677323N
Hospital Revenue Code	278
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$399.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$231.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Community & State	$25.30
Rate for Payer: Wellpoint Medicaid Managed Care	$27.82

BALLOON FORTREX OTW 12x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677323
Hospital Revenue Code	278
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$399.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$231.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Community & State	$25.30
Rate for Payer: Wellpoint Medicaid Managed Care	$27.82

BALLOON FORTREX OTW 12x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677323N
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$231.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

Know your out-of-pocket cost for care.

All Charges