Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

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

BALLOON FORTREX OTW 6x40x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682550N
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 6x40x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682550N
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 6x40x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682550
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 6x40x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682550
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 6x80x80CM

Facility

$818.30

Service Code	HCPCS C1725
Hospital Charge Code	270682549
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 6x80x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682549N
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 6x80x80CM

Facility

$818.30

Service Code	HCPCS C1725
Hospital Charge Code	270682549
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 6x80x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682549N
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 7x40x80CM

Facility

$818.30

Service Code	HCPCS C1725
Hospital Charge Code	270682547
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 7x40x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682547N
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 7x40x80CM

Facility

$818.30

Service Code	HCPCS C1725
Hospital Charge Code	270682547
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 7x40x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682547N
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 7x80x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682548N
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 7x80x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682548
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 7x80x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682548N
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 7x80x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682548
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 8x40x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682551N
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 8x40x80CM

Facility

$818.30

Service Code	HCPCS C1725
Hospital Charge Code	270682551
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 8x40x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682551N
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 8x40x80CM

Facility

$818.30

Service Code	HCPCS C1725
Hospital Charge Code	270682551
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 8x80x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682552
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 8x80x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682552N
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 8x80x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682552
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 8x80x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682552N
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

Know your out-of-pocket cost for care.

All Charges