Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON FORTREX OTW 9x40x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677318N
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 9x40x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677318
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 9x40x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677318N
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 9x40x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677318
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 9x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677319N
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 9x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677319
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 9x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677319
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 9x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677319N
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 HERNIA *********

Facility

$1,889.00

Hospital Charge Code	1606193
Hospital Revenue Code	272
Min. Negotiated Rate	$45.52
Max. Negotiated Rate	$944.50
Rate for Payer: Aetna Commercial	$717.82
Rate for Payer: Aetna Medicare Advantage	$566.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$481.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$481.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$481.69
Rate for Payer: Cigna Commercial	$944.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$566.70
Rate for Payer: Oxford Commercial	$377.80
Rate for Payer: Qualcare PPO/HMO/WC	$283.35
Rate for Payer: UnitedHealthcare Commercial	$377.80
Rate for Payer: UnitedHealthcare Community & State	$45.52
Rate for Payer: Wellpoint Medicaid Managed Care	$50.06

BALLOON HERNIA *********

Facility

$1,889.00

Hospital Charge Code	1606193
Hospital Revenue Code	272
Min. Negotiated Rate	$283.35
Max. Negotiated Rate	$283.35
Rate for Payer: Qualcare PPO/HMO/WC	$283.35

BALLOON HP ULTRA 15 FRX5 MM

Facility

$2,320.00

Service Code	HCPCS C1726
Hospital Charge Code	270684718
Hospital Revenue Code	278
Min. Negotiated Rate	$348.00
Max. Negotiated Rate	$561.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$464.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$510.40
Rate for Payer: Qualcare PPO/HMO/WC	$348.00

BALLOON HP ULTRA 15 FRX5 MM

Facility

$2,320.00

Service Code	HCPCS C1726
Hospital Charge Code	270684718
Hospital Revenue Code	278
Min. Negotiated Rate	$55.91
Max. Negotiated Rate	$1,160.00
Rate for Payer: Aetna Commercial	$881.60
Rate for Payer: Aetna Medicare Advantage	$696.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$591.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$591.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$464.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$591.60
Rate for Payer: Cigna Commercial	$1,160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.44
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$510.40
Rate for Payer: Qualcare PPO/HMO/WC	$348.00
Rate for Payer: UnitedHealthcare Community & State	$55.91
Rate for Payer: Wellpoint Medicaid Managed Care	$61.48

BALLOON IABP 8FR 25cc

Facility

$4,010.00

Hospital Charge Code	270629772
Hospital Revenue Code	272
Min. Negotiated Rate	$96.64
Max. Negotiated Rate	$2,005.00
Rate for Payer: Aetna Commercial	$1,523.80
Rate for Payer: Aetna Medicare Advantage	$1,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,022.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,022.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,022.55
Rate for Payer: Cigna Commercial	$2,005.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,203.00
Rate for Payer: Oxford Commercial	$802.00
Rate for Payer: Qualcare PPO/HMO/WC	$601.50
Rate for Payer: UnitedHealthcare Commercial	$802.00
Rate for Payer: UnitedHealthcare Community & State	$96.64
Rate for Payer: Wellpoint Medicaid Managed Care	$106.27

BALLOON IABP 8FR 25cc

Facility

$4,010.00

Hospital Charge Code	270629772
Hospital Revenue Code	272
Min. Negotiated Rate	$601.50
Max. Negotiated Rate	$601.50
Rate for Payer: Qualcare PPO/HMO/WC	$601.50

BALLOON I/A LINEAR 7.5FR 34CC

Facility

$4,375.00

Service Code	HCPCS C1725
Hospital Charge Code	270657682S
Hospital Revenue Code	278
Min. Negotiated Rate	$105.44
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,662.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Community & State	$105.44
Rate for Payer: Wellpoint Medicaid Managed Care	$115.94

BALLOON I/A LINEAR 7.5FR 34CC

Facility

$4,375.00

Service Code	HCPCS C1725
Hospital Charge Code	270657682
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

BALLOON I/A LINEAR 7.5FR 34CC

Facility

$4,375.00

Service Code	HCPCS C1725
Hospital Charge Code	270657682N
Hospital Revenue Code	278
Min. Negotiated Rate	$105.44
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,662.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Community & State	$105.44
Rate for Payer: Wellpoint Medicaid Managed Care	$115.94

BALLOON I/A LINEAR 7.5FR 34CC

Facility

$4,375.00

Service Code	HCPCS C1725
Hospital Charge Code	270657682N
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

BALLOON I/A LINEAR 7.5FR 34CC

Facility

$4,375.00

Service Code	HCPCS C1725
Hospital Charge Code	270657682S
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

BALLOON I/A LINEAR 7.5FR 34CC

Facility

$4,375.00

Service Code	HCPCS C1725
Hospital Charge Code	270657682
Hospital Revenue Code	278
Min. Negotiated Rate	$105.44
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,662.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$962.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Community & State	$105.44
Rate for Payer: Wellpoint Medicaid Managed Care	$115.94

BALLOON INTRAGASTRIC ORBERA

Facility

$9,875.00

Service Code	HCPCS L8699
Hospital Charge Code	270693542
Hospital Revenue Code	278
Min. Negotiated Rate	$1,481.25
Max. Negotiated Rate	$2,389.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,389.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,172.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,481.25

BALLOON INTRAGASTRIC ORBERA

Facility

$9,875.00

Service Code	HCPCS L8699
Hospital Charge Code	270693542
Hospital Revenue Code	278
Min. Negotiated Rate	$237.99
Max. Negotiated Rate	$4,937.50
Rate for Payer: Aetna Commercial	$3,752.50
Rate for Payer: Aetna Medicare Advantage	$2,962.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,518.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,518.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,518.12
Rate for Payer: Cigna Commercial	$4,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,389.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,172.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,481.25
Rate for Payer: UnitedHealthcare Community & State	$237.99
Rate for Payer: Wellpoint Medicaid Managed Care	$261.69

BALLOON JADEOTW014120x5.0x150

Facility

$775.00

Hospital Charge Code	270705572
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

BALLOON JADEOTW014120x5.0x150

Facility

$775.00

Hospital Charge Code	270705572
Hospital Revenue Code	279
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$294.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.50
Rate for Payer: Oxford Commercial	$155.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Commercial	$155.00
Rate for Payer: UnitedHealthcare Community & State	$18.68
Rate for Payer: Wellpoint Medicaid Managed Care	$20.54

BALLOON JADEOTW014150x1.5x120

Facility

$775.00

Hospital Charge Code	270705193
Hospital Revenue Code	279
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

Know your out-of-pocket cost for care.

All Charges