Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON JADEOTW018150x6.0x40

Facility

$725.00

Hospital Charge Code	270705278
Hospital Revenue Code	279
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$108.75
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

BALLOON JADEOTW018150x6.0x40

Facility

$725.00

Hospital Charge Code	270705278
Hospital Revenue Code	279
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.50
Rate for Payer: Oxford Commercial	$145.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Commercial	$145.00
Rate for Payer: UnitedHealthcare Community & State	$17.47
Rate for Payer: Wellpoint Medicaid Managed Care	$19.21

BALLOON JADEOTW018150x6.0x60

Facility

$725.00

Hospital Charge Code	270705279
Hospital Revenue Code	279
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$108.75
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

BALLOON JADEOTW018150x6.0x60

Facility

$725.00

Hospital Charge Code	270705279
Hospital Revenue Code	279
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.50
Rate for Payer: Oxford Commercial	$145.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Commercial	$145.00
Rate for Payer: UnitedHealthcare Community & State	$17.47
Rate for Payer: Wellpoint Medicaid Managed Care	$19.21

BALLOON JADEOTW018150x6.0x80

Facility

$725.00

Hospital Charge Code	270705280
Hospital Revenue Code	279
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.50
Rate for Payer: Oxford Commercial	$145.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Commercial	$145.00
Rate for Payer: UnitedHealthcare Community & State	$17.47
Rate for Payer: Wellpoint Medicaid Managed Care	$19.21

BALLOON JADEOTW018150x6.0x80

Facility

$725.00

Hospital Charge Code	270705280
Hospital Revenue Code	279
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$108.75
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

BALLOON JADEOTW018240x3.5x150

Facility

$725.00

Hospital Charge Code	270705579
Hospital Revenue Code	279
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$108.75
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

BALLOON JADEOTW018240x3.5x150

Facility

$725.00

Hospital Charge Code	270705579
Hospital Revenue Code	279
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.50
Rate for Payer: Oxford Commercial	$145.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Commercial	$145.00
Rate for Payer: UnitedHealthcare Community & State	$17.47
Rate for Payer: Wellpoint Medicaid Managed Care	$19.21

BALLOON KAYE NEPHROSTOMY 17FR

Facility

$1,440.00

Hospital Charge Code	270676630
Hospital Revenue Code	278
Min. Negotiated Rate	$216.00
Max. Negotiated Rate	$348.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$288.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$348.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$316.80
Rate for Payer: Qualcare PPO/HMO/WC	$216.00

BALLOON KAYE NEPHROSTOMY 17FR

Facility

$1,440.00

Hospital Charge Code	270676630
Hospital Revenue Code	278
Min. Negotiated Rate	$34.70
Max. Negotiated Rate	$720.00
Rate for Payer: Aetna Commercial	$547.20
Rate for Payer: Aetna Medicare Advantage	$432.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$367.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$367.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$288.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$367.20
Rate for Payer: Cigna Commercial	$720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$348.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$316.80
Rate for Payer: Qualcare PPO/HMO/WC	$216.00
Rate for Payer: UnitedHealthcare Community & State	$34.70
Rate for Payer: Wellpoint Medicaid Managed Care	$38.16

BALLOON L.P.18frX2.5cm 6355

Facility

$495.00

Hospital Charge Code	270639885
Hospital Revenue Code	272
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$74.25
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

BALLOON L.P.18frX2.5cm 6355

Facility

$495.00

Hospital Charge Code	270639885
Hospital Revenue Code	272
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$188.10
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.50
Rate for Payer: Oxford Commercial	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Commercial	$99.00
Rate for Payer: UnitedHealthcare Community & State	$11.93
Rate for Payer: Wellpoint Medicaid Managed Care	$13.12

BALLOON L.P.20frX2.5cm 6368

Facility

$495.00

Hospital Charge Code	270639884
Hospital Revenue Code	272
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$188.10
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.50
Rate for Payer: Oxford Commercial	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Commercial	$99.00
Rate for Payer: UnitedHealthcare Community & State	$11.93
Rate for Payer: Wellpoint Medicaid Managed Care	$13.12

BALLOON L.P.20frX2.5cm 6368

Facility

$495.00

Hospital Charge Code	270639884
Hospital Revenue Code	272
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$74.25
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

BALLOON LUTONIX 4x100MM 130MM

Facility

$8,250.00

Hospital Charge Code	270676074
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

BALLOON LUTONIX 4x100MM 130MM

Facility

$8,250.00

Hospital Charge Code	270676074
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

BALLOON LUTONIX 4x60MM 130CM

Facility

$8,250.00

Service Code	HCPCS C2623
Hospital Charge Code	270671190
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

BALLOON LUTONIX 4x60MM 130CM

Facility

$8,250.00

Service Code	HCPCS C2623
Hospital Charge Code	270671190
Hospital Revenue Code	278
Min. Negotiated Rate	$198.82
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$198.82
Rate for Payer: Wellpoint Medicaid Managed Care	$218.62

BALLOON MARSHAL #17-881*****

Facility

$950.00

Service Code	HCPCS C1725
Hospital Charge Code	270624015
Hospital Revenue Code	272
Min. Negotiated Rate	$22.89
Max. Negotiated Rate	$475.00
Rate for Payer: Aetna Commercial	$361.00
Rate for Payer: Aetna Medicare Advantage	$285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.25
Rate for Payer: Cigna Commercial	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.00
Rate for Payer: Oxford Commercial	$190.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.50
Rate for Payer: UnitedHealthcare Commercial	$190.00
Rate for Payer: UnitedHealthcare Community & State	$22.89
Rate for Payer: Wellpoint Medicaid Managed Care	$25.18

BALLOON MARSHAL #17-881*****

Facility

$950.00

Service Code	HCPCS C1725
Hospital Charge Code	270624015
Hospital Revenue Code	272
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$142.50
Rate for Payer: Qualcare PPO/HMO/WC	$142.50

BALLOON MAVERICK MONO 1.5x20mm

Facility

$1,295.00

Hospital Charge Code	270640736
Hospital Revenue Code	272
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$647.50
Rate for Payer: Aetna Commercial	$492.10
Rate for Payer: Aetna Medicare Advantage	$388.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.23
Rate for Payer: Cigna Commercial	$647.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.50
Rate for Payer: Oxford Commercial	$259.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.25
Rate for Payer: UnitedHealthcare Commercial	$259.00
Rate for Payer: UnitedHealthcare Community & State	$31.21
Rate for Payer: Wellpoint Medicaid Managed Care	$34.32

BALLOON MAVERICK MONO 1.5x20mm

Facility

$1,295.00

Hospital Charge Code	270640736
Hospital Revenue Code	272
Min. Negotiated Rate	$194.25
Max. Negotiated Rate	$194.25
Rate for Payer: Qualcare PPO/HMO/WC	$194.25

BALLOON MAVERICK MONO 2.25x15

Facility

$1,295.00

Hospital Charge Code	270639395
Hospital Revenue Code	272
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$647.50
Rate for Payer: Aetna Commercial	$492.10
Rate for Payer: Aetna Medicare Advantage	$388.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.23
Rate for Payer: Cigna Commercial	$647.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.50
Rate for Payer: Oxford Commercial	$259.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.25
Rate for Payer: UnitedHealthcare Commercial	$259.00
Rate for Payer: UnitedHealthcare Community & State	$31.21
Rate for Payer: Wellpoint Medicaid Managed Care	$34.32

BALLOON MAVERICK MONO 2.25x15

Facility

$1,295.00

Hospital Charge Code	270639395
Hospital Revenue Code	272
Min. Negotiated Rate	$194.25
Max. Negotiated Rate	$194.25
Rate for Payer: Qualcare PPO/HMO/WC	$194.25

BALLOON MAVERICK MONO 2.75x12

Facility

$1,295.00

Hospital Charge Code	270638417
Hospital Revenue Code	272
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$647.50
Rate for Payer: Aetna Commercial	$492.10
Rate for Payer: Aetna Medicare Advantage	$388.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.23
Rate for Payer: Cigna Commercial	$647.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.50
Rate for Payer: Oxford Commercial	$259.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.25
Rate for Payer: UnitedHealthcare Commercial	$259.00
Rate for Payer: UnitedHealthcare Community & State	$31.21
Rate for Payer: Wellpoint Medicaid Managed Care	$34.32

Know your out-of-pocket cost for care.

All Charges