Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON MAV MON 3x15 389281530

Facility

$1,036.00

Hospital Charge Code	270638388C
Hospital Revenue Code	272
Min. Negotiated Rate	$24.97
Max. Negotiated Rate	$518.00
Rate for Payer: Aetna Commercial	$393.68
Rate for Payer: Aetna Medicare Advantage	$310.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$264.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$264.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$264.18
Rate for Payer: Cigna Commercial	$518.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$310.80
Rate for Payer: Oxford Commercial	$207.20
Rate for Payer: Qualcare PPO/HMO/WC	$155.40
Rate for Payer: UnitedHealthcare Commercial	$207.20
Rate for Payer: UnitedHealthcare Community & State	$24.97
Rate for Payer: Wellpoint Medicaid Managed Care	$27.45

BALLOON MAV MON 3x15 389281530

Facility

$1,036.00

Hospital Charge Code	270638388C
Hospital Revenue Code	272
Min. Negotiated Rate	$155.40
Max. Negotiated Rate	$155.40
Rate for Payer: Qualcare PPO/HMO/WC	$155.40

BALLOON MAV OTW 2x12 206201220

Facility

$1,295.00

Hospital Charge Code	270636612V
Hospital Revenue Code	278
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) NJ Health	$259.00
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	$313.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$284.90
Rate for Payer: Qualcare PPO/HMO/WC	$194.25
Rate for Payer: UnitedHealthcare Community & State	$31.21
Rate for Payer: Wellpoint Medicaid Managed Care	$34.32

BALLOON MAV OTW 2x12 206201220

Facility

$1,295.00

Hospital Charge Code	270636612V
Hospital Revenue Code	278
Min. Negotiated Rate	$194.25
Max. Negotiated Rate	$313.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$259.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.39
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$284.90
Rate for Payer: Qualcare PPO/HMO/WC	$194.25

BALLOON MAV OTW 3x15 206201530

Facility

$1,036.00

Hospital Charge Code	270636765C
Hospital Revenue Code	272
Min. Negotiated Rate	$155.40
Max. Negotiated Rate	$155.40
Rate for Payer: Qualcare PPO/HMO/WC	$155.40

BALLOON MAV OTW 3x15 206201530

Facility

$1,036.00

Hospital Charge Code	270636765C
Hospital Revenue Code	272
Min. Negotiated Rate	$24.97
Max. Negotiated Rate	$518.00
Rate for Payer: Aetna Commercial	$393.68
Rate for Payer: Aetna Medicare Advantage	$310.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$264.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$264.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$264.18
Rate for Payer: Cigna Commercial	$518.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$310.80
Rate for Payer: Oxford Commercial	$207.20
Rate for Payer: Qualcare PPO/HMO/WC	$155.40
Rate for Payer: UnitedHealthcare Commercial	$207.20
Rate for Payer: UnitedHealthcare Community & State	$24.97
Rate for Payer: Wellpoint Medicaid Managed Care	$27.45

BALLOON MCV BILI 12F 4MM 6734

Facility

$1,839.25

Hospital Charge Code	270609409
Hospital Revenue Code	272
Min. Negotiated Rate	$44.33
Max. Negotiated Rate	$919.62
Rate for Payer: Aetna Commercial	$698.91
Rate for Payer: Aetna Medicare Advantage	$551.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$469.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$469.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$469.01
Rate for Payer: Cigna Commercial	$919.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$551.77
Rate for Payer: Oxford Commercial	$367.85
Rate for Payer: Qualcare PPO/HMO/WC	$275.89
Rate for Payer: UnitedHealthcare Commercial	$367.85
Rate for Payer: UnitedHealthcare Community & State	$44.33
Rate for Payer: Wellpoint Medicaid Managed Care	$48.74

BALLOON MCV BILI 12F 4MM 6734

Facility

$1,839.25

Hospital Charge Code	270609409
Hospital Revenue Code	272
Min. Negotiated Rate	$275.89
Max. Negotiated Rate	$275.89
Rate for Payer: Qualcare PPO/HMO/WC	$275.89

BALLOON MCV BILI 18F 6MM 6738

Facility

$1,801.65

Hospital Charge Code	270609410
Hospital Revenue Code	272
Min. Negotiated Rate	$43.42
Max. Negotiated Rate	$900.83
Rate for Payer: Aetna Commercial	$684.63
Rate for Payer: Aetna Medicare Advantage	$540.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.42
Rate for Payer: Cigna Commercial	$900.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$540.50
Rate for Payer: Oxford Commercial	$360.33
Rate for Payer: Qualcare PPO/HMO/WC	$270.25
Rate for Payer: UnitedHealthcare Commercial	$360.33
Rate for Payer: UnitedHealthcare Community & State	$43.42
Rate for Payer: Wellpoint Medicaid Managed Care	$47.74

BALLOON MCV BILI 18F 6MM 6738

Facility

$1,801.65

Hospital Charge Code	270609410
Hospital Revenue Code	272
Min. Negotiated Rate	$270.25
Max. Negotiated Rate	$270.25
Rate for Payer: Qualcare PPO/HMO/WC	$270.25

BALLOON MCV BILI 24F 8MM 6742

Facility

$1,801.65

Hospital Charge Code	270609411
Hospital Revenue Code	272
Min. Negotiated Rate	$43.42
Max. Negotiated Rate	$900.83
Rate for Payer: Aetna Commercial	$684.63
Rate for Payer: Aetna Medicare Advantage	$540.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.42
Rate for Payer: Cigna Commercial	$900.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$540.50
Rate for Payer: Oxford Commercial	$360.33
Rate for Payer: Qualcare PPO/HMO/WC	$270.25
Rate for Payer: UnitedHealthcare Commercial	$360.33
Rate for Payer: UnitedHealthcare Community & State	$43.42
Rate for Payer: Wellpoint Medicaid Managed Care	$47.74

BALLOON MCV BILI 24F 8MM 6742

Facility

$1,801.65

Hospital Charge Code	270609411
Hospital Revenue Code	272
Min. Negotiated Rate	$270.25
Max. Negotiated Rate	$270.25
Rate for Payer: Qualcare PPO/HMO/WC	$270.25

BALLOON MINI TREK OTW 1.2x12mm

Facility

$850.00

Hospital Charge Code	270646869
Hospital Revenue Code	272
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.00
Rate for Payer: Oxford Commercial	$170.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$170.00
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

BALLOON MINI TREK OTW 1.2x12mm

Facility

$850.00

Hospital Charge Code	270646869
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON MINI TREK OTW 1.2X12MM

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270646869C
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON MINI TREK OTW 1.2X12MM

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270646869C
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

BALLOON MINI TREK OTW 1.2x15mm

Facility

$850.00

Hospital Charge Code	270646870
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON MINI TREK OTW 1.2x15mm

Facility

$850.00

Hospital Charge Code	270646870
Hospital Revenue Code	272
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.00
Rate for Payer: Oxford Commercial	$170.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$170.00
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

BALLOON MINI TREK OTW 1.2X15MM

Facility

$1,075.00

Service Code	HCPCS C1725
Hospital Charge Code	270646870C
Hospital Revenue Code	278
Min. Negotiated Rate	$25.91
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$408.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25
Rate for Payer: UnitedHealthcare Community & State	$25.91
Rate for Payer: Wellpoint Medicaid Managed Care	$28.49

BALLOON MINI TREK OTW 1.2X15MM

Facility

$1,075.00

Service Code	HCPCS C1725
Hospital Charge Code	270646870C
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$236.50
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

BALLOON MINI TREK OTW 1.2x8mm

Facility

$850.00

Hospital Charge Code	270646868
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON MINI TREK OTW 1.2x8mm

Facility

$850.00

Hospital Charge Code	270646868
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

BALLOON MINI TREK OTW 1.2X8MM

Facility

$850.00

Hospital Charge Code	270646868C
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

BALLOON MINI TREK OTW 1.2X8MM

Facility

$850.00

Hospital Charge Code	270646868C
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON MINI TREK OTW 1.5x12mm

Facility

$850.00

Hospital Charge Code	270645297
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

Know your out-of-pocket cost for care.

All Charges