Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON MUSTANG 7.0 X 60 X75CM

Facility

$1,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270653950
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BALLOON MUSTANG 7.0 X 60 X75CM

Facility

$1,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270653950
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

BALLOON MUSTANG OTW 6 F 10x20X

Facility

$1,250.00

Hospital Charge Code	270678232
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

BALLOON MUSTANG OTW 6 F 10x20X

Facility

$1,250.00

Hospital Charge Code	270678232
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BALLOON MUSTANG OTW 9.0x20x75

Facility

$1,250.00

Hospital Charge Code	270677784
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

BALLOON MUSTANG OTW 9.0x20x75

Facility

$1,250.00

Hospital Charge Code	270677784
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BALLOON MUSTANG OTW 9.0X40X75

Facility

$1,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270677785
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BALLOON MUSTANG OTW 9.0X40X75

Facility

$1,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270677785
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

BALLOON MUSTANG OVER THE WIRE

Facility

$1,250.00

Hospital Charge Code	270661182
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BALLOON MUSTANG OVER THE WIRE

Facility

$1,250.00

Hospital Charge Code	270661182
Hospital Revenue Code	278
Min. Negotiated Rate	$30.12
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

BALLOON MV MN 3.5x15 389281535

Facility

$1,036.00

Hospital Charge Code	270639279C
Hospital Revenue Code	272
Min. Negotiated Rate	$155.40
Max. Negotiated Rate	$155.40
Rate for Payer: Qualcare PPO/HMO/WC	$155.40

BALLOON MV MN 3.5x15 389281535

Facility

$1,036.00

Hospital Charge Code	270639279C
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 MV MONO 2x20 389282020

Facility

$1,036.00

Hospital Charge Code	270639300C
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 MV MONO 2x20 389282020

Facility

$1,036.00

Hospital Charge Code	270639300C
Hospital Revenue Code	272
Min. Negotiated Rate	$155.40
Max. Negotiated Rate	$155.40
Rate for Payer: Qualcare PPO/HMO/WC	$155.40

BALLOON NANOCROSS PTA 1.5 x 20

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270644842C
Hospital Revenue Code	278
Min. Negotiated Rate	$230.79
Max. Negotiated Rate	$372.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79

BALLOON NANOCROSS PTA 1.5 x 20

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270644842C
Hospital Revenue Code	278
Min. Negotiated Rate	$37.08
Max. Negotiated Rate	$769.30
Rate for Payer: Aetna Commercial	$584.67
Rate for Payer: Aetna Medicare Advantage	$461.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.34
Rate for Payer: Cigna Commercial	$769.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79
Rate for Payer: UnitedHealthcare Community & State	$37.08
Rate for Payer: Wellpoint Medicaid Managed Care	$40.77

BALLOON NANOCROSS PTA 1.5x20MM

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	270644842N
Hospital Revenue Code	278
Min. Negotiated Rate	$39.16
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Community & State	$39.16
Rate for Payer: Wellpoint Medicaid Managed Care	$43.06

BALLOON NANOCROSS PTA 1.5x20MM

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	270644842N
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$393.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

BALLOON NANOCROSS PTA 1.5x20MM

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270644842
Hospital Revenue Code	278
Min. Negotiated Rate	$230.79
Max. Negotiated Rate	$372.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79

BALLOON NANOCROSS PTA 1.5x20MM

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270644842
Hospital Revenue Code	278
Min. Negotiated Rate	$37.08
Max. Negotiated Rate	$769.30
Rate for Payer: Aetna Commercial	$584.67
Rate for Payer: Aetna Medicare Advantage	$461.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.34
Rate for Payer: Cigna Commercial	$769.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79
Rate for Payer: UnitedHealthcare Community & State	$37.08
Rate for Payer: Wellpoint Medicaid Managed Care	$40.77

BALLOON NANOCROSS PTA 1.5x40MM

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270671649
Hospital Revenue Code	278
Min. Negotiated Rate	$230.79
Max. Negotiated Rate	$372.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79

BALLOON NANOCROSS PTA 1.5x40MM

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	270671649N
Hospital Revenue Code	278
Min. Negotiated Rate	$39.16
Max. Negotiated Rate	$812.50
Rate for Payer: Aetna Commercial	$617.50
Rate for Payer: Aetna Medicare Advantage	$487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$414.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$414.38
Rate for Payer: Cigna Commercial	$812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75
Rate for Payer: UnitedHealthcare Community & State	$39.16
Rate for Payer: Wellpoint Medicaid Managed Care	$43.06

BALLOON NANOCROSS PTA 1.5x40MM

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	270671649N
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$393.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$393.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$357.50
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

BALLOON NANOCROSS PTA 1.5x40MM

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270671649
Hospital Revenue Code	278
Min. Negotiated Rate	$37.08
Max. Negotiated Rate	$769.30
Rate for Payer: Aetna Commercial	$584.67
Rate for Payer: Aetna Medicare Advantage	$461.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.34
Rate for Payer: Cigna Commercial	$769.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79
Rate for Payer: UnitedHealthcare Community & State	$37.08
Rate for Payer: Wellpoint Medicaid Managed Care	$40.77

BALLOON NANOCROSS PTA 1.5X40MM

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270671649S
Hospital Revenue Code	278
Min. Negotiated Rate	$230.79
Max. Negotiated Rate	$372.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$338.49
Rate for Payer: Qualcare PPO/HMO/WC	$230.79

Know your out-of-pocket cost for care.

All Charges