Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON NANOCROSS PTA 2.0x60MM

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270671650
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 2.0x60MM

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	270671650N
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 2.0x60MM

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270671650S
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 2.0x60MM

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270671650S
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 2.5x100

Facility

$1,375.00

Hospital Charge Code	270671653
Hospital Revenue Code	278
Min. Negotiated Rate	$206.25
Max. Negotiated Rate	$332.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$206.25

BALLOON NANOCROSS PTA 2.5x100

Facility

$1,375.00

Hospital Charge Code	270671653
Hospital Revenue Code	278
Min. Negotiated Rate	$33.14
Max. Negotiated Rate	$687.50
Rate for Payer: Aetna Commercial	$522.50
Rate for Payer: Aetna Medicare Advantage	$412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.62
Rate for Payer: Cigna Commercial	$687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$206.25
Rate for Payer: UnitedHealthcare Community & State	$33.14
Rate for Payer: Wellpoint Medicaid Managed Care	$36.44

BALLOON NANOCROSS PTA 2.5X100

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270671653S
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 2.5X100

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270671653S
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 2.5x120

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270636982
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 2.5x120

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	270636982N
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 2.5x120

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270636982
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 2.5x120

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	270636982N
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 2.5X120

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270636982C
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 2.5X120

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270636982C
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 2.5x150

Facility

$1,852.20

Service Code	HCPCS C1725
Hospital Charge Code	270644447
Hospital Revenue Code	278
Min. Negotiated Rate	$44.64
Max. Negotiated Rate	$926.10
Rate for Payer: Aetna Commercial	$703.84
Rate for Payer: Aetna Medicare Advantage	$555.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$472.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$472.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$370.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$472.31
Rate for Payer: Cigna Commercial	$926.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$448.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$407.48
Rate for Payer: Qualcare PPO/HMO/WC	$277.83
Rate for Payer: UnitedHealthcare Community & State	$44.64
Rate for Payer: Wellpoint Medicaid Managed Care	$49.08

BALLOON NANOCROSS PTA 2.5x150

Facility

$1,852.20

Service Code	HCPCS C1725
Hospital Charge Code	270644447
Hospital Revenue Code	278
Min. Negotiated Rate	$277.83
Max. Negotiated Rate	$448.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$370.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$448.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$407.48
Rate for Payer: Qualcare PPO/HMO/WC	$277.83

BALLOON NANOCROSS PTA 2.5x150

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	270644447N
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 2.5x150

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	270644447N
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 2.5x20MM

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	270644446N
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 2.5x20MM

Facility

$1,734.60

Service Code	HCPCS C1725
Hospital Charge Code	270644446
Hospital Revenue Code	278
Min. Negotiated Rate	$260.19
Max. Negotiated Rate	$419.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$346.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$419.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$381.61
Rate for Payer: Qualcare PPO/HMO/WC	$260.19

BALLOON NANOCROSS PTA 2.5x20MM

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	270644446N
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 2.5x20MM

Facility

$1,734.60

Service Code	HCPCS C1725
Hospital Charge Code	270644446
Hospital Revenue Code	278
Min. Negotiated Rate	$41.80
Max. Negotiated Rate	$867.30
Rate for Payer: Aetna Commercial	$659.15
Rate for Payer: Aetna Medicare Advantage	$520.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$442.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$442.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$346.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$442.32
Rate for Payer: Cigna Commercial	$867.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$419.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$381.61
Rate for Payer: Qualcare PPO/HMO/WC	$260.19
Rate for Payer: UnitedHealthcare Community & State	$41.80
Rate for Payer: Wellpoint Medicaid Managed Care	$45.97

BALLOON NANOCROSS PTA 2.5x210

Facility

$1,852.20

Service Code	HCPCS C1725
Hospital Charge Code	270644366
Hospital Revenue Code	278
Min. Negotiated Rate	$277.83
Max. Negotiated Rate	$448.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$370.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$448.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$407.48
Rate for Payer: Qualcare PPO/HMO/WC	$277.83

BALLOON NANOCROSS PTA 2.5x210

Facility

$1,625.00

Service Code	HCPCS C1725
Hospital Charge Code	270644366N
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 2.5x210

Facility

$1,852.20

Service Code	HCPCS C1725
Hospital Charge Code	270644366
Hospital Revenue Code	278
Min. Negotiated Rate	$44.64
Max. Negotiated Rate	$926.10
Rate for Payer: Aetna Commercial	$703.84
Rate for Payer: Aetna Medicare Advantage	$555.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$472.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$472.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$370.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$472.31
Rate for Payer: Cigna Commercial	$926.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$448.23
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$407.48
Rate for Payer: Qualcare PPO/HMO/WC	$277.83
Rate for Payer: UnitedHealthcare Community & State	$44.64
Rate for Payer: Wellpoint Medicaid Managed Care	$49.08

Know your out-of-pocket cost for care.

All Charges