Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON NC PANTERA LEO 4.5/12

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701002S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON NC PANTERA LEO 4.5/15

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700975S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON NC PANTERA LEO 4.5/15

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700975S
Hospital Revenue Code	272
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Oxford Commercial	$70.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$70.00
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

BALLOON NC PANTERA LEO 4.5/8

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701020S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON NC PANTERA LEO 4.5/8

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701020S
Hospital Revenue Code	272
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Oxford Commercial	$70.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$70.00
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

BALLOON NC PANTERA LEO 5.0/12

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701000S
Hospital Revenue Code	272
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Oxford Commercial	$70.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$70.00
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

BALLOON NC PANTERA LEO 5.0/12

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701000S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON NC PANTERA LEO 5.0/15

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700973S
Hospital Revenue Code	272
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Oxford Commercial	$70.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$70.00
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

BALLOON NC PANTERA LEO 5.0/15

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700973S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON NC PANTERA LEO 5.0/8

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701019S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON NC PANTERA LEO 5.0/8

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701019S
Hospital Revenue Code	272
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.00
Rate for Payer: Oxford Commercial	$70.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$70.00
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.28

BALLOON NCRS PTA AB14W02504015

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270643677S
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 NCRS PTA AB14W02504015

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270643677S
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 NEPHROSTOMY

Facility

$1,348.50

Hospital Charge Code	270650767
Hospital Revenue Code	272
Min. Negotiated Rate	$202.28
Max. Negotiated Rate	$202.28
Rate for Payer: Qualcare PPO/HMO/WC	$202.28

BALLOON NEPHROSTOMY

Facility

$1,348.50

Hospital Charge Code	270650767
Hospital Revenue Code	272
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$674.25
Rate for Payer: Aetna Commercial	$512.43
Rate for Payer: Aetna Medicare Advantage	$404.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$343.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$343.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$343.87
Rate for Payer: Cigna Commercial	$674.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$404.55
Rate for Payer: Oxford Commercial	$269.70
Rate for Payer: Qualcare PPO/HMO/WC	$202.28
Rate for Payer: UnitedHealthcare Commercial	$269.70
Rate for Payer: UnitedHealthcare Community & State	$32.50
Rate for Payer: Wellpoint Medicaid Managed Care	$35.74

BALLOON NINJA OTW 2.5x10mm

Facility

$1,099.45

Hospital Charge Code	270639422
Hospital Revenue Code	272
Min. Negotiated Rate	$26.50
Max. Negotiated Rate	$549.73
Rate for Payer: Aetna Commercial	$417.79
Rate for Payer: Aetna Medicare Advantage	$329.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.36
Rate for Payer: Cigna Commercial	$549.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$329.83
Rate for Payer: Oxford Commercial	$219.89
Rate for Payer: Qualcare PPO/HMO/WC	$164.92
Rate for Payer: UnitedHealthcare Commercial	$219.89
Rate for Payer: UnitedHealthcare Community & State	$26.50
Rate for Payer: Wellpoint Medicaid Managed Care	$29.14

BALLOON NINJA OTW 2.5x10mm

Facility

$1,099.45

Hospital Charge Code	270639422
Hospital Revenue Code	272
Min. Negotiated Rate	$164.92
Max. Negotiated Rate	$164.92
Rate for Payer: Qualcare PPO/HMO/WC	$164.92

BALLOON OCCLUSION 262924

Facility

$1,016.85

Hospital Charge Code	270632205
Hospital Revenue Code	272
Min. Negotiated Rate	$24.51
Max. Negotiated Rate	$508.43
Rate for Payer: Aetna Commercial	$386.40
Rate for Payer: Aetna Medicare Advantage	$305.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$259.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$259.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$259.30
Rate for Payer: Cigna Commercial	$508.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$305.06
Rate for Payer: Oxford Commercial	$203.37
Rate for Payer: Qualcare PPO/HMO/WC	$152.53
Rate for Payer: UnitedHealthcare Commercial	$203.37
Rate for Payer: UnitedHealthcare Community & State	$24.51
Rate for Payer: Wellpoint Medicaid Managed Care	$26.95

BALLOON OCCLUSION 262924

Facility

$1,016.85

Hospital Charge Code	270632728
Hospital Revenue Code	272
Min. Negotiated Rate	$24.51
Max. Negotiated Rate	$508.43
Rate for Payer: Aetna Commercial	$386.40
Rate for Payer: Aetna Medicare Advantage	$305.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$259.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$259.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$259.30
Rate for Payer: Cigna Commercial	$508.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$305.06
Rate for Payer: Oxford Commercial	$203.37
Rate for Payer: Qualcare PPO/HMO/WC	$152.53
Rate for Payer: UnitedHealthcare Commercial	$203.37
Rate for Payer: UnitedHealthcare Community & State	$24.51
Rate for Payer: Wellpoint Medicaid Managed Care	$26.95

BALLOON OCCLUSION 262924

Facility

$1,016.85

Hospital Charge Code	270632205
Hospital Revenue Code	272
Min. Negotiated Rate	$152.53
Max. Negotiated Rate	$152.53
Rate for Payer: Qualcare PPO/HMO/WC	$152.53

BALLOON OCCLUSION 262924

Facility

$1,016.85

Hospital Charge Code	270632728
Hospital Revenue Code	272
Min. Negotiated Rate	$152.53
Max. Negotiated Rate	$152.53
Rate for Payer: Qualcare PPO/HMO/WC	$152.53

BALLOON OPTA LP 8x4 80cm

Facility

$1,325.00

Hospital Charge Code	270626132
Hospital Revenue Code	272
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$198.75
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

BALLOON OPTA LP 8x4 80cm

Facility

$1,325.00

Hospital Charge Code	270626132
Hospital Revenue Code	272
Min. Negotiated Rate	$31.93
Max. Negotiated Rate	$662.50
Rate for Payer: Aetna Commercial	$503.50
Rate for Payer: Aetna Medicare Advantage	$397.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.88
Rate for Payer: Cigna Commercial	$662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$397.50
Rate for Payer: Oxford Commercial	$265.00
Rate for Payer: Qualcare PPO/HMO/WC	$198.75
Rate for Payer: UnitedHealthcare Commercial	$265.00
Rate for Payer: UnitedHealthcare Community & State	$31.93
Rate for Payer: Wellpoint Medicaid Managed Care	$35.11

BALLOON OPTA PRO CRD 4197040S

Facility

$1,237.65

Hospital Charge Code	270625961
Hospital Revenue Code	272
Min. Negotiated Rate	$185.65
Max. Negotiated Rate	$185.65
Rate for Payer: Qualcare PPO/HMO/WC	$185.65

BALLOON OPTA PRO CRD 4197040S

Facility

$1,237.65

Hospital Charge Code	270625961
Hospital Revenue Code	272
Min. Negotiated Rate	$29.83
Max. Negotiated Rate	$618.83
Rate for Payer: Aetna Commercial	$470.31
Rate for Payer: Aetna Medicare Advantage	$371.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$315.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$315.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$315.60
Rate for Payer: Cigna Commercial	$618.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$371.30
Rate for Payer: Oxford Commercial	$247.53
Rate for Payer: Qualcare PPO/HMO/WC	$185.65
Rate for Payer: UnitedHealthcare Commercial	$247.53
Rate for Payer: UnitedHealthcare Community & State	$29.83
Rate for Payer: Wellpoint Medicaid Managed Care	$32.80

Know your out-of-pocket cost for care.

All Charges