Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON PANTERA PRO 1.5/6

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270700997S
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 PANTERA PRO 3.0/15

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701022S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON PANTERA PRO 3.0/15

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701045S
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 PANTERA PRO 3.0/15

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701045S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON PANTERA PRO 3.0/15

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701022S
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 PANTERA WH PRO 1.5/15

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701017S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON PANTERA WH PRO 1.5/15

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701017S
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 PC RAPTOR 3.5x15

Facility

$1,433.75

Hospital Charge Code	270633347
Hospital Revenue Code	272
Min. Negotiated Rate	$215.06
Max. Negotiated Rate	$215.06
Rate for Payer: Qualcare PPO/HMO/WC	$215.06

BALLOON PC RAPTOR 3.5x15

Facility

$1,433.75

Hospital Charge Code	270633347
Hospital Revenue Code	272
Min. Negotiated Rate	$34.55
Max. Negotiated Rate	$716.88
Rate for Payer: Aetna Commercial	$544.83
Rate for Payer: Aetna Medicare Advantage	$430.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.61
Rate for Payer: Cigna Commercial	$716.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$430.12
Rate for Payer: Oxford Commercial	$286.75
Rate for Payer: Qualcare PPO/HMO/WC	$215.06
Rate for Payer: UnitedHealthcare Commercial	$286.75
Rate for Payer: UnitedHealthcare Community & State	$34.55
Rate for Payer: Wellpoint Medicaid Managed Care	$37.99

BALLOON PFLEX CR 80cm 4208040S

Facility

$1,237.65

Hospital Charge Code	270625419
Hospital Revenue Code	272
Min. Negotiated Rate	$185.65
Max. Negotiated Rate	$185.65
Rate for Payer: Qualcare PPO/HMO/WC	$185.65

BALLOON PFLEX CR 80cm 4208040S

Facility

$1,237.65

Hospital Charge Code	270625419
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

BALLOON POLAR 3.0x100 150cm

Facility

$4,500.00

Hospital Charge Code	270639273
Hospital Revenue Code	272
Min. Negotiated Rate	$108.45
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,350.00
Rate for Payer: Oxford Commercial	$900.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$900.00
Rate for Payer: UnitedHealthcare Community & State	$108.45
Rate for Payer: Wellpoint Medicaid Managed Care	$119.25

BALLOON POLAR 3.0x100 150cm

Facility

$4,500.00

Hospital Charge Code	270639273
Hospital Revenue Code	272
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

BALLOON POWERCROSS PTA 3x100mm

Facility

$1,125.00

Hospital Charge Code	270671660
Hospital Revenue Code	278
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

BALLOON POWERCROSS PTA 3x100mm

Facility

$1,125.00

Hospital Charge Code	270671660
Hospital Revenue Code	278
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

BALLOON POWERCROSS PTA 3x120mm

Facility

$1,125.00

Hospital Charge Code	270671661
Hospital Revenue Code	278
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

BALLOON POWERCROSS PTA 3x120mm

Facility

$1,125.00

Hospital Charge Code	270671661
Hospital Revenue Code	278
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

BALLOON POWERCROSS PTA 4x100mm

Facility

$1,125.00

Hospital Charge Code	270671666
Hospital Revenue Code	278
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

BALLOON POWERCROSS PTA 4x100mm

Facility

$1,125.00

Hospital Charge Code	270671666
Hospital Revenue Code	278
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

BALLOON POWERCROSS PTA 4x120mm

Facility

$1,125.00

Hospital Charge Code	270671667
Hospital Revenue Code	278
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

BALLOON POWERCROSS PTA 4x120mm

Facility

$1,125.00

Hospital Charge Code	270671667
Hospital Revenue Code	278
Min. Negotiated Rate	$27.11
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$247.50
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$29.81

BALLOON POWERCROSS PTA 4x150mm

Facility

$1,250.00

Hospital Charge Code	270646037
Hospital Revenue Code	272
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) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$250.00
Rate for Payer: UnitedHealthcare Community & State	$30.12
Rate for Payer: Wellpoint Medicaid Managed Care	$33.12

BALLOON POWERCROSS PTA 4x150mm

Facility

$1,250.00

Hospital Charge Code	270646037
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BALLOON POWERCROSS PTA 4x150mm

Facility

$1,250.00

Hospital Charge Code	270646037C
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 POWERCROSS PTA 4x150mm

Facility

$1,250.00

Hospital Charge Code	270646037C
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

Know your out-of-pocket cost for care.

All Charges