Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON QUANTUM OTW 3.0x20mm

Facility

$1,295.00

Hospital Charge Code	270639417
Hospital Revenue Code	272
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) PPO	$330.23
Rate for Payer: Cigna Commercial	$647.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.50
Rate for Payer: Oxford Commercial	$259.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.25
Rate for Payer: UnitedHealthcare Commercial	$259.00
Rate for Payer: UnitedHealthcare Community & State	$31.21
Rate for Payer: Wellpoint Medicaid Managed Care	$34.32

BALLOON QUANTUM OTW 3.5x15mm

Facility

$1,295.00

Hospital Charge Code	270638918
Hospital Revenue Code	272
Min. Negotiated Rate	$194.25
Max. Negotiated Rate	$194.25
Rate for Payer: Qualcare PPO/HMO/WC	$194.25

BALLOON QUANTUM OTW 3.5x15mm

Facility

$1,295.00

Hospital Charge Code	270638918
Hospital Revenue Code	272
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) PPO	$330.23
Rate for Payer: Cigna Commercial	$647.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.50
Rate for Payer: Oxford Commercial	$259.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.25
Rate for Payer: UnitedHealthcare Commercial	$259.00
Rate for Payer: UnitedHealthcare Community & State	$31.21
Rate for Payer: Wellpoint Medicaid Managed Care	$34.32

BALLOON QUANTUM OTW 3.5x20mm

Facility

$1,295.00

Hospital Charge Code	270639415
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 QUANTUM OTW 3.5x20mm

Facility

$1,295.00

Hospital Charge Code	270639415
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 RAIDE 10-11 MM

Facility

$535.00

Hospital Charge Code	270700220
Hospital Revenue Code	272
Min. Negotiated Rate	$12.89
Max. Negotiated Rate	$267.50
Rate for Payer: Aetna Commercial	$203.30
Rate for Payer: Aetna Medicare Advantage	$160.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.43
Rate for Payer: Cigna Commercial	$267.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.50
Rate for Payer: Oxford Commercial	$107.00
Rate for Payer: Qualcare PPO/HMO/WC	$80.25
Rate for Payer: UnitedHealthcare Commercial	$107.00
Rate for Payer: UnitedHealthcare Community & State	$12.89
Rate for Payer: Wellpoint Medicaid Managed Care	$14.18

BALLOON RAIDE 10-11 MM

Facility

$535.00

Hospital Charge Code	270700220
Hospital Revenue Code	272
Min. Negotiated Rate	$80.25
Max. Negotiated Rate	$80.25
Rate for Payer: Qualcare PPO/HMO/WC	$80.25

BALLOON RAPTOR OTW 2.75x15mm

Facility

$1,099.45

Hospital Charge Code	270637414
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 RAPTOR OTW 2.75x15mm

Facility

$1,099.45

Hospital Charge Code	270637414
Hospital Revenue Code	272
Min. Negotiated Rate	$164.92
Max. Negotiated Rate	$164.92
Rate for Payer: Qualcare PPO/HMO/WC	$164.92

BALLOON RAPTOR OTW 3.0x10mm

Facility

$1,099.45

Hospital Charge Code	270637561
Hospital Revenue Code	272
Min. Negotiated Rate	$164.92
Max. Negotiated Rate	$164.92
Rate for Payer: Qualcare PPO/HMO/WC	$164.92

BALLOON RAPTOR OTW 3.0x10mm

Facility

$1,099.45

Hospital Charge Code	270637561
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 REPLCMT MCV 12 6612

Facility

$309.65

Hospital Charge Code	270604784
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.12
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 12 6612

Facility

$309.65

Hospital Charge Code	270604784
Hospital Revenue Code	278
Min. Negotiated Rate	$7.46
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$117.67
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.12
Rate for Payer: Qualcare PPO/HMO/WC	$46.45
Rate for Payer: UnitedHealthcare Community & State	$7.46
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

BALLOON REPLCMT MCV 13 6613

Facility

$309.65

Hospital Charge Code	270604785
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.12
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 13 6613

Facility

$309.65

Hospital Charge Code	270604785
Hospital Revenue Code	278
Min. Negotiated Rate	$7.46
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$117.67
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.12
Rate for Payer: Qualcare PPO/HMO/WC	$46.45
Rate for Payer: UnitedHealthcare Community & State	$7.46
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

BALLOON REPLCMT MCV 14 6614

Facility

$616.00

Hospital Charge Code	270604786
Hospital Revenue Code	278
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$308.00
Rate for Payer: Aetna Commercial	$234.08
Rate for Payer: Aetna Medicare Advantage	$184.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.08
Rate for Payer: Cigna Commercial	$308.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$135.52
Rate for Payer: Qualcare PPO/HMO/WC	$92.40
Rate for Payer: UnitedHealthcare Community & State	$14.85
Rate for Payer: Wellpoint Medicaid Managed Care	$16.32

BALLOON REPLCMT MCV 14 6614

Facility

$616.00

Hospital Charge Code	270604786
Hospital Revenue Code	278
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$149.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$135.52
Rate for Payer: Qualcare PPO/HMO/WC	$92.40

BALLOON REPLCMT MCV 15 6615

Facility

$309.65

Hospital Charge Code	270604787
Hospital Revenue Code	278
Min. Negotiated Rate	$7.46
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$117.67
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.12
Rate for Payer: Qualcare PPO/HMO/WC	$46.45
Rate for Payer: UnitedHealthcare Community & State	$7.46
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

BALLOON REPLCMT MCV 15 6615

Facility

$309.65

Hospital Charge Code	270604787
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.12
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 16 6616

Facility

$309.65

Hospital Charge Code	270604789
Hospital Revenue Code	278
Min. Negotiated Rate	$7.46
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$117.67
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.12
Rate for Payer: Qualcare PPO/HMO/WC	$46.45
Rate for Payer: UnitedHealthcare Community & State	$7.46
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

BALLOON REPLCMT MCV 16 6616

Facility

$309.65

Hospital Charge Code	270604789
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.12
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 17 6617

Facility

$309.65

Service Code	HCPCS C1726
Hospital Charge Code	270604790
Hospital Revenue Code	278
Min. Negotiated Rate	$7.46
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$117.67
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.12
Rate for Payer: Qualcare PPO/HMO/WC	$46.45
Rate for Payer: UnitedHealthcare Community & State	$7.46
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

BALLOON REPLCMT MCV 17 6617

Facility

$309.65

Service Code	HCPCS C1726
Hospital Charge Code	270604790
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.12
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 18 6618

Facility

$309.65

Hospital Charge Code	270604791
Hospital Revenue Code	278
Min. Negotiated Rate	$46.45
Max. Negotiated Rate	$74.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.12
Rate for Payer: Qualcare PPO/HMO/WC	$46.45

BALLOON REPLCMT MCV 18 6618

Facility

$309.65

Hospital Charge Code	270604791
Hospital Revenue Code	278
Min. Negotiated Rate	$7.46
Max. Negotiated Rate	$154.82
Rate for Payer: Aetna Commercial	$117.67
Rate for Payer: Aetna Medicare Advantage	$92.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.96
Rate for Payer: Cigna Commercial	$154.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$68.12
Rate for Payer: Qualcare PPO/HMO/WC	$46.45
Rate for Payer: UnitedHealthcare Community & State	$7.46
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

Know your out-of-pocket cost for care.

All Charges