Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON VOYAGER RX 4.0x8mm

Facility

$1,175.00

Hospital Charge Code	270642998C
Hospital Revenue Code	278
Min. Negotiated Rate	$28.32
Max. Negotiated Rate	$587.50
Rate for Payer: Aetna Commercial	$446.50
Rate for Payer: Aetna Medicare Advantage	$352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.62
Rate for Payer: Cigna Commercial	$587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.25
Rate for Payer: UnitedHealthcare Community & State	$28.32
Rate for Payer: Wellpoint Medicaid Managed Care	$31.14

BALLOON VOYAGER RX 4.0x8mm

Facility

$1,175.00

Hospital Charge Code	270642998C
Hospital Revenue Code	278
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$284.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$258.50
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

BALLOON VOYAGE RX 3.0x15mm OTW

Facility

$850.00

Hospital Charge Code	270645181C
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON VOYAGE RX 3.0x15mm OTW

Facility

$850.00

Hospital Charge Code	270645181C
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

BALLOON VOYAGE RX 3.0x20mm OTW

Facility

$850.00

Hospital Charge Code	270645182C
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON VOYAGE RX 3.0x20mm OTW

Facility

$850.00

Hospital Charge Code	270645182C
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

BALLOON VOYAYER NC 3.0X 20MM

Facility

$850.00

Hospital Charge Code	2706431922
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

BALLOON VOYAYER NC 3.0X 20MM

Facility

$850.00

Hospital Charge Code	2706431922
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON VOYAYER NC 3.5X 15MM

Facility

$850.00

Hospital Charge Code	2706431930
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

BALLOON VOYAYER NC 3.5X 15MM

Facility

$850.00

Hospital Charge Code	2706431930
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$187.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON VOY NC 2.0x8 101175108

Facility

$1,275.00

Hospital Charge Code	270643176C
Hospital Revenue Code	278
Min. Negotiated Rate	$30.73
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$484.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$280.50
Rate for Payer: Qualcare PPO/HMO/WC	$191.25
Rate for Payer: UnitedHealthcare Community & State	$30.73
Rate for Payer: Wellpoint Medicaid Managed Care	$33.79

BALLOON VOY NC 2.0x8 101175108

Facility

$1,275.00

Hospital Charge Code	270643176C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$280.50
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLOON VOY NC 3.0x8 101175408

Facility

$1,275.00

Hospital Charge Code	270643059C
Hospital Revenue Code	278
Min. Negotiated Rate	$30.73
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$484.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$280.50
Rate for Payer: Qualcare PPO/HMO/WC	$191.25
Rate for Payer: UnitedHealthcare Community & State	$30.73
Rate for Payer: Wellpoint Medicaid Managed Care	$33.79

BALLOON VOY NC 3.0x8 101175408

Facility

$1,275.00

Hospital Charge Code	270643059C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$280.50
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLOON VOY RX 2.0x8 101139208

Facility

$1,275.00

Hospital Charge Code	270643062C
Hospital Revenue Code	278
Min. Negotiated Rate	$30.73
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$484.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$280.50
Rate for Payer: Qualcare PPO/HMO/WC	$191.25
Rate for Payer: UnitedHealthcare Community & State	$30.73
Rate for Payer: Wellpoint Medicaid Managed Care	$33.79

BALLOON VOY RX 2.0x8 101139208

Facility

$1,275.00

Hospital Charge Code	270643062C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$280.50
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLOON VOY RX 2.5x8 101139408

Facility

$1,275.00

Hospital Charge Code	270643064C
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$308.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$280.50
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

BALLOON VOY RX 2.5x8 101139408

Facility

$1,275.00

Hospital Charge Code	270643064C
Hospital Revenue Code	278
Min. Negotiated Rate	$30.73
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$484.50
Rate for Payer: Aetna Medicare Advantage	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$325.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$308.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$280.50
Rate for Payer: Qualcare PPO/HMO/WC	$191.25
Rate for Payer: UnitedHealthcare Community & State	$30.73
Rate for Payer: Wellpoint Medicaid Managed Care	$33.79

BALLOONWALRUSGDCATH087 95CM

Facility

$8,750.00

Service Code	HCPCS C1757
Hospital Charge Code	270694053S
Hospital Revenue Code	278
Min. Negotiated Rate	$210.88
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$3,325.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50
Rate for Payer: UnitedHealthcare Community & State	$210.88
Rate for Payer: Wellpoint Medicaid Managed Care	$231.88

BALLOONWALRUSGDCATH087 95CM

Facility

$8,750.00

Service Code	HCPCS C1757
Hospital Charge Code	270694053S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,925.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

BALLOON WH PANTERA PRO 1.5/20

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701049S
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 WH PANTERA PRO 1.5/20

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701049S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON WH PANTERA PRO 2.0/10

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701005S
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 WH PANTERA PRO 2.0/10

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701005S
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON WH PANTERA PRO 2.0/20

Facility

$350.00

Service Code	HCPCS C1725
Hospital Charge Code	270701047S
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

Know your out-of-pocket cost for care.

All Charges