Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH BALLN 7/4/135 SYN 19398

Facility

$888.00

Hospital Charge Code	270627350
Hospital Revenue Code	272
Min. Negotiated Rate	$133.20
Max. Negotiated Rate	$133.20
Rate for Payer: Qualcare PPO/HMO/WC	$133.20

CATH BALLN 7/4/135 SYN 19398

Facility

$888.00

Hospital Charge Code	270627350
Hospital Revenue Code	272
Min. Negotiated Rate	$21.40
Max. Negotiated Rate	$444.00
Rate for Payer: Aetna Commercial	$337.44
Rate for Payer: Aetna Medicare Advantage	$266.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$226.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$226.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$226.44
Rate for Payer: Cigna Commercial	$444.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.40
Rate for Payer: Oxford Commercial	$177.60
Rate for Payer: Qualcare PPO/HMO/WC	$133.20
Rate for Payer: UnitedHealthcare Commercial	$177.60
Rate for Payer: UnitedHealthcare Community & State	$21.40
Rate for Payer: Wellpoint Medicaid Managed Care	$23.53

CATH BALLN 9 4 5 8 8/75 16-517

Facility

$1,020.00

Hospital Charge Code	270623524V
Hospital Revenue Code	278
Min. Negotiated Rate	$24.58
Max. Negotiated Rate	$510.00
Rate for Payer: Aetna Commercial	$387.60
Rate for Payer: Aetna Medicare Advantage	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$260.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$260.10
Rate for Payer: Cigna Commercial	$510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$224.40
Rate for Payer: Qualcare PPO/HMO/WC	$153.00
Rate for Payer: UnitedHealthcare Community & State	$24.58
Rate for Payer: Wellpoint Medicaid Managed Care	$27.03

CATH BALLN 9 4 5 8 8/75 16-517

Facility

$1,020.00

Hospital Charge Code	270623524V
Hospital Revenue Code	278
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$246.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$204.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.84
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$224.40
Rate for Payer: Qualcare PPO/HMO/WC	$153.00

CATH BALLN ADM 050250130

Facility

$1,472.50

Hospital Charge Code	270658392
Hospital Revenue Code	272
Min. Negotiated Rate	$35.49
Max. Negotiated Rate	$736.25
Rate for Payer: Aetna Commercial	$559.55
Rate for Payer: Aetna Medicare Advantage	$441.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.49
Rate for Payer: Cigna Commercial	$736.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.75
Rate for Payer: Oxford Commercial	$294.50
Rate for Payer: Qualcare PPO/HMO/WC	$220.88
Rate for Payer: UnitedHealthcare Commercial	$294.50
Rate for Payer: UnitedHealthcare Community & State	$35.49
Rate for Payer: Wellpoint Medicaid Managed Care	$39.02

CATH BALLN ADM 050250130

Facility

$1,472.50

Hospital Charge Code	270658392
Hospital Revenue Code	272
Min. Negotiated Rate	$220.88
Max. Negotiated Rate	$220.88
Rate for Payer: Qualcare PPO/HMO/WC	$220.88

CATH BALLN ADM EXTRM 5/150/130

Facility

$1,092.50

Service Code	HCPCS C1725
Hospital Charge Code	270658390
Hospital Revenue Code	278
Min. Negotiated Rate	$26.33
Max. Negotiated Rate	$546.25
Rate for Payer: Aetna Commercial	$415.15
Rate for Payer: Aetna Medicare Advantage	$327.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$218.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.59
Rate for Payer: Cigna Commercial	$546.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$264.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$240.35
Rate for Payer: Qualcare PPO/HMO/WC	$163.88
Rate for Payer: UnitedHealthcare Community & State	$26.33
Rate for Payer: Wellpoint Medicaid Managed Care	$28.95

CATH BALLN ADM EXTRM 5/150/130

Facility

$1,092.50

Service Code	HCPCS C1725
Hospital Charge Code	270658390
Hospital Revenue Code	278
Min. Negotiated Rate	$163.88
Max. Negotiated Rate	$264.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$218.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$264.38
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$240.35
Rate for Payer: Qualcare PPO/HMO/WC	$163.88

CATH BALLN CHOCOLATE 2.5X40CM

Facility

$3,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270687518S
Hospital Revenue Code	278
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$925.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$841.50
Rate for Payer: Qualcare PPO/HMO/WC	$573.75

CATH BALLN CHOCOLATE 2.5X40CM

Facility

$3,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270687518S
Hospital Revenue Code	278
Min. Negotiated Rate	$92.18
Max. Negotiated Rate	$1,912.50
Rate for Payer: Aetna Commercial	$1,453.50
Rate for Payer: Aetna Medicare Advantage	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$975.38
Rate for Payer: Cigna Commercial	$1,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$841.50
Rate for Payer: Qualcare PPO/HMO/WC	$573.75
Rate for Payer: UnitedHealthcare Community & State	$92.18
Rate for Payer: Wellpoint Medicaid Managed Care	$101.36

CATH BALLN CHOCOLATE 2.5X40CM

Facility

$3,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270687518C
Hospital Revenue Code	278
Min. Negotiated Rate	$92.18
Max. Negotiated Rate	$1,912.50
Rate for Payer: Aetna Commercial	$1,453.50
Rate for Payer: Aetna Medicare Advantage	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$975.38
Rate for Payer: Cigna Commercial	$1,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$841.50
Rate for Payer: Qualcare PPO/HMO/WC	$573.75
Rate for Payer: UnitedHealthcare Community & State	$92.18
Rate for Payer: Wellpoint Medicaid Managed Care	$101.36

CATH BALLN CHOCOLATE 2.5X40CM

Facility

$3,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270687518
Hospital Revenue Code	278
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$925.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$841.50
Rate for Payer: Qualcare PPO/HMO/WC	$573.75

CATH BALLN CHOCOLATE 2.5X40CM

Facility

$3,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270687518
Hospital Revenue Code	278
Min. Negotiated Rate	$92.18
Max. Negotiated Rate	$1,912.50
Rate for Payer: Aetna Commercial	$1,453.50
Rate for Payer: Aetna Medicare Advantage	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$975.38
Rate for Payer: Cigna Commercial	$1,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$841.50
Rate for Payer: Qualcare PPO/HMO/WC	$573.75
Rate for Payer: UnitedHealthcare Community & State	$92.18
Rate for Payer: Wellpoint Medicaid Managed Care	$101.36

CATH BALLN CHOCOLATE 2.5X40CM

Facility

$3,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270687518C
Hospital Revenue Code	278
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$925.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$841.50
Rate for Payer: Qualcare PPO/HMO/WC	$573.75

CATH BALLN CHOCOLATE 3.5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685242
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

CATH BALLN CHOCOLATE 3.5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685242
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 3.5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685242N
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 3.5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685242N
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

CATH BALLN CHOCOLATE 5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685241
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

CATH BALLN CHOCOLATE 5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685241N
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

CATH BALLN CHOCOLATE 5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685241
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685241N
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 6X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685243N
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 6X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685243
Hospital Revenue Code	278
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

CATH BALLN CHOCOLATE 6X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685243
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,155.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

Know your out-of-pocket cost for care.

All Charges