Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATH BALLN CHOCOLATE 6X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685243N
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 BALL NC VOYAGER 2.75x8

Facility

$1,275.00

Hospital Charge Code	2709003706
Hospital Revenue Code	272
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) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$382.50
Rate for Payer: Oxford Commercial	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$191.25
Rate for Payer: UnitedHealthcare Commercial	$255.00
Rate for Payer: UnitedHealthcare Community & State	$30.73
Rate for Payer: Wellpoint Medicaid Managed Care	$33.79

CATH BALL NC VOYAGER 2.75x8

Facility

$1,275.00

Hospital Charge Code	2709003706
Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$191.25
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

CATH BALL NC VOYAGER 3.5x8

Facility

$1,275.00

Hospital Charge Code	2709003708
Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$191.25
Rate for Payer: Qualcare PPO/HMO/WC	$191.25

CATH BALL NC VOYAGER 3.5x8

Facility

$1,275.00

Hospital Charge Code	2709003708
Hospital Revenue Code	272
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) PPO	$325.12
Rate for Payer: Cigna Commercial	$637.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$382.50
Rate for Payer: Oxford Commercial	$255.00
Rate for Payer: Qualcare PPO/HMO/WC	$191.25
Rate for Payer: UnitedHealthcare Commercial	$255.00
Rate for Payer: UnitedHealthcare Community & State	$30.73
Rate for Payer: Wellpoint Medicaid Managed Care	$33.79

CATH BALLN DIAMD 5x2x75C 16437

Facility

$1,044.50

Hospital Charge Code	270628314V
Hospital Revenue Code	278
Min. Negotiated Rate	$156.68
Max. Negotiated Rate	$252.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$208.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$229.79
Rate for Payer: Qualcare PPO/HMO/WC	$156.68

CATH BALLN DIAMD 5x2x75C 16437

Facility

$1,044.50

Hospital Charge Code	270628314V
Hospital Revenue Code	278
Min. Negotiated Rate	$25.17
Max. Negotiated Rate	$522.25
Rate for Payer: Aetna Commercial	$396.91
Rate for Payer: Aetna Medicare Advantage	$313.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$208.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.35
Rate for Payer: Cigna Commercial	$522.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$229.79
Rate for Payer: Qualcare PPO/HMO/WC	$156.68
Rate for Payer: UnitedHealthcare Community & State	$25.17
Rate for Payer: Wellpoint Medicaid Managed Care	$27.68

CATH BALLN DIAMD 6x4x75C 16463

Facility

$1,044.50

Hospital Charge Code	270618563V
Hospital Revenue Code	278
Min. Negotiated Rate	$156.68
Max. Negotiated Rate	$252.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$208.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$229.79
Rate for Payer: Qualcare PPO/HMO/WC	$156.68

CATH BALLN DIAMD 6x4x75C 16463

Facility

$1,044.50

Hospital Charge Code	270618563V
Hospital Revenue Code	278
Min. Negotiated Rate	$25.17
Max. Negotiated Rate	$522.25
Rate for Payer: Aetna Commercial	$396.91
Rate for Payer: Aetna Medicare Advantage	$313.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$208.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.35
Rate for Payer: Cigna Commercial	$522.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$252.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$229.79
Rate for Payer: Qualcare PPO/HMO/WC	$156.68
Rate for Payer: UnitedHealthcare Community & State	$25.17
Rate for Payer: Wellpoint Medicaid Managed Care	$27.68

CATH BALLN DIAMD 7x4x75c 16483

Facility

$1,080.50

Hospital Charge Code	270618564V
Hospital Revenue Code	278
Min. Negotiated Rate	$162.07
Max. Negotiated Rate	$261.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$237.71
Rate for Payer: Qualcare PPO/HMO/WC	$162.07

CATH BALLN DIAMD 7x4x75c 16483

Facility

$1,080.50

Hospital Charge Code	270618564V
Hospital Revenue Code	278
Min. Negotiated Rate	$26.04
Max. Negotiated Rate	$540.25
Rate for Payer: Aetna Commercial	$410.59
Rate for Payer: Aetna Medicare Advantage	$324.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$216.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.53
Rate for Payer: Cigna Commercial	$540.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$237.71
Rate for Payer: Qualcare PPO/HMO/WC	$162.07
Rate for Payer: UnitedHealthcare Community & State	$26.04
Rate for Payer: Wellpoint Medicaid Managed Care	$28.63

CATH BALLN SL 6x4x80 4386040SP

Facility

$1,884.85

Hospital Charge Code	270632137
Hospital Revenue Code	278
Min. Negotiated Rate	$282.73
Max. Negotiated Rate	$456.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$376.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$456.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$414.67
Rate for Payer: Qualcare PPO/HMO/WC	$282.73

CATH BALLN SL 6x4x80 4386040SP

Facility

$1,884.85

Hospital Charge Code	270632137V
Hospital Revenue Code	278
Min. Negotiated Rate	$282.73
Max. Negotiated Rate	$456.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$376.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$456.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$414.67
Rate for Payer: Qualcare PPO/HMO/WC	$282.73

CATH BALLN SL 6x4x80 4386040SP

Facility

$1,884.85

Hospital Charge Code	270632137V
Hospital Revenue Code	278
Min. Negotiated Rate	$45.42
Max. Negotiated Rate	$942.42
Rate for Payer: Aetna Commercial	$716.24
Rate for Payer: Aetna Medicare Advantage	$565.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$480.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$480.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$376.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$480.64
Rate for Payer: Cigna Commercial	$942.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$456.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$414.67
Rate for Payer: Qualcare PPO/HMO/WC	$282.73
Rate for Payer: UnitedHealthcare Community & State	$45.42
Rate for Payer: Wellpoint Medicaid Managed Care	$49.95

CATH BALLN SL 6x4x80 4386040SP

Facility

$1,884.85

Hospital Charge Code	270632137
Hospital Revenue Code	278
Min. Negotiated Rate	$45.42
Max. Negotiated Rate	$942.42
Rate for Payer: Aetna Commercial	$716.24
Rate for Payer: Aetna Medicare Advantage	$565.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$480.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$480.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$376.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$480.64
Rate for Payer: Cigna Commercial	$942.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$456.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$414.67
Rate for Payer: Qualcare PPO/HMO/WC	$282.73
Rate for Payer: UnitedHealthcare Community & State	$45.42
Rate for Payer: Wellpoint Medicaid Managed Care	$49.95

CATH BALLN SLALOM 438-8020

Facility

$1,993.65

Hospital Charge Code	270624009
Hospital Revenue Code	272
Min. Negotiated Rate	$299.05
Max. Negotiated Rate	$299.05
Rate for Payer: Qualcare PPO/HMO/WC	$299.05

CATH BALLN SLALOM 438-8020

Facility

$1,993.65

Hospital Charge Code	270624009
Hospital Revenue Code	272
Min. Negotiated Rate	$48.05
Max. Negotiated Rate	$996.83
Rate for Payer: Aetna Commercial	$757.59
Rate for Payer: Aetna Medicare Advantage	$598.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$508.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$508.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$508.38
Rate for Payer: Cigna Commercial	$996.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$598.10
Rate for Payer: Oxford Commercial	$398.73
Rate for Payer: Qualcare PPO/HMO/WC	$299.05
Rate for Payer: UnitedHealthcare Commercial	$398.73
Rate for Payer: UnitedHealthcare Community & State	$48.05
Rate for Payer: Wellpoint Medicaid Managed Care	$52.83

CATH BALLN SLALOM 6x2 4386020S

Facility

$1,900.00

Hospital Charge Code	270630050V
Hospital Revenue Code	278
Min. Negotiated Rate	$285.00
Max. Negotiated Rate	$459.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$459.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$418.00
Rate for Payer: Qualcare PPO/HMO/WC	$285.00

CATH BALLN SLALOM 6x2 4386020S

Facility

$1,884.85

Hospital Charge Code	270630050
Hospital Revenue Code	278
Min. Negotiated Rate	$45.42
Max. Negotiated Rate	$942.42
Rate for Payer: Aetna Commercial	$716.24
Rate for Payer: Aetna Medicare Advantage	$565.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$480.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$480.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$376.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$480.64
Rate for Payer: Cigna Commercial	$942.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$456.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$414.67
Rate for Payer: Qualcare PPO/HMO/WC	$282.73
Rate for Payer: UnitedHealthcare Community & State	$45.42
Rate for Payer: Wellpoint Medicaid Managed Care	$49.95

CATH BALLN SLALOM 6x2 4386020S

Facility

$1,900.00

Hospital Charge Code	270630050V
Hospital Revenue Code	278
Min. Negotiated Rate	$45.79
Max. Negotiated Rate	$950.00
Rate for Payer: Aetna Commercial	$722.00
Rate for Payer: Aetna Medicare Advantage	$570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$484.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$484.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$380.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$484.50
Rate for Payer: Cigna Commercial	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$459.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$418.00
Rate for Payer: Qualcare PPO/HMO/WC	$285.00
Rate for Payer: UnitedHealthcare Community & State	$45.79
Rate for Payer: Wellpoint Medicaid Managed Care	$50.35

CATH BALLN SLALOM 6x2 4386020S

Facility

$1,884.85

Hospital Charge Code	270630050
Hospital Revenue Code	278
Min. Negotiated Rate	$282.73
Max. Negotiated Rate	$456.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$376.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$456.13
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$414.67
Rate for Payer: Qualcare PPO/HMO/WC	$282.73

CATH BALLN VIVA 4.0x40 1333140

Facility

$1,875.00

Hospital Charge Code	270633627V
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$453.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

CATH BALLN VIVA 4.0x40 1333140

Facility

$1,875.00

Hospital Charge Code	270633627V
Hospital Revenue Code	278
Min. Negotiated Rate	$45.19
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$712.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$281.25
Rate for Payer: UnitedHealthcare Community & State	$45.19
Rate for Payer: Wellpoint Medicaid Managed Care	$49.69

CATH BALLN VIVA 4.0x40 1333140

Facility

$1,860.00

Hospital Charge Code	270633627
Hospital Revenue Code	278
Min. Negotiated Rate	$44.83
Max. Negotiated Rate	$930.00
Rate for Payer: Aetna Commercial	$706.80
Rate for Payer: Aetna Medicare Advantage	$558.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$474.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$474.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$372.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$474.30
Rate for Payer: Cigna Commercial	$930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$409.20
Rate for Payer: Qualcare PPO/HMO/WC	$279.00
Rate for Payer: UnitedHealthcare Community & State	$44.83
Rate for Payer: Wellpoint Medicaid Managed Care	$49.29

CATH BALLN VIVA 4.0x40 1333140

Facility

$1,860.00

Hospital Charge Code	270633627
Hospital Revenue Code	278
Min. Negotiated Rate	$279.00
Max. Negotiated Rate	$450.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$372.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$450.12
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$409.20
Rate for Payer: Qualcare PPO/HMO/WC	$279.00

Know your out-of-pocket cost for care.

All Charges