Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATHBALLONADMI.XTREME 8/20/130

Facility

$1,000.00

Hospital Charge Code	2709003830
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CATHBALLONADMI.XTREME 8/20/130

Facility

$1,000.00

Hospital Charge Code	2709003830
Hospital Revenue Code	272
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

CATHBALLONADMI.XTREME 8/40/130

Facility

$1,000.00

Hospital Charge Code	2709003832
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CATHBALLONADMI.XTREME 8/40/130

Facility

$1,000.00

Hospital Charge Code	2709003832
Hospital Revenue Code	272
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

CATHBALLONADMI.XTREME 8/60/130

Facility

$1,000.00

Hospital Charge Code	2709003834
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CATHBALLONADMI.XTREME 8/60/130

Facility

$1,000.00

Hospital Charge Code	2709003834
Hospital Revenue Code	272
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

CATHBALLONADMI.XTREME 9/20/130

Facility

$1,000.00

Hospital Charge Code	209003837
Hospital Revenue Code	272
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

CATHBALLONADMI.XTREME 9/20/130

Facility

$1,000.00

Hospital Charge Code	209003837
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CATHBALLONADMI.XTREME 9/40/130

Facility

$1,000.00

Hospital Charge Code	5709003838
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

CATHBALLONADMI.XTREME 9/40/130

Facility

$1,000.00

Hospital Charge Code	5709003838
Hospital Revenue Code	272
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.00
Rate for Payer: Oxford Commercial	$200.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Commercial	$200.00
Rate for Payer: UnitedHealthcare Community & State	$24.10
Rate for Payer: Wellpoint Medicaid Managed Care	$26.50

CATH BALLON AMPHN 1 5/20/150

Facility

$1,615.00

Service Code	HCPCS C1725
Hospital Charge Code	270657934
Hospital Revenue Code	278
Min. Negotiated Rate	$38.92
Max. Negotiated Rate	$807.50
Rate for Payer: Aetna Commercial	$613.70
Rate for Payer: Aetna Medicare Advantage	$484.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$411.82
Rate for Payer: Cigna Commercial	$807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$355.30
Rate for Payer: Qualcare PPO/HMO/WC	$242.25
Rate for Payer: UnitedHealthcare Community & State	$38.92
Rate for Payer: Wellpoint Medicaid Managed Care	$42.80

CATH BALLON AMPHN 1 5/20/150

Facility

$1,615.00

Service Code	HCPCS C1725
Hospital Charge Code	270657934
Hospital Revenue Code	278
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$390.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$355.30
Rate for Payer: Qualcare PPO/HMO/WC	$242.25

CATH BALLON AMPHN 2 5/120/150

Facility

$1,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270661861
Hospital Revenue Code	278
Min. Negotiated Rate	$43.98
Max. Negotiated Rate	$912.50
Rate for Payer: Aetna Commercial	$693.50
Rate for Payer: Aetna Medicare Advantage	$547.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$365.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.38
Rate for Payer: Cigna Commercial	$912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$401.50
Rate for Payer: Qualcare PPO/HMO/WC	$273.75
Rate for Payer: UnitedHealthcare Community & State	$43.98
Rate for Payer: Wellpoint Medicaid Managed Care	$48.36

CATH BALLON AMPHN 2 5/120/150

Facility

$1,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270661861
Hospital Revenue Code	278
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$441.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$401.50
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

CATH BALLON ECLIPSE DUAL 6X15

Facility

$9,250.00

Service Code	HCPCS C2628
Hospital Charge Code	270697182S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

CATH BALLON ECLIPSE DUAL 6X15

Facility

$9,250.00

Service Code	HCPCS C2628
Hospital Charge Code	270697182S
Hospital Revenue Code	278
Min. Negotiated Rate	$222.93
Max. Negotiated Rate	$4,625.00
Rate for Payer: Aetna Commercial	$3,515.00
Rate for Payer: Aetna Medicare Advantage	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.75
Rate for Payer: Cigna Commercial	$4,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,035.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50
Rate for Payer: UnitedHealthcare Community & State	$222.93
Rate for Payer: Wellpoint Medicaid Managed Care	$245.12

CATH BALLON PTA DILAIT 14LP3-2

Facility

$2,650.00

Hospital Charge Code	270662854
Hospital Revenue Code	278
Min. Negotiated Rate	$63.87
Max. Negotiated Rate	$1,325.00
Rate for Payer: Aetna Commercial	$1,007.00
Rate for Payer: Aetna Medicare Advantage	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$675.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$675.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$675.75
Rate for Payer: Cigna Commercial	$1,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$641.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$583.00
Rate for Payer: Qualcare PPO/HMO/WC	$397.50
Rate for Payer: UnitedHealthcare Community & State	$63.87
Rate for Payer: Wellpoint Medicaid Managed Care	$70.22

CATH BALLON PTA DILAIT 14LP3-2

Facility

$2,650.00

Hospital Charge Code	270662854
Hospital Revenue Code	278
Min. Negotiated Rate	$397.50
Max. Negotiated Rate	$641.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$530.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$641.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$583.00
Rate for Payer: Qualcare PPO/HMO/WC	$397.50

CATH BALLON PTA DILATI 14LP2-8

Facility

$2,650.00

Hospital Charge Code	270662853
Hospital Revenue Code	278
Min. Negotiated Rate	$63.87
Max. Negotiated Rate	$1,325.00
Rate for Payer: Aetna Commercial	$1,007.00
Rate for Payer: Aetna Medicare Advantage	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$675.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$675.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$675.75
Rate for Payer: Cigna Commercial	$1,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$641.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$583.00
Rate for Payer: Qualcare PPO/HMO/WC	$397.50
Rate for Payer: UnitedHealthcare Community & State	$63.87
Rate for Payer: Wellpoint Medicaid Managed Care	$70.22

CATH BALLON PTA DILATI 14LP2-8

Facility

$2,650.00

Hospital Charge Code	270662853
Hospital Revenue Code	278
Min. Negotiated Rate	$397.50
Max. Negotiated Rate	$641.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$530.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$641.30
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$583.00
Rate for Payer: Qualcare PPO/HMO/WC	$397.50

CATH BALLON STERLING 6X2X80

Facility

$1,976.25

Hospital Charge Code	2709005798
Hospital Revenue Code	272
Min. Negotiated Rate	$296.44
Max. Negotiated Rate	$296.44
Rate for Payer: Qualcare PPO/HMO/WC	$296.44

CATH BALLON STERLING 6X2X80

Facility

$1,976.25

Hospital Charge Code	2709005798
Hospital Revenue Code	272
Min. Negotiated Rate	$47.63
Max. Negotiated Rate	$988.12
Rate for Payer: Aetna Commercial	$750.98
Rate for Payer: Aetna Medicare Advantage	$592.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.94
Rate for Payer: Cigna Commercial	$988.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.88
Rate for Payer: Oxford Commercial	$395.25
Rate for Payer: Qualcare PPO/HMO/WC	$296.44
Rate for Payer: UnitedHealthcare Commercial	$395.25
Rate for Payer: UnitedHealthcare Community & State	$47.63
Rate for Payer: Wellpoint Medicaid Managed Care	$52.37

CATH BALLON STERLING 7X2X80

Facility

$1,976.25

Hospital Charge Code	2709005799
Hospital Revenue Code	272
Min. Negotiated Rate	$47.63
Max. Negotiated Rate	$988.12
Rate for Payer: Aetna Commercial	$750.98
Rate for Payer: Aetna Medicare Advantage	$592.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.94
Rate for Payer: Cigna Commercial	$988.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.88
Rate for Payer: Oxford Commercial	$395.25
Rate for Payer: Qualcare PPO/HMO/WC	$296.44
Rate for Payer: UnitedHealthcare Commercial	$395.25
Rate for Payer: UnitedHealthcare Community & State	$47.63
Rate for Payer: Wellpoint Medicaid Managed Care	$52.37

CATH BALLON STERLING 7X2X80

Facility

$1,976.25

Hospital Charge Code	2709005799
Hospital Revenue Code	272
Min. Negotiated Rate	$296.44
Max. Negotiated Rate	$296.44
Rate for Payer: Qualcare PPO/HMO/WC	$296.44

CATHBALLON UT/SDS OTW 10/2/75

Facility

$1,355.00

Hospital Charge Code	2709005863
Hospital Revenue Code	272
Min. Negotiated Rate	$203.25
Max. Negotiated Rate	$203.25
Rate for Payer: Qualcare PPO/HMO/WC	$203.25

Know your out-of-pocket cost for care.

All Charges