Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

CATHBALLOONVOYAGERRXCOMP3.5X20

Facility

$850.00

Hospital Charge Code	2709001135
Hospital Revenue Code	272
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) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.00
Rate for Payer: Oxford Commercial	$170.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$170.00
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

CATHBALLOONVOYAGERRXCOMP3.5X20

Facility

$850.00

Hospital Charge Code	2709001135
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

CATHBALLOONVOYAGERRXCOMP4.0X12

Facility

$850.00

Hospital Charge Code	2709001132
Hospital Revenue Code	272
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) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.00
Rate for Payer: Oxford Commercial	$170.00
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Commercial	$170.00
Rate for Payer: UnitedHealthcare Community & State	$20.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.52

CATHBALLOONVOYAGERRXCOMP4.0X12

Facility

$850.00

Hospital Charge Code	2709001132
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

CATH BALL UT/SDS OTW 10/4/75

Facility

$1,020.00

Hospital Charge Code	2709003632
Hospital Revenue Code	272
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) PPO	$260.10
Rate for Payer: Cigna Commercial	$510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$306.00
Rate for Payer: Oxford Commercial	$204.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.00
Rate for Payer: UnitedHealthcare Commercial	$204.00
Rate for Payer: UnitedHealthcare Community & State	$24.58
Rate for Payer: Wellpoint Medicaid Managed Care	$27.03

CATH BALL UT/SDS OTW 10/4/75

Facility

$1,020.00

Hospital Charge Code	2709003632
Hospital Revenue Code	272
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$153.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.00

CATH BALM SLAM 3x2x80 4383020S

Facility

$1,884.85

Hospital Charge Code	270629623
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 BALM SLAM 3x2x80 4383020S

Facility

$1,884.85

Hospital Charge Code	270629623
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 BALM SLAM 3x2x80 4383020S

Facility

$1,900.00

Hospital Charge Code	270629623V
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 BALM SLAM 3x2x80 4383020S

Facility

$1,900.00

Hospital Charge Code	270629623V
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 BALN 10X60X80

Facility

$900.00

Service Code	HCPCS C1725
Hospital Charge Code	270661305
Hospital Revenue Code	278
Min. Negotiated Rate	$21.69
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$342.00
Rate for Payer: Aetna Medicare Advantage	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.50
Rate for Payer: Cigna Commercial	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00
Rate for Payer: UnitedHealthcare Community & State	$21.69
Rate for Payer: Wellpoint Medicaid Managed Care	$23.85

CATH BALN 10X60X80

Facility

$900.00

Service Code	HCPCS C1725
Hospital Charge Code	270661305
Hospital Revenue Code	278
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$217.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.80
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$198.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.00

CATH BALN 3x40x135 T304013501

Facility

$3,968.00

Hospital Charge Code	270635039
Hospital Revenue Code	278
Min. Negotiated Rate	$595.20
Max. Negotiated Rate	$960.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$793.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$960.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$872.96
Rate for Payer: Qualcare PPO/HMO/WC	$595.20

CATH BALN 3x40x135 T304013501

Facility

$3,968.00

Hospital Charge Code	270635039
Hospital Revenue Code	278
Min. Negotiated Rate	$95.63
Max. Negotiated Rate	$1,984.00
Rate for Payer: Aetna Commercial	$1,507.84
Rate for Payer: Aetna Medicare Advantage	$1,190.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,011.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,011.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$793.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,011.84
Rate for Payer: Cigna Commercial	$1,984.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$960.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$872.96
Rate for Payer: Qualcare PPO/HMO/WC	$595.20
Rate for Payer: UnitedHealthcare Community & State	$95.63
Rate for Payer: Wellpoint Medicaid Managed Care	$105.15

CATH BALN 3x40x135 T304013501

Facility

$4,232.25

Hospital Charge Code	270635039V
Hospital Revenue Code	278
Min. Negotiated Rate	$634.84
Max. Negotiated Rate	$1,024.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$846.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,024.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$931.10
Rate for Payer: Qualcare PPO/HMO/WC	$634.84

CATH BALN 3x40x135 T304013501

Facility

$4,232.25

Hospital Charge Code	270635039V
Hospital Revenue Code	278
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$2,116.12
Rate for Payer: Aetna Commercial	$1,608.26
Rate for Payer: Aetna Medicare Advantage	$1,269.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,079.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,079.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$846.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,079.22
Rate for Payer: Cigna Commercial	$2,116.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,024.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$931.10
Rate for Payer: Qualcare PPO/HMO/WC	$634.84
Rate for Payer: UnitedHealthcare Community & State	$102.00
Rate for Payer: Wellpoint Medicaid Managed Care	$112.15

CATH BALN ADMIRAL 6/60/80 XTRM

Facility

$700.00

Service Code	HCPCS C1725
Hospital Charge Code	270660312
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

CATH BALN ADMIRAL 6/60/80 XTRM

Facility

$700.00

Service Code	HCPCS C1725
Hospital Charge Code	270660312
Hospital Revenue Code	278
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Community & State	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$18.55

CATH BALN ADML 7X60X80

Facility

$700.00

Service Code	HCPCS C1725
Hospital Charge Code	270659677
Hospital Revenue Code	278
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Community & State	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$18.55

CATH BALN ADML 7X60X80

Facility

$700.00

Service Code	HCPCS C1725
Hospital Charge Code	270659677
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$154.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

CATH BALN AMP 025150152

Facility

$1,750.00

Service Code	HCPCS C1725
Hospital Charge Code	270657941
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

CATH BALN AMP 025150152

Facility

$1,750.00

Service Code	HCPCS C1725
Hospital Charge Code	270657941
Hospital Revenue Code	278
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$385.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$42.17
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

CATH BALN DEL ARO MAX KT *****

Facility

$922.00

Hospital Charge Code	1604545
Hospital Revenue Code	272
Min. Negotiated Rate	$138.30
Max. Negotiated Rate	$138.30
Rate for Payer: Qualcare PPO/HMO/WC	$138.30

CATH BALN DEL ARO MAX KT *****

Facility

$922.00

Hospital Charge Code	1604545
Hospital Revenue Code	272
Min. Negotiated Rate	$22.22
Max. Negotiated Rate	$461.00
Rate for Payer: Aetna Commercial	$350.36
Rate for Payer: Aetna Medicare Advantage	$276.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.11
Rate for Payer: Cigna Commercial	$461.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$276.60
Rate for Payer: Oxford Commercial	$184.40
Rate for Payer: Qualcare PPO/HMO/WC	$138.30
Rate for Payer: UnitedHealthcare Commercial	$184.40
Rate for Payer: UnitedHealthcare Community & State	$22.22
Rate for Payer: Wellpoint Medicaid Managed Care	$24.43

CATH BALN DIAD 7x2x75 5F 16477

Facility

$1,020.00

Hospital Charge Code	270629351V
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

Know your out-of-pocket cost for care.

All Charges