Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT 6x120x120 PRB3506120120

Facility

$1,695.00

Service Code	HCPCS C2617
Hospital Charge Code	270637893S
Hospital Revenue Code	278
Min. Negotiated Rate	$40.85
Max. Negotiated Rate	$847.50
Rate for Payer: Aetna Commercial	$644.10
Rate for Payer: Aetna Medicare Advantage	$508.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$432.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$432.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$339.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$432.23
Rate for Payer: Cigna Commercial	$847.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$410.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$372.90
Rate for Payer: Qualcare PPO/HMO/WC	$254.25
Rate for Payer: UnitedHealthcare Community & State	$40.85
Rate for Payer: Wellpoint Medicaid Managed Care	$44.92

STENT 6x120x120 PRB3506120120

Facility

$1,695.00

Service Code	HCPCS C2617
Hospital Charge Code	270637893N
Hospital Revenue Code	278
Min. Negotiated Rate	$254.25
Max. Negotiated Rate	$410.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$339.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$410.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$372.90
Rate for Payer: Qualcare PPO/HMO/WC	$254.25

STENT 6x120x120 PRB3506120120

Facility

$1,695.00

Service Code	HCPCS C2617
Hospital Charge Code	270637893S
Hospital Revenue Code	278
Min. Negotiated Rate	$254.25
Max. Negotiated Rate	$410.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$339.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$410.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$372.90
Rate for Payer: Qualcare PPO/HMO/WC	$254.25

STENT 6x120x120 PRB3506120120

Facility

$1,695.00

Service Code	HCPCS C2617
Hospital Charge Code	270637893N
Hospital Revenue Code	278
Min. Negotiated Rate	$40.85
Max. Negotiated Rate	$847.50
Rate for Payer: Aetna Commercial	$644.10
Rate for Payer: Aetna Medicare Advantage	$508.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$432.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$432.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$339.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$432.23
Rate for Payer: Cigna Commercial	$847.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$410.19
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$372.90
Rate for Payer: Qualcare PPO/HMO/WC	$254.25
Rate for Payer: UnitedHealthcare Community & State	$40.85
Rate for Payer: Wellpoint Medicaid Managed Care	$44.92

STENT 6 X 30 MM CAROTID NITIN

Facility

$6,100.00

Service Code	HCPCS C1875
Hospital Charge Code	270682517
Hospital Revenue Code	278
Min. Negotiated Rate	$147.01
Max. Negotiated Rate	$3,050.00
Rate for Payer: Aetna Commercial	$2,318.00
Rate for Payer: Aetna Medicare Advantage	$1,830.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,555.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,555.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,220.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,555.50
Rate for Payer: Cigna Commercial	$3,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,476.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,342.00
Rate for Payer: Qualcare PPO/HMO/WC	$915.00
Rate for Payer: UnitedHealthcare Community & State	$147.01
Rate for Payer: Wellpoint Medicaid Managed Care	$161.65

STENT 6 X 30 MM CAROTID NITIN

Facility

$6,100.00

Service Code	HCPCS C1875
Hospital Charge Code	270682517
Hospital Revenue Code	278
Min. Negotiated Rate	$915.00
Max. Negotiated Rate	$1,476.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,476.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,342.00
Rate for Payer: Qualcare PPO/HMO/WC	$915.00

STENT 6X30MM CAROTID NITIN

Facility

$6,100.00

Service Code	HCPCS C1875
Hospital Charge Code	270682517S
Hospital Revenue Code	278
Min. Negotiated Rate	$915.00
Max. Negotiated Rate	$1,476.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,476.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,342.00
Rate for Payer: Qualcare PPO/HMO/WC	$915.00

STENT 6X30MM CAROTID NITIN

Facility

$6,100.00

Service Code	HCPCS C1875
Hospital Charge Code	270682517S
Hospital Revenue Code	278
Min. Negotiated Rate	$147.01
Max. Negotiated Rate	$3,050.00
Rate for Payer: Aetna Commercial	$2,318.00
Rate for Payer: Aetna Medicare Advantage	$1,830.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,555.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,555.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,220.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,555.50
Rate for Payer: Cigna Commercial	$3,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,476.20
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,342.00
Rate for Payer: Qualcare PPO/HMO/WC	$915.00
Rate for Payer: UnitedHealthcare Community & State	$147.01
Rate for Payer: Wellpoint Medicaid Managed Care	$161.65

STENT 6x30x135 1012534-30

Facility

$4,750.00

Hospital Charge Code	270647805
Hospital Revenue Code	278
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

STENT 6x30x135 1012534-30

Facility

$4,750.00

Hospital Charge Code	270647805
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

STENT 6X30X135 1012534-30

Facility

$4,750.00

Hospital Charge Code	270647805C
Hospital Revenue Code	278
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

STENT 6X30X135 1012534-30

Facility

$4,750.00

Hospital Charge Code	270647805C
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

STENT 6x40x135 1012534-40

Facility

$4,750.00

Hospital Charge Code	270647806
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

STENT 6x40x135 1012534-40

Facility

$4,750.00

Hospital Charge Code	270647806
Hospital Revenue Code	278
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

STENT 6X40X135 1012534-40

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270647806C
Hospital Revenue Code	278
Min. Negotiated Rate	$581.25
Max. Negotiated Rate	$937.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$852.50
Rate for Payer: Qualcare PPO/HMO/WC	$581.25

STENT 6X40X135 1012534-40

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270647806C
Hospital Revenue Code	278
Min. Negotiated Rate	$93.39
Max. Negotiated Rate	$1,937.50
Rate for Payer: Aetna Commercial	$1,472.50
Rate for Payer: Aetna Medicare Advantage	$1,162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$988.12
Rate for Payer: Cigna Commercial	$1,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$852.50
Rate for Payer: Qualcare PPO/HMO/WC	$581.25
Rate for Payer: UnitedHealthcare Community & State	$93.39
Rate for Payer: Wellpoint Medicaid Managed Care	$102.69

STENT 6X60X135 1012534-60

Facility

$4,750.00

Hospital Charge Code	270647807C
Hospital Revenue Code	278
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

STENT 6X60X135 1012534-60

Facility

$4,750.00

Hospital Charge Code	270647807C
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

STENT 6X80X135 1012534-80

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270647808C
Hospital Revenue Code	278
Min. Negotiated Rate	$581.25
Max. Negotiated Rate	$937.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$852.50
Rate for Payer: Qualcare PPO/HMO/WC	$581.25

STENT 6X80X135 1012534-80

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270647808C
Hospital Revenue Code	278
Min. Negotiated Rate	$93.39
Max. Negotiated Rate	$1,937.50
Rate for Payer: Aetna Commercial	$1,472.50
Rate for Payer: Aetna Medicare Advantage	$1,162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$988.12
Rate for Payer: Cigna Commercial	$1,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$852.50
Rate for Payer: Qualcare PPO/HMO/WC	$581.25
Rate for Payer: UnitedHealthcare Community & State	$93.39
Rate for Payer: Wellpoint Medicaid Managed Care	$102.69

STENT 7X100X135 1012535-100

Facility

$4,750.00

Hospital Charge Code	270647817C
Hospital Revenue Code	278
Min. Negotiated Rate	$114.47
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$114.47
Rate for Payer: Wellpoint Medicaid Managed Care	$125.88

STENT 7X100X135 1012535-100

Facility

$4,750.00

Hospital Charge Code	270647817C
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,045.00
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

STENT 7x120x120 PRB3507120120

Facility

$7,500.00

Hospital Charge Code	270638403V
Hospital Revenue Code	278
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: Wellpoint Medicaid Managed Care	$198.75

STENT 7x120x120 PRB3507120120

Facility

$7,500.00

Hospital Charge Code	270638403V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

STENT 7x150x120 PRB3507150120

Facility

$7,500.00

Hospital Charge Code	270638366V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

Know your out-of-pocket cost for care.

All Charges