Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT 9.0X40X80 1012531-40

Facility

$4,750.00

Hospital Charge Code	270647800C
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 9.0X40X80 1012531-40

Facility

$4,750.00

Hospital Charge Code	270647800C
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 9X60X135 1012537-60

Facility

$4,750.00

Hospital Charge Code	270647823C
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 9X60X135 1012537-60

Facility

$4,780.00

Hospital Charge Code	270847823C
Hospital Revenue Code	278
Min. Negotiated Rate	$717.00
Max. Negotiated Rate	$1,156.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$956.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,051.60
Rate for Payer: Qualcare PPO/HMO/WC	$717.00

STENT 9X60X135 1012537-60

Facility

$4,750.00

Hospital Charge Code	270647823C
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 9X60X135 1012537-60

Facility

$4,780.00

Hospital Charge Code	270847823C
Hospital Revenue Code	278
Min. Negotiated Rate	$115.20
Max. Negotiated Rate	$2,390.00
Rate for Payer: Aetna Commercial	$1,816.40
Rate for Payer: Aetna Medicare Advantage	$1,434.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,218.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,218.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$956.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,218.90
Rate for Payer: Cigna Commercial	$2,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,051.60
Rate for Payer: Qualcare PPO/HMO/WC	$717.00
Rate for Payer: UnitedHealthcare Community & State	$115.20
Rate for Payer: Wellpoint Medicaid Managed Care	$126.67

STENT 9X80X135 1012537-80

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270647824C
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 9X80X135 1012537-80

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270647824C
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 AB 6x100 135cm1010564100

Facility

$6,448.00

Hospital Charge Code	270633920V
Hospital Revenue Code	278
Min. Negotiated Rate	$967.20
Max. Negotiated Rate	$1,560.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,418.56
Rate for Payer: Qualcare PPO/HMO/WC	$967.20

STENT AB 6x100 135cm1010564100

Facility

$6,448.00

Hospital Charge Code	270633920
Hospital Revenue Code	278
Min. Negotiated Rate	$155.40
Max. Negotiated Rate	$3,224.00
Rate for Payer: Aetna Commercial	$2,450.24
Rate for Payer: Aetna Medicare Advantage	$1,934.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,644.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,644.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,644.24
Rate for Payer: Cigna Commercial	$3,224.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,418.56
Rate for Payer: Qualcare PPO/HMO/WC	$967.20
Rate for Payer: UnitedHealthcare Community & State	$155.40
Rate for Payer: Wellpoint Medicaid Managed Care	$170.87

STENT AB 6x100 135cm1010564100

Facility

$6,448.00

Hospital Charge Code	270633920V
Hospital Revenue Code	278
Min. Negotiated Rate	$155.40
Max. Negotiated Rate	$3,224.00
Rate for Payer: Aetna Commercial	$2,450.24
Rate for Payer: Aetna Medicare Advantage	$1,934.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,644.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,644.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,644.24
Rate for Payer: Cigna Commercial	$3,224.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,418.56
Rate for Payer: Qualcare PPO/HMO/WC	$967.20
Rate for Payer: UnitedHealthcare Community & State	$155.40
Rate for Payer: Wellpoint Medicaid Managed Care	$170.87

STENT AB 6x100 135cm1010564100

Facility

$6,448.00

Hospital Charge Code	270633920
Hospital Revenue Code	278
Min. Negotiated Rate	$967.20
Max. Negotiated Rate	$1,560.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,289.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.42
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,418.56
Rate for Payer: Qualcare PPO/HMO/WC	$967.20

STENT ABRE 14MMX100MMX 90CM

Facility

$7,975.00

Hospital Charge Code	270695849
Hospital Revenue Code	272
Min. Negotiated Rate	$192.20
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,392.50
Rate for Payer: Oxford Commercial	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Commercial	$1,595.00
Rate for Payer: UnitedHealthcare Community & State	$192.20
Rate for Payer: Wellpoint Medicaid Managed Care	$211.34

STENT ABRE 14MMX100MMX 90CM

Facility

$7,975.00

Hospital Charge Code	270695849
Hospital Revenue Code	272
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,196.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

STENT ABRE 14MMX100MMX90CM

Facility

$0.01

Service Code	HCPCS C1876
Hospital Charge Code	270695849Z
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

STENT ABRE 14MMX100MMX90CM

Facility

$0.01

Service Code	HCPCS C1876
Hospital Charge Code	270695849Z
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

STENT ABRE 14MMX 120MMX 90CM

Facility

$7,975.00

Hospital Charge Code	270695850
Hospital Revenue Code	272
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,196.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

STENT ABRE 14MMX 120MMX 90CM

Facility

$7,975.00

Hospital Charge Code	270695850
Hospital Revenue Code	272
Min. Negotiated Rate	$192.20
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,392.50
Rate for Payer: Oxford Commercial	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Commercial	$1,595.00
Rate for Payer: UnitedHealthcare Community & State	$192.20
Rate for Payer: Wellpoint Medicaid Managed Care	$211.34

STENT ABRE 14MMX 120MMX90CM

Facility

$0.01

Service Code	HCPCS C1876
Hospital Charge Code	270695850Z
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

STENT ABRE 14MMX 120MMX90CM

Facility

$0.01

Service Code	HCPCS C1876
Hospital Charge Code	270695850Z
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

STENT ABRE 14MMX 150MMX 90CM

Facility

$9,125.00

Hospital Charge Code	270695851
Hospital Revenue Code	272
Min. Negotiated Rate	$1,368.75
Max. Negotiated Rate	$1,368.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,368.75

STENT ABRE 14MMX 150MMX 90CM

Facility

$9,125.00

Hospital Charge Code	270695851
Hospital Revenue Code	272
Min. Negotiated Rate	$219.91
Max. Negotiated Rate	$4,562.50
Rate for Payer: Aetna Commercial	$3,467.50
Rate for Payer: Aetna Medicare Advantage	$2,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,326.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,326.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,326.88
Rate for Payer: Cigna Commercial	$4,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,737.50
Rate for Payer: Oxford Commercial	$1,825.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,368.75
Rate for Payer: UnitedHealthcare Commercial	$1,825.00
Rate for Payer: UnitedHealthcare Community & State	$219.91
Rate for Payer: Wellpoint Medicaid Managed Care	$241.81

STENT ABRE 14MMX 150MMX90CM

Facility

$0.01

Service Code	HCPCS C1876
Hospital Charge Code	270695851Z
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

STENT ABRE 14MMX 150MMX90CM

Facility

$0.01

Service Code	HCPCS C1876
Hospital Charge Code	270695851Z
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

STENT ABRE 14MMX 80MMX 90CM

Facility

$7,975.00

Hospital Charge Code	270695848
Hospital Revenue Code	272
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,196.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

Know your out-of-pocket cost for care.

All Charges