Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT ACCLK 6.5X190 1011649-65

Facility

$7,750.00

Hospital Charge Code	270635737
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT ACCLK 6.5X190 1011649-65

Facility

$7,750.00

Hospital Charge Code	270635737
Hospital Revenue Code	278
Min. Negotiated Rate	$186.78
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,705.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$186.78
Rate for Payer: Wellpoint Medicaid Managed Care	$205.38

STENT ACULK 7-10x30 1011344-30

Facility

$11,160.00

Hospital Charge Code	270636416V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,674.00
Max. Negotiated Rate	$2,700.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,232.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,700.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,455.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,674.00

STENT ACULK 7-10x30 1011344-30

Facility

$11,160.00

Hospital Charge Code	270636416V
Hospital Revenue Code	278
Min. Negotiated Rate	$268.96
Max. Negotiated Rate	$5,580.00
Rate for Payer: Aetna Commercial	$4,240.80
Rate for Payer: Aetna Medicare Advantage	$3,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,845.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,845.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,232.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,845.80
Rate for Payer: Cigna Commercial	$5,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,700.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,455.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,674.00
Rate for Payer: UnitedHealthcare Community & State	$268.96
Rate for Payer: Wellpoint Medicaid Managed Care	$295.74

STENT ACULK 7-10x30 1011344-30

Facility

$11,160.00

Hospital Charge Code	270636416
Hospital Revenue Code	278
Min. Negotiated Rate	$268.96
Max. Negotiated Rate	$5,580.00
Rate for Payer: Aetna Commercial	$4,240.80
Rate for Payer: Aetna Medicare Advantage	$3,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,845.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,845.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,232.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,845.80
Rate for Payer: Cigna Commercial	$5,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,700.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,455.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,674.00
Rate for Payer: UnitedHealthcare Community & State	$268.96
Rate for Payer: Wellpoint Medicaid Managed Care	$295.74

STENT ACULK 7-10x30 1011344-30

Facility

$11,160.00

Hospital Charge Code	270636416
Hospital Revenue Code	278
Min. Negotiated Rate	$1,674.00
Max. Negotiated Rate	$2,700.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,232.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,700.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,455.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,674.00

STENT ACULK 7-10x40 1011344-40

Facility

$11,160.00

Hospital Charge Code	270635410
Hospital Revenue Code	278
Min. Negotiated Rate	$268.96
Max. Negotiated Rate	$5,580.00
Rate for Payer: Aetna Commercial	$4,240.80
Rate for Payer: Aetna Medicare Advantage	$3,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,845.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,845.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,232.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,845.80
Rate for Payer: Cigna Commercial	$5,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,700.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,455.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,674.00
Rate for Payer: UnitedHealthcare Community & State	$268.96
Rate for Payer: Wellpoint Medicaid Managed Care	$295.74

STENT ACULK 7-10x40 1011344-40

Facility

$11,160.00

Hospital Charge Code	270635410
Hospital Revenue Code	278
Min. Negotiated Rate	$1,674.00
Max. Negotiated Rate	$2,700.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,232.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,700.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,455.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,674.00

STENT ACULK 7-10x40 1011344-40

Facility

$11,160.00

Hospital Charge Code	270635410V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,674.00
Max. Negotiated Rate	$2,700.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,232.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,700.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,455.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,674.00

STENT ACULK 7-10x40 1011344-40

Facility

$11,160.00

Hospital Charge Code	270635410V
Hospital Revenue Code	278
Min. Negotiated Rate	$268.96
Max. Negotiated Rate	$5,580.00
Rate for Payer: Aetna Commercial	$4,240.80
Rate for Payer: Aetna Medicare Advantage	$3,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,845.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,845.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,232.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,845.80
Rate for Payer: Cigna Commercial	$5,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,700.72
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,455.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,674.00
Rate for Payer: UnitedHealthcare Community & State	$268.96
Rate for Payer: Wellpoint Medicaid Managed Care	$295.74

STENT ADVANIX BILIARY 10FR12cm

Facility

$651.90

Hospital Charge Code	270675944
Hospital Revenue Code	278
Min. Negotiated Rate	$97.78
Max. Negotiated Rate	$157.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.42
Rate for Payer: Qualcare PPO/HMO/WC	$97.78

STENT ADVANIX BILIARY 10FR12cm

Facility

$651.90

Hospital Charge Code	270675944
Hospital Revenue Code	278
Min. Negotiated Rate	$15.71
Max. Negotiated Rate	$325.95
Rate for Payer: Aetna Commercial	$247.72
Rate for Payer: Aetna Medicare Advantage	$195.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.23
Rate for Payer: Cigna Commercial	$325.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.42
Rate for Payer: Qualcare PPO/HMO/WC	$97.78
Rate for Payer: UnitedHealthcare Community & State	$15.71
Rate for Payer: Wellpoint Medicaid Managed Care	$17.28

STENT ADVANIX BILIARY 10FR 5CM

Facility

$661.00

Hospital Charge Code	270675169
Hospital Revenue Code	278
Min. Negotiated Rate	$99.15
Max. Negotiated Rate	$159.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.42
Rate for Payer: Qualcare PPO/HMO/WC	$99.15

STENT ADVANIX BILIARY 10FR 5CM

Facility

$661.00

Hospital Charge Code	270675169
Hospital Revenue Code	278
Min. Negotiated Rate	$15.93
Max. Negotiated Rate	$330.50
Rate for Payer: Aetna Commercial	$251.18
Rate for Payer: Aetna Medicare Advantage	$198.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.56
Rate for Payer: Cigna Commercial	$330.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.42
Rate for Payer: Qualcare PPO/HMO/WC	$99.15
Rate for Payer: UnitedHealthcare Community & State	$15.93
Rate for Payer: Wellpoint Medicaid Managed Care	$17.52

STENT ADVANIX BILIARY 10FR 7CM

Facility

$661.00

Service Code	HCPCS C2625
Hospital Charge Code	270669218
Hospital Revenue Code	278
Min. Negotiated Rate	$15.93
Max. Negotiated Rate	$330.50
Rate for Payer: Aetna Commercial	$251.18
Rate for Payer: Aetna Medicare Advantage	$198.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.56
Rate for Payer: Cigna Commercial	$330.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.42
Rate for Payer: Qualcare PPO/HMO/WC	$99.15
Rate for Payer: UnitedHealthcare Community & State	$15.93
Rate for Payer: Wellpoint Medicaid Managed Care	$17.52

STENT ADVANIX BILIARY 10FR 7CM

Facility

$661.00

Service Code	HCPCS C2625
Hospital Charge Code	270669218
Hospital Revenue Code	278
Min. Negotiated Rate	$99.15
Max. Negotiated Rate	$159.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$145.42
Rate for Payer: Qualcare PPO/HMO/WC	$99.15

STENT ADVANIX BILIARY 10FR 9CM

Facility

$651.90

Service Code	HCPCS C2625
Hospital Charge Code	270675170
Hospital Revenue Code	278
Min. Negotiated Rate	$15.71
Max. Negotiated Rate	$325.95
Rate for Payer: Aetna Commercial	$247.72
Rate for Payer: Aetna Medicare Advantage	$195.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.23
Rate for Payer: Cigna Commercial	$325.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.42
Rate for Payer: Qualcare PPO/HMO/WC	$97.78
Rate for Payer: UnitedHealthcare Community & State	$15.71
Rate for Payer: Wellpoint Medicaid Managed Care	$17.28

STENT ADVANIX BILIARY 10FR 9CM

Facility

$651.90

Service Code	HCPCS C2625
Hospital Charge Code	270675170
Hospital Revenue Code	278
Min. Negotiated Rate	$97.78
Max. Negotiated Rate	$157.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.76
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$143.42
Rate for Payer: Qualcare PPO/HMO/WC	$97.78

STENT ADVANIX BILIARY 1OF 12CM

Facility

$725.00

Hospital Charge Code	270663638
Hospital Revenue Code	278
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Community & State	$17.47
Rate for Payer: Wellpoint Medicaid Managed Care	$19.21

STENT ADVANIX BILIARY 1OF 12CM

Facility

$725.00

Hospital Charge Code	270663638
Hospital Revenue Code	278
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$175.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

STENT ADVANIX BILIARY 1OF 15CM

Facility

$725.00

Hospital Charge Code	270663639
Hospital Revenue Code	278
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Community & State	$17.47
Rate for Payer: Wellpoint Medicaid Managed Care	$19.21

STENT ADVANIX BILIARY 1OF 15CM

Facility

$725.00

Hospital Charge Code	270663639
Hospital Revenue Code	278
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$175.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

STENT ADVANIX BILIARY 1OF 18CM

Facility

$725.00

Hospital Charge Code	270663640
Hospital Revenue Code	278
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$175.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

STENT ADVANIX BILIARY 1OF 18CM

Facility

$725.00

Hospital Charge Code	270663640
Hospital Revenue Code	278
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Community & State	$17.47
Rate for Payer: Wellpoint Medicaid Managed Care	$19.21

STENT ADVANIX BILIARY 1 OF 5CM

Facility

$725.00

Hospital Charge Code	270663635
Hospital Revenue Code	278
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$175.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$159.50
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

Know your out-of-pocket cost for care.

All Charges