Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT BILIARY MCV 10Fx7c 5461

Facility

$640.00

Service Code	HCPCS C2625
Hospital Charge Code	270628066
Hospital Revenue Code	278
Min. Negotiated Rate	$96.00
Max. Negotiated Rate	$154.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$140.80
Rate for Payer: Qualcare PPO/HMO/WC	$96.00

STENT BILIARY MCV 8 5Fx7c 4566

Facility

$580.40

Hospital Charge Code	270628069
Hospital Revenue Code	278
Min. Negotiated Rate	$13.99
Max. Negotiated Rate	$290.20
Rate for Payer: Aetna Commercial	$220.55
Rate for Payer: Aetna Medicare Advantage	$174.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.00
Rate for Payer: Cigna Commercial	$290.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.69
Rate for Payer: Qualcare PPO/HMO/WC	$87.06
Rate for Payer: UnitedHealthcare Community & State	$13.99
Rate for Payer: Wellpoint Medicaid Managed Care	$15.38

STENT BILIARY MCV 8 5Fx7c 4566

Facility

$580.40

Hospital Charge Code	270628069
Hospital Revenue Code	278
Min. Negotiated Rate	$87.06
Max. Negotiated Rate	$140.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.46
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$127.69
Rate for Payer: Qualcare PPO/HMO/WC	$87.06

STENT BILIARY PALMAZ 7x15/80

Facility

$9,031.25

Hospital Charge Code	270635630
Hospital Revenue Code	278
Min. Negotiated Rate	$217.65
Max. Negotiated Rate	$4,515.62
Rate for Payer: Aetna Commercial	$3,431.88
Rate for Payer: Aetna Medicare Advantage	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,302.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,302.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,806.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,302.97
Rate for Payer: Cigna Commercial	$4,515.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,185.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,986.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,354.69
Rate for Payer: UnitedHealthcare Community & State	$217.65
Rate for Payer: Wellpoint Medicaid Managed Care	$239.33

STENT BILIARY PALMAZ 7x15/80

Facility

$9,031.25

Hospital Charge Code	270635630
Hospital Revenue Code	278
Min. Negotiated Rate	$1,354.69
Max. Negotiated Rate	$2,185.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,806.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,185.56
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,986.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,354.69

STENT BILIARY PROSTHESIS***

Facility

$494.00

Hospital Charge Code	2300549
Hospital Revenue Code	279
Min. Negotiated Rate	$74.10
Max. Negotiated Rate	$74.10
Rate for Payer: Qualcare PPO/HMO/WC	$74.10

STENT BILIARY PROSTHESIS***

Facility

$494.00

Hospital Charge Code	2300549
Hospital Revenue Code	279
Min. Negotiated Rate	$11.91
Max. Negotiated Rate	$247.00
Rate for Payer: Aetna Commercial	$187.72
Rate for Payer: Aetna Medicare Advantage	$148.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.97
Rate for Payer: Cigna Commercial	$247.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.20
Rate for Payer: Oxford Commercial	$98.80
Rate for Payer: Qualcare PPO/HMO/WC	$74.10
Rate for Payer: UnitedHealthcare Commercial	$98.80
Rate for Payer: UnitedHealthcare Community & State	$11.91
Rate for Payer: Wellpoint Medicaid Managed Care	$13.09

STENT BILIARY RX 7FR 12cm 4558

Facility

$640.00

Service Code	HCPCS C2625
Hospital Charge Code	270636840
Hospital Revenue Code	278
Min. Negotiated Rate	$15.42
Max. Negotiated Rate	$320.00
Rate for Payer: Aetna Commercial	$243.20
Rate for Payer: Aetna Medicare Advantage	$192.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.20
Rate for Payer: Cigna Commercial	$320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$140.80
Rate for Payer: Qualcare PPO/HMO/WC	$96.00
Rate for Payer: UnitedHealthcare Community & State	$15.42
Rate for Payer: Wellpoint Medicaid Managed Care	$16.96

STENT BILIARY RX 7FR 12cm 4558

Facility

$640.00

Service Code	HCPCS C2625
Hospital Charge Code	270636840
Hospital Revenue Code	278
Min. Negotiated Rate	$96.00
Max. Negotiated Rate	$154.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$140.80
Rate for Payer: Qualcare PPO/HMO/WC	$96.00

STENT BILIARY RX 7FR 5CM 4555

Facility

$455.60

Service Code	HCPCS C2625
Hospital Charge Code	270636466
Hospital Revenue Code	278
Min. Negotiated Rate	$10.98
Max. Negotiated Rate	$227.80
Rate for Payer: Aetna Commercial	$173.13
Rate for Payer: Aetna Medicare Advantage	$136.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.18
Rate for Payer: Cigna Commercial	$227.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$100.23
Rate for Payer: Qualcare PPO/HMO/WC	$68.34
Rate for Payer: UnitedHealthcare Community & State	$10.98
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

STENT BILIARY RX 7FR 5CM 4555

Facility

$455.60

Service Code	HCPCS C2625
Hospital Charge Code	270636466
Hospital Revenue Code	278
Min. Negotiated Rate	$68.34
Max. Negotiated Rate	$110.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.26
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$100.23
Rate for Payer: Qualcare PPO/HMO/WC	$68.34

STENT BILIARY RX COVER RMV 10X

Facility

$12,999.50

Service Code	HCPCS C2625
Hospital Charge Code	270680141
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.92
Max. Negotiated Rate	$3,145.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,859.89
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92

STENT BILIARY RX COVER RMV 10X

Facility

$12,999.50

Service Code	HCPCS C2625
Hospital Charge Code	270680141
Hospital Revenue Code	278
Min. Negotiated Rate	$313.29
Max. Negotiated Rate	$6,499.75
Rate for Payer: Aetna Commercial	$4,939.81
Rate for Payer: Aetna Medicare Advantage	$3,899.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,314.87
Rate for Payer: Cigna Commercial	$6,499.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,859.89
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92
Rate for Payer: UnitedHealthcare Community & State	$313.29
Rate for Payer: Wellpoint Medicaid Managed Care	$344.49

STENT BILIARY ZEM 7F ZEBD-7-10

Facility

$656.85

Hospital Charge Code	270608988
Hospital Revenue Code	278
Min. Negotiated Rate	$98.53
Max. Negotiated Rate	$158.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$131.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$144.51
Rate for Payer: Qualcare PPO/HMO/WC	$98.53

STENT BILIARY ZEM 7F ZEBD-7-10

Facility

$656.85

Hospital Charge Code	270608988
Hospital Revenue Code	278
Min. Negotiated Rate	$15.83
Max. Negotiated Rate	$328.43
Rate for Payer: Aetna Commercial	$249.60
Rate for Payer: Aetna Medicare Advantage	$197.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$131.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.50
Rate for Payer: Cigna Commercial	$328.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.96
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$144.51
Rate for Payer: Qualcare PPO/HMO/WC	$98.53
Rate for Payer: UnitedHealthcare Community & State	$15.83
Rate for Payer: Wellpoint Medicaid Managed Care	$17.41

STENT BILIARY ZEM 7F ZEBD-7-12

Facility

$440.00

Hospital Charge Code	270625568
Hospital Revenue Code	278
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$220.00
Rate for Payer: Aetna Commercial	$167.20
Rate for Payer: Aetna Medicare Advantage	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.20
Rate for Payer: Cigna Commercial	$220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$96.80
Rate for Payer: Qualcare PPO/HMO/WC	$66.00
Rate for Payer: UnitedHealthcare Community & State	$10.60
Rate for Payer: Wellpoint Medicaid Managed Care	$11.66

STENT BILIARY ZEM 7F ZEBD-7-12

Facility

$440.00

Hospital Charge Code	270625568
Hospital Revenue Code	278
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.48
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$96.80
Rate for Payer: Qualcare PPO/HMO/WC	$66.00

STENT BILIARY ZIMMON ZEBD-7-4

Facility

$685.00

Service Code	HCPCS C2617
Hospital Charge Code	270609869
Hospital Revenue Code	278
Min. Negotiated Rate	$102.75
Max. Negotiated Rate	$165.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$150.70
Rate for Payer: Qualcare PPO/HMO/WC	$102.75

STENT BILIARY ZIMMON ZEBD-7-4

Facility

$685.00

Service Code	HCPCS C2617
Hospital Charge Code	270609869
Hospital Revenue Code	278
Min. Negotiated Rate	$16.51
Max. Negotiated Rate	$342.50
Rate for Payer: Aetna Commercial	$260.30
Rate for Payer: Aetna Medicare Advantage	$205.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.68
Rate for Payer: Cigna Commercial	$342.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$150.70
Rate for Payer: Qualcare PPO/HMO/WC	$102.75
Rate for Payer: UnitedHealthcare Community & State	$16.51
Rate for Payer: Wellpoint Medicaid Managed Care	$18.15

STENT BILIARY ZIMMON ZEBD-7-7

Facility

$685.00

Service Code	HCPCS C2625
Hospital Charge Code	270600972
Hospital Revenue Code	278
Min. Negotiated Rate	$16.51
Max. Negotiated Rate	$342.50
Rate for Payer: Aetna Commercial	$260.30
Rate for Payer: Aetna Medicare Advantage	$205.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.68
Rate for Payer: Cigna Commercial	$342.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$150.70
Rate for Payer: Qualcare PPO/HMO/WC	$102.75
Rate for Payer: UnitedHealthcare Community & State	$16.51
Rate for Payer: Wellpoint Medicaid Managed Care	$18.15

STENT BILIARY ZIMMON ZEBD-7-7

Facility

$685.00

Service Code	HCPCS C2625
Hospital Charge Code	270600972
Hospital Revenue Code	278
Min. Negotiated Rate	$102.75
Max. Negotiated Rate	$165.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.77
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$150.70
Rate for Payer: Qualcare PPO/HMO/WC	$102.75

STENT BILLARY ADVANIX 10X7

Facility

$670.00

Service Code	HCPCS C2625
Hospital Charge Code	270663474
Hospital Revenue Code	278
Min. Negotiated Rate	$16.15
Max. Negotiated Rate	$335.00
Rate for Payer: Aetna Commercial	$254.60
Rate for Payer: Aetna Medicare Advantage	$201.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.85
Rate for Payer: Cigna Commercial	$335.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$147.40
Rate for Payer: Qualcare PPO/HMO/WC	$100.50
Rate for Payer: UnitedHealthcare Community & State	$16.15
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

STENT BILLARY ADVANIX 10X7

Facility

$670.00

Service Code	HCPCS C2625
Hospital Charge Code	270663474
Hospital Revenue Code	278
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$162.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$147.40
Rate for Payer: Qualcare PPO/HMO/WC	$100.50

STENT BIL PL 7x18x80 PB1870BSS

Facility

$7,167.25

Hospital Charge Code	270635362V
Hospital Revenue Code	278
Min. Negotiated Rate	$172.73
Max. Negotiated Rate	$3,583.62
Rate for Payer: Aetna Commercial	$2,723.55
Rate for Payer: Aetna Medicare Advantage	$2,150.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,827.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,827.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,433.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,827.65
Rate for Payer: Cigna Commercial	$3,583.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,734.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,576.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.09
Rate for Payer: UnitedHealthcare Community & State	$172.73
Rate for Payer: Wellpoint Medicaid Managed Care	$189.93

STENT BIL PL 7x18x80 PB1870BSS

Facility

$7,167.25

Hospital Charge Code	270635362V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.09
Max. Negotiated Rate	$1,734.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,433.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,734.47
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$1,576.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,075.09

Know your out-of-pocket cost for care.

All Charges