Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

STENT BIOMIM 3D SWIR FLW 7x100

Facility

$5,750.00

Hospital Charge Code	270705375
Hospital Revenue Code	279
Min. Negotiated Rate	$138.57
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$2,185.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,725.00
Rate for Payer: Oxford Commercial	$1,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Commercial	$1,150.00
Rate for Payer: UnitedHealthcare Community & State	$138.57
Rate for Payer: Wellpoint Medicaid Managed Care	$152.38

STENT BIOMIM 3D SWIR FLW 7x150

Facility

$5,750.00

Hospital Charge Code	270705376
Hospital Revenue Code	279
Min. Negotiated Rate	$862.50
Max. Negotiated Rate	$862.50
Rate for Payer: Qualcare PPO/HMO/WC	$862.50

STENT BIOMIM 3D SWIR FLW 7x150

Facility

$5,750.00

Hospital Charge Code	270705376
Hospital Revenue Code	279
Min. Negotiated Rate	$138.57
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$2,185.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,725.00
Rate for Payer: Oxford Commercial	$1,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Commercial	$1,150.00
Rate for Payer: UnitedHealthcare Community & State	$138.57
Rate for Payer: Wellpoint Medicaid Managed Care	$152.38

STENT BIOMIM 3D SWIR FLW 7x80

Facility

$5,250.00

Hospital Charge Code	270705378
Hospital Revenue Code	279
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$787.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

STENT BIOMIM 3D SWIR FLW 7x80

Facility

$5,250.00

Hospital Charge Code	270705378
Hospital Revenue Code	279
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,575.00
Rate for Payer: Oxford Commercial	$1,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Commercial	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$126.53
Rate for Payer: Wellpoint Medicaid Managed Care	$139.12

STENT CAST COV.9MM X 38MMX80CM

Facility

$12,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270653404
Hospital Revenue Code	278
Min. Negotiated Rate	$310.29
Max. Negotiated Rate	$6,437.50
Rate for Payer: Aetna Commercial	$4,892.50
Rate for Payer: Aetna Medicare Advantage	$3,862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,283.12
Rate for Payer: Cigna Commercial	$6,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,832.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25
Rate for Payer: UnitedHealthcare Community & State	$310.29
Rate for Payer: Wellpoint Medicaid Managed Care	$341.19

STENT CAST COV.9MM X 38MMX80CM

Facility

$12,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270653404N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$3,115.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,832.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25

STENT CAST COV.9MM X 38MMX80CM

Facility

$12,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270653404N
Hospital Revenue Code	278
Min. Negotiated Rate	$310.29
Max. Negotiated Rate	$6,437.50
Rate for Payer: Aetna Commercial	$4,892.50
Rate for Payer: Aetna Medicare Advantage	$3,862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,283.12
Rate for Payer: Cigna Commercial	$6,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,832.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25
Rate for Payer: UnitedHealthcare Community & State	$310.29
Rate for Payer: Wellpoint Medicaid Managed Care	$341.19

STENT CAST COV.9MM X 38MMX80CM

Facility

$12,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270653404
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$3,115.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,832.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25

STENT CAST COVD 10x59 80 85421

Facility

$13,144.00

Hospital Charge Code	270634583V
Hospital Revenue Code	278
Min. Negotiated Rate	$316.77
Max. Negotiated Rate	$6,572.00
Rate for Payer: Aetna Commercial	$4,994.72
Rate for Payer: Aetna Medicare Advantage	$3,943.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,351.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,351.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,628.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,351.72
Rate for Payer: Cigna Commercial	$6,572.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,180.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,891.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,971.60
Rate for Payer: UnitedHealthcare Community & State	$316.77
Rate for Payer: Wellpoint Medicaid Managed Care	$348.32

STENT CAST COVD 10x59 80 85421

Facility

$13,144.00

Hospital Charge Code	270634583
Hospital Revenue Code	278
Min. Negotiated Rate	$1,971.60
Max. Negotiated Rate	$3,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,628.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,180.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,891.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,971.60

STENT CAST COVD 10x59 80 85421

Facility

$13,144.00

Hospital Charge Code	270634583
Hospital Revenue Code	278
Min. Negotiated Rate	$316.77
Max. Negotiated Rate	$6,572.00
Rate for Payer: Aetna Commercial	$4,994.72
Rate for Payer: Aetna Medicare Advantage	$3,943.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,351.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,351.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,628.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,351.72
Rate for Payer: Cigna Commercial	$6,572.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,180.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,891.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,971.60
Rate for Payer: UnitedHealthcare Community & State	$316.77
Rate for Payer: Wellpoint Medicaid Managed Care	$348.32

STENT CAST COVD 10x59 80 85421

Facility

$13,144.00

Hospital Charge Code	270634583V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,971.60
Max. Negotiated Rate	$3,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,628.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,180.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,891.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,971.60

STENT CAST COVD 12x38 80 85422

Facility

$12,152.00

Hospital Charge Code	270634584V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,822.80
Max. Negotiated Rate	$2,940.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,430.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,940.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,673.44
Rate for Payer: Qualcare PPO/HMO/WC	$1,822.80

STENT CAST COVD 12x38 80 85422

Facility

$12,152.00

Hospital Charge Code	270634584
Hospital Revenue Code	278
Min. Negotiated Rate	$1,822.80
Max. Negotiated Rate	$2,940.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,430.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,940.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,673.44
Rate for Payer: Qualcare PPO/HMO/WC	$1,822.80

STENT CAST COVD 12x38 80 85422

Facility

$12,152.00

Hospital Charge Code	270634584
Hospital Revenue Code	278
Min. Negotiated Rate	$292.86
Max. Negotiated Rate	$6,076.00
Rate for Payer: Aetna Commercial	$4,617.76
Rate for Payer: Aetna Medicare Advantage	$3,645.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,098.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,098.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,430.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,098.76
Rate for Payer: Cigna Commercial	$6,076.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,940.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,673.44
Rate for Payer: Qualcare PPO/HMO/WC	$1,822.80
Rate for Payer: UnitedHealthcare Community & State	$292.86
Rate for Payer: Wellpoint Medicaid Managed Care	$322.03

STENT CAST COVD 12x38 80 85422

Facility

$12,152.00

Hospital Charge Code	270634584V
Hospital Revenue Code	278
Min. Negotiated Rate	$292.86
Max. Negotiated Rate	$6,076.00
Rate for Payer: Aetna Commercial	$4,617.76
Rate for Payer: Aetna Medicare Advantage	$3,645.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,098.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,098.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,430.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,098.76
Rate for Payer: Cigna Commercial	$6,076.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,940.78
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,673.44
Rate for Payer: Qualcare PPO/HMO/WC	$1,822.80
Rate for Payer: UnitedHealthcare Community & State	$292.86
Rate for Payer: Wellpoint Medicaid Managed Care	$322.03

STENT CAST COVD 7x50 120 85415

Facility

$13,144.00

Hospital Charge Code	270634391
Hospital Revenue Code	278
Min. Negotiated Rate	$316.77
Max. Negotiated Rate	$6,572.00
Rate for Payer: Aetna Commercial	$4,994.72
Rate for Payer: Aetna Medicare Advantage	$3,943.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,351.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,351.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,628.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,351.72
Rate for Payer: Cigna Commercial	$6,572.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,180.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,891.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,971.60
Rate for Payer: UnitedHealthcare Community & State	$316.77
Rate for Payer: Wellpoint Medicaid Managed Care	$348.32

STENT CAST COVD 7x50 120 85415

Facility

$13,144.00

Hospital Charge Code	270634391
Hospital Revenue Code	278
Min. Negotiated Rate	$1,971.60
Max. Negotiated Rate	$3,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,628.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,180.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,891.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,971.60

STENT CAST COVD 7x50 120 85415

Facility

$13,144.00

Hospital Charge Code	270634391V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,971.60
Max. Negotiated Rate	$3,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,628.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,180.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,891.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,971.60

STENT CAST COVD 7x50 120 85415

Facility

$13,144.00

Hospital Charge Code	270634391V
Hospital Revenue Code	278
Min. Negotiated Rate	$316.77
Max. Negotiated Rate	$6,572.00
Rate for Payer: Aetna Commercial	$4,994.72
Rate for Payer: Aetna Medicare Advantage	$3,943.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,351.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,351.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,628.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,351.72
Rate for Payer: Cigna Commercial	$6,572.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,180.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,891.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,971.60
Rate for Payer: UnitedHealthcare Community & State	$316.77
Rate for Payer: Wellpoint Medicaid Managed Care	$348.32

STENT CAST COVD 8x59 120 85417

Facility

$13,144.00

Hospital Charge Code	270634395V
Hospital Revenue Code	278
Min. Negotiated Rate	$316.77
Max. Negotiated Rate	$6,572.00
Rate for Payer: Aetna Commercial	$4,994.72
Rate for Payer: Aetna Medicare Advantage	$3,943.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,351.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,351.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,628.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,351.72
Rate for Payer: Cigna Commercial	$6,572.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,180.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,891.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,971.60
Rate for Payer: UnitedHealthcare Community & State	$316.77
Rate for Payer: Wellpoint Medicaid Managed Care	$348.32

STENT CAST COVD 8x59 120 85417

Facility

$13,144.00

Hospital Charge Code	270634395
Hospital Revenue Code	278
Min. Negotiated Rate	$1,971.60
Max. Negotiated Rate	$3,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,628.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,180.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,891.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,971.60

STENT CAST COVD 8x59 120 85417

Facility

$13,144.00

Hospital Charge Code	270634395V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,971.60
Max. Negotiated Rate	$3,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,628.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,180.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,891.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,971.60

STENT CAST COVD 8x59 120 85417

Facility

$13,144.00

Hospital Charge Code	270634395
Hospital Revenue Code	278
Min. Negotiated Rate	$316.77
Max. Negotiated Rate	$6,572.00
Rate for Payer: Aetna Commercial	$4,994.72
Rate for Payer: Aetna Medicare Advantage	$3,943.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,351.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,351.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,628.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,351.72
Rate for Payer: Cigna Commercial	$6,572.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,180.85
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$2,891.68
Rate for Payer: Qualcare PPO/HMO/WC	$1,971.60
Rate for Payer: UnitedHealthcare Community & State	$316.77
Rate for Payer: Wellpoint Medicaid Managed Care	$348.32

Know your out-of-pocket cost for care.

All Charges